Inspection on 24/04/07 for Meadow Lodge Care Home

This inspection was carried out on 24th April 2007.

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 27/09/06

Meadow Lodge Care Home 16/06/06

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 Kulwant Ghuman Key Unannounced Inspection 24th April 2007 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.V335186.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.V335186.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 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.V335186.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. 27th September 2006 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 but this does not fully access the first floor. 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 tarmaced forecourt that accommodates some car parking. The home has a ramped access available. The fees at the home range from £314 to £365. Meadow Lodge Care Home DS0000065927.V335186.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the last key inspection the home received a random inspection from the pharmacist inspector to monitor compliance with the requirements regarding the management of medicines on 02/11/06. Following this visit a statutory enforcement notice was issued on 07/11/06. Two inspectors carried out this unannounced key inspection over one day in April 2007. The pharmacist inspector visited the home a few days earlier to assess the management of medicines in the home which had improved significantly. As part of the inspection process the inspectors spent time with the proprietor and acting manager, had lunch with some people living in the home, toured the building, spoke with two staff briefly, observed interactions in the home and spoke generally with four people living in the home. There had been no complaints about the home and one adult protection issue had been raised that was dealt with appropriately by the home. What the service does well: People living in the home are provided with some very good information about the home before they are admitted. People living in the home’ medical needs were being met however, the documentation did not always support this. The medication system had improved since the last key inspection ensuring the people living in the home received their medication as prescribed. Able people living in the home were able to come and go from the home and maintain links with the community through their churches and families. Visitors were welcomed to the home. Meals were nourishing, provided choices and met a variety of needs. The service provides care to the people living in the home in a light, warm and comfortable environment. People living in the home’ bedrooms were comfortable and people living in the home were able to bring personal belongings to personalise their rooms. Meadow Lodge Care Home DS0000065927.V335186.R01.S.doc Version 5.2 Page 6 There were facilities in the home to help people living in the home with mobility difficulties. People living in the home were spoken to in a friendly manner and good relationships were evident. What has improved since the last inspection? What they could do better: The assessment procedure needed to be improved to ensure that all the relevant information had been received by the home and that the people living in the home needs could be met. People living in the home and their relatives needed to be encouraged to visit the home prior to admission and a record of the visit maintained. Care plans and risk assessments needed to be developed so that they covered all the resident’s needs and were person centred so that the resident received care in a way that they wanted. Staff needed to follow moving and handling assessments to ensure that they or the people living in the home were not injured during any procedures. The recording of medical appointments and visits from other professionals needed to be recorded in a way that ensured that it was easy to track what actions had been taken and what the outcomes were. The activities programme needed to be developed following discussions with the people living in the home. Activities suitable for people living in the home who develop dementia needed to be identified. Activity plans needed to be incorporated into the care plans for the people living in the home. All staff needed to be provided with health and safety, moving and handling, food hygiene and first aid training to ensure people living in the home are cared for in a safe way. It was important that a registered manager was in place to ensure that the home developed its policies and practices in a positive way and so that people living in the home and their families were assured that a knowledgeable and responsible person was in day to day management of the home. Meadow Lodge Care Home DS0000065927.V335186.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Meadow Lodge Care Home DS0000065927.V335186.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.V335186.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): 1,2,3,4,and 5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home was not in possession of full details about people living in the home’ needs before they were admitted to the home. The assessment procedure did not show that assessments were carried out prior to admission to the home and that people living in the home were able to visit the home enabling them to make informed decisions about whether to move into the home or not. EVIDENCE: The service user guide stated people living in the home could be admitted to the home if they were over the age of 60 whereas the registration was for older people, that is, over 65 years of age. The service user guide indicated that there was a 28 day trial period to determine whether the home was suitable for the resident and whether the home could meet the resident’s needs, however, there was no evidence on the two files sampled that this had been undertaken. Meadow Lodge Care Home DS0000065927.V335186.R01.S.doc Version 5.2 Page 10 The home notified prospective people living in the home via a letter to confirm that their needs could be met at the home. Two people living in the home’ files were sampled to assess the admission process. Neither of the files evidenced that the people living in the home had carried out a pre-admission visit to the home so it could not be assured that people living in the home were making informed decisions about whether to move into the home or not. It could not be determined whether the individual had been assessed prior to admission to the home as not all assessments were signed or dated. For one of the people living in the home the social work assessment and hospital discharge identified very different needs. It was very important that the preadmission assessment was carried out so the home knew what the resident’s needs were. The assessment and care plan made no reference to how the resident’s needs had been affected by the strokes they had suffered. The second file indicated that there was an admission plan that provided some information about daily activities, and some detail about mental health concerns. The initial care plan did not state the needs but there were comments such as ‘give support she may need’ and there were some details about dietary likes and details. The home needed to ensure that a contract was in place for all people living in the home, regardless of who was funding the placement, so that they were aware of what the conditions of living at the home were. There were no 28 day reviews being carried out to ensure that the people living in the home were being consulted as to whether the home was suitable for them and to confirm that they wished to continue living there and that the home was able to meet their needs. Meadow Lodge Care Home DS0000065927.V335186.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments were not person centred and did not give adequate detail to enable all staff to provide care in a knowledgeable and consistent manner. Following the issue of a Statutory Requirement Notice in November 2007 the home has worked hard to improve medicine management to a safe level. EVIDENCE: Due to the fact that there had been a number of acting managers there were a variety of care plan formats on the files. This could be confusing for staff and the registered person needed to ensure that the most recent working care plan was available to the staff and the others were archived. Four people living in the home’ files were sampled at this inspection. Meadow Lodge Care Home DS0000065927.V335186.R01.S.doc Version 5.2 Page 12 The most recent care plan consisted of separate sheets covering issues such as maintaining safe environment, nutrition, communication, mental health, skin, breathing, elimination, sleeping, personal hygiene and control of body temperature. The care plans consisted of tick boxes and an ‘actions to be taken’ section that did not detail the people living in the home needs and how these were to be assisted by the staff. The care plans were not individualised and did not identify what the people living in the home could do for themselves and what assistance they needed from the staff. For example, one of the files stated that the resident was doubly incontinent and the actions stated:Ensure privacy and dignity. Explain all tasks to ----. Offer toilet 3-4 hourly. Ensure correct use of incontinence pad. Change pad as required. Inform if any changes. Review monthly. For another resident the care plan was exactly the same except the toilet was to be offered 2-3 hourly. There was no indication of any assessment of incontinence and therefore whether offering the toilet would be of any benefit to the people living in the home’. There was no indication of the size of pad to be used and whether it was the same pad at night-time. For one resident it was identified that a pressure cushion was needed on the chair, a soft foam mattress was needed on the bed and 2/3 pillows were used to keep the skin healthy and intact and the actions to be taken were:Wash and pat dry skin. Maintain privacy and dignity. Explain all tasks. Report changes. The equipment identified above was in use on the chair in the lounge and on the bed however, the cushion was not in use during the lunch time period. There was no guidance for the staff about whether the cushion needed to be used. For another resident who had suffered from several strokes there was no indication on the care plan of how the resident had been affected and whether the resident’s abilities to undertake everyday tasks had been affected. Meadow Lodge Care Home DS0000065927.V335186.R01.S.doc Version 5.2 Page 13 Not all files had a completed waterlow assessment or nutritional assessment in place. There were some risk assessments in place and some were good but others did not have a corresponding management plan in place. For example, one resident became angry if the food was cold or if the resident was short of money. There was no indication what the staff needed to do particularly as the nutritional assessment indicated that the resident was at risk of refusing meals. The moving and handling assessment did not identify the hoist and sling to be used. Although the use of a hoist was identified in the assessment it was noted that during the day the staff did not use the hoist for transfers but rather used under arm manoeuvres that were not safe for either staff or people living in the home. The fact that staff were undertaking manual manoeuvres was also indicated in the records which on one occasion indicated that the ‘resident was bearing weight on the staff’. Care plans and risk assessments needed to be reviewed on a monthly basis or sooner if needed, to ensure that the people living in the home’ needs were met in a manner that was safe and met their requirements. Doctors’ visits were recorded in people living in the home’ daily records or the communication book and difficult to track. There was a sheet for recording professional visits but this was not in use. The pharmacist inspector visited the home on 17/04/07 as part of the unannounced inspection to assess the medicine management. A statutory requirement notice was issued on 7th November 2007 due to the severity of the breaches in the regulations surrounding medication practices in the home. Partial compliance was reached during a follow up unannounced inspection on 27th December 2007. The majority of the requirements had been met following this inspection. One outstanding requirement was still to be achieved but the manager and owners were keen to address this issue. During the pharmacist inspection five people who lived in the home, medicine charts and their relating medication were looked at together with some corresponding care plans. One member of staff was spoken with and all feedback was given to the manager and owners. People who live in the home were encouraged to self administer their medicines but no risk assessments could be found or compliance checks to confirm that they safely take their medication. Care plans did not support selfadministration. Meadow Lodge Care Home DS0000065927.V335186.R01.S.doc Version 5.2 Page 14 The home had recently changed manager and a new system had been installed to administer the medicines from. This had resulted in the medicines being administered as prescribed and records accurately reflected practice. This was commended. Currently the home undertook weekly audits of all the medicines in the home which had served to improve practice. People who live in the home were encouraged to participate in social activities outside, but medication was either secondary dispensed into another container or not given at all. There were no supporting policies for staff to safely secondary dispense against and alternative solutions had not been discussed with the doctor to avoid the need to take medicines during the day. Each medicine chart had a facing page to identify the person but important information had not been communicated to the pharmacist to include on the medicine chart, for example any allergies the person may have had. This could result in a medicine being dispensed, which could have been detrimental to the wellbeing of the person. All controlled drug entries and medication were correct at the time of the inspection. One care assistant who handled medication was spoken with. She had a limited knowledge of what the medicines were for but had recently completed an accredited course in the safe handling of medicines. The policies and procedures had not been re-written despite a previous requirement and the current policies do not protect and promote good practice for the people who live in the home or the staff. Following the issue of a Statutory Requirement Notice in November 2007 the home had worked hard to improve medicine management to a safe level. The privacy and dignity of the people living in the home were generally safeguarded in the home however there were glass panels in some bedroom doors that did not provide a sufficient level of privacy to ensure that their dignity was maintained. Not all toilet and bathroom doors had locks in place that were in working order. Bedroom doors all had appropriate locks fitted and there was lockable furniture in the bedrooms for the people living in the home to lock away items of value. The bedroom doors, of some of the people living in the home who were unable to manage their own keys, were locked by the staff in line with relatives’ wishes. Meadow Lodge Care Home DS0000065927.V335186.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans did not identify individual requirements for recreational activities and there were no records that identified that opportunities for social activities were being made available to people living in the home who were unable to go out alone. People living in the home appeared to be happy with the food provided at the home. EVIDENCE: Care plans for the people living in the home did not include adequate details of how their social needs were to be met. There was some evidence in the daily records of people living in the home reading newspapers and visitors coming to the home. The inspectors were told that the home ensured that people living in the home who spent the majority of their time in their rooms did not become isolated by encouraging them to come downstairs for meals, to have a cigarette or suggest that they sit downstairs whilst their rooms were being cleaned or bed made. In addition the home was planning to set up a key working system and this would give the staff specific responsibilities. Meadow Lodge Care Home DS0000065927.V335186.R01.S.doc Version 5.2 Page 16 The care plan for one of the people living in the home suggested that there was limited understanding of the needs of individuals with dementia. For example, it stated that the individual was ‘unable to go out’ however during discussions it was agreed that the restriction on going out was due to limited mobility and the availability of staff which could be addressed. Also in terms of being able to be ‘involved in painting’ it stated that the resident would not be able to concentrate. There was no indication that this had ever been tried. The resident may not have been able to produce ‘a painting’ in the traditional sense but there may well have been some positive outcomes for the resident to be able to take part in such an activity in terms of fulfilment of producing something and touching things and seeing colours. A couple of people living in the home had advocates that were linked to churches they attended. There were some people living in the home who did not have many visitors and one persons relative acted as an advocate on their behalf and raised general issues on behalf of the people living in the home. People living in the home who were able to go out alone were encouraged to do so. There was no activities programme in place but the inspectors were told that there were games available in the home. The registered person needed to ensure that individual plans were available for the people living in the home in order to ensure that their social needs were being met. There appeared to be no restrictions on people living in the home’ movements within the home. Meetings to find out the views of people living in the home were not being held on a regular basis. The last recorded meeting was held in September 2006. There were choices available at the midday meal on the day of the inspection. The inspectors were able to take a meal with the people living in the home and it was observed that the mealtime was unhurried and they were given appropriate assistance where needed. One person did however send the main meal and sweet back to the kitchen as there was too much food on the plate. The staff needed to be aware of individual needs as for some people living in the home it could be very off putting to have too much food on the plate. It would be better to present a small serving in these situations and offer more once the meal had been eaten. Examination of the food records indicated that there was some variety in the meals however the registered person needed to be careful that the main meal and tea time sandwiches were not the same meat eg roast chicken and then chicken sandwiches, beef casserole and then beef burgers. Records were being kept of what the people living in the home were eating however there was no indication of whether the meals were fully or partly Meadow Lodge Care Home DS0000065927.V335186.R01.S.doc Version 5.2 Page 17 eaten and this may be important to enable staff to gauge if they were eating enough. The records did not record any fruits being given to the people living in the home and the records only stated that ‘veg’ were being given. There was no indication to show whether these were the same ‘veg’ every day. Drinks were being taken to people living in the home on a trolley at various times during the day. Staff needed to be mindful that the records were a true reflection. For example for one person the care plan indicated that he preferred coffee however, the records recorded tea. The inspectors were informed that the kitchen had been recently refurbished. The kitchen was not inspected at this inspection as the home had had a recent visit from the environmental health officer. Soft diets were appropriately plated up and looked attractive, however staff needed to be mindful that it was not mixed up on the plate. Good interactions were observed between the people living in the home and staff. The inspectors were informed that cultural diets would be met where required and this was the case for at least two of the people living in the home at the home at the time of the inspection. Meadow Lodge Care Home DS0000065927.V335186.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The views of people living in the home and their representatives were listened to and acted upon. The home was responding appropriately to issues of adult protection that were raised. EVIDENCE: There had been no complaints made to the CSCI since the last key inspection. Two small issues had been raised at the home and these had been appropriately addressed. There had been one issue of adult protection raised at the home regarding financial abuse. The home had acted appropriately in this matter and were working with the social work department to ensure that the resident was safeguarded as far as possible. Training for the staff in respect of adult protection had been arranged for 15.5.07. The acting manager stated that she had a copy of the multi-agency guidelines available but they were not in the home at the time of the inspection. Meadow Lodge Care Home DS0000065927.V335186.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment was generally homely, warm and safe. Some areas including bathing facilities and outdoor facilities needed to be upgraded to provide comfortable and safe facilities. EVIDENCE: The home was generally well decorated and clean however some areas including some of the bathing and shower facilities needed upgrading. One shared bedroom was also looking tired and needed to be brought up to the standard of other rooms. The two lounges on the ground floor were large and comfortable. The people living in the home tended to sit in the lounges based on a gender division although one female resident sat with the men and one of the men sat with the women. There were two dining rooms that were used by the people living in the home. Meadow Lodge Care Home DS0000065927.V335186.R01.S.doc Version 5.2 Page 20 There was a very large garden to the rear of the home. At the time of the inspection some work was being undertaken on the garden however, plans needed to be made for the future landscaping and levelling of the garden to enable it be fully accessible to the people living in the home. The home had adaptations in place that included a ramped access into the home, stair lift to assist people living in the home upstairs, rails throughout the home and an emergency call system throughout the home. Bedroom sizes varied, some were quite small but contained the furniture required and met the needs of the people living in the home. There were some shared bedrooms. Some bedrooms had en-suite facilities. Bedrooms had commodes available if they were required. Any rusting commodes needed to be replaced. Furniture in bedrooms was generally of a good standard. All bedrooms had a yale lock fitted and the latches had been disabled to prevent the people living in the home dropping the latch and thereby preventing access by the staff in case of an emergency. Some of the bedroom doors had a coloured film on the glass panels however, the films did not ensure that the privacy and dignity of the people living in the home could be assured. Some of the bedding on the people living in the home’ beds needed ironing. There was a walk-in shower on the first floor and a bath with a bath seat in it. The inspectors were told that the bath was not being used. The bathroom was in need of upgrading. The registered person indicated that a grant was to be provided that would be used to upgrade the bathroom. This would provide the people living in the home with a choice of bathing facility. On the ground floor there was a shower room that was in need of upgrading. The registered person needed to ensure that tablets of soap were removed from the communal bathing facilities to reduce the risks of cross infection. Liquid soap and paper towels were available for staff use. There were toiletries belonging to the people living in the home left in communal bathing facilities. The toilet next to the bathroom did not have a wash hand basin and therefore promoting infection control was not easy. There was an issue of odour control in one bedroom and damp under the window. Meadow Lodge Care Home DS0000065927.V335186.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recruitment procedures safeguarded the people living in the home but staff did not have the appropriate training to ensure that they were able to carry out their roles in a safe and appropriate way. EVIDENCE: The registered person indicated that the aim was to have two care staff, the manager and a senior care assistant on duty during the morning. During the afternoon there was a senior care and two care staff on duty. During the night there were two waking night staff on duty. Examination of the staff rota indicated that the above staffing levels were being maintained. There was a cook available in the home who worked 8am to 2pm five days a week. The domestic assistant was on duty 9am to 2pm five days a week. The care staff undertook these duties on the days that the domestic assistant was not on duty. Care staff undertook laundry tasks. The registered person needed to ensure that there were sufficient staff on duty to ensure all their needs could be met including activities in and outside the home. The recruitment procedure was examined and generally safeguarded the people living in the home. Two issues were identified, these were ensuring that a reference was taken from the most recent employer and not from Meadow Lodge Care Home DS0000065927.V335186.R01.S.doc Version 5.2 Page 22 relatives, that the documents regarding rights to work in the country were fully checked out. Staff were undertaking induction training that met the requirements for Skills for Care. The staff training folder indicated that some training had been undertaken by some staff but it did not show that all staff had undertaken mandatory training in all areas. The inspectors were told that 50 of the staff had achieved NVQ level 2 or equivalent. The staff training matrix was not available in the home but was to be faxed to the inspector after the inspection. The matrix indicated that not all staff had completed the mandatory training of food hygiene, infection control, manual handling, fire safety, health and safety and first aid. The matrix did not indicate the number of staff who had completed NVQ level 2 training or equivalent or the dates of when the training had been undertaken. It was important that the cook and domestic assistant also undertook adult protection training so that they were aware of what abuse was and what their responsibilities were if they every suspected that abuse was occurring in the home. The staff group were from a variety of cultural backgrounds and could meet the needs of the people living in the home. There was a more stable staff group and there were good interactions observed between staff and people living in the home. Meadow Lodge Care Home DS0000065927.V335186.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home was being overseen on a day to day basis by the registered person. Some issues of health and safety needed to be addressed to ensure that the people living in the home were not put at risk. EVIDENCE: The home had appointed another manager who was still in her probationary period. It was agreed that after a successful probationary period an application to register the manager would be submitted to CSCI. The acting manager was a qualified nurse but needed to undertake the registered managers award. Meadow Lodge Care Home DS0000065927.V335186.R01.S.doc Version 5.2 Page 24 It was important that a registered manager was in place to oversee the development of issues such as care plans and risk assessments and so that there was leadership for the staff. The home was managed in the best interests of the people living in the home and it was evident that the registered person was very involved in the day to day running of the home and wanted the home to develop positively. The home had started to undertake some questionnaires with the people living in the home and their relatives and was developing a quality assurance system. There were records of monies that were being handled on behalf of the people living in the home. The majority of people living in the home’ monies were being handled by their relatives or the local authority. There were three people living in the home whose monies were being deposited into an account that had been set up solely for people living in the home monies. This was due to difficulties experienced in setting up individual accounts for people living in the home. These records were very clear and well managed. The registered person must ensure that all required notifications were forwarded to CSCI in a timely manner as some deaths had not been notified as required. Examination of the fire records and maintenance of equipment showed that the home was being well maintained and people living in the home and staff safeguarded. In addition there were weekly checks on the fire equipment and hot water temperatures in the home. Care plans and risk assessments for people living in the home needed to be sorted so that the up to date ones were available to staff and the rest archived. Records about the people living in the home should not be left in the dining room accessible to anyone. A communal book should not be used for the recording of personal information such as appointments and actions taken with individual staff. There were some issues of infection control that the registered person needed to address. During the inspection the emergency alarm was activated in a bathroom. The staff did not respond and instead cancelled the alarm at the panel. The registered person stated that the staff should not have done this. The inspectors were told that the staff thought it was the toilet downstairs. This indicated that either the staff were not being attentive enough or the indicator on the panel was not clear. The registered person needed to look into this issue. Meadow Lodge Care Home DS0000065927.V335186.R01.S.doc Version 5.2 Page 25 Staff were not following the identified moving and handling assessment identified for one of the people living in the home and could put themselves and the people living in the home at risk. Meadow Lodge Care Home DS0000065927.V335186.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 2 2 1 2 1 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 2 3 X 2 3 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 X 1 1 Meadow Lodge Care Home DS0000065927.V335186.R01.S.doc Version 5.2 Page 27 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 OP1 Regulation 5 Requirement The registered person must ensure that the service user guide and statement of purpose is amended to clarify that the home is registered to care for people 65 years of age and over. This will ensure that the people moving into the home will have access to all the information to make a decision about whether to move into the home. 2. OP2 5(1)(b) The registered person must ensure that there is a contract/terms and conditions of residence between the home and people living in the home in place. This will ensure that people living in the home will be aware of the conditions of living in the home. 3. OP3 14(1)(b) (d)(2) The registered person must ensure a full assessment is carried out on all prospective residents. (This requirement was partly DS0000065927.V335186.R01.S.doc Timescale for action 01/07/07 01/07/07 01/06/07 Meadow Lodge Care Home Version 5.2 Page 28 met and had been outstanding since 28/04/06) This will ensure that the needs of people moving into the home will have their needs met by the home. 4. OP4 12(4)(b) The home must ensure that it records enough detail on people living in the home cultural needs for appropriate care to be given by all care staff. (This requirement had been partly met.) b) All staff must receive training in dementia awareness, aggression and alcohol awareness. (Carried forward from previous inspection. Previous timescales given 31/07/06 and 01/01/07). This will ensure that all the needs of the people living in the home will be met. 5. OP7 15 a) The registered person must ensure that care plans are individualised and identify tasks that the people living in the home can do for themselves and what assistance is needed from the staff and how this is to be provided. b) Care plans must be reviewed monthly. (Previous timescales given 28/08/02, 28/02/06, 28/04/06, 31/07/0) and 01/01/07) This will ensure that the needs of the people living in the home will be met in a way that is Meadow Lodge Care Home DS0000065927.V335186.R01.S.doc Version 5.2 Page 29 01/08/07 01/08/07 6. OP8 12(1)(a) acceptable to them. The registered person must ensure that all people living in the home have nutritional and tissue viability risk assessments in place. This will ensure that the people living in the home will be less likely to develop pressure sores and have their nutritional needs met. 01/08/07 7. OP8 12(1)(a) The registered person must 01/06/07 ensure that GP and other professional visits to people living in the home are recorded in a manner that makes clear the reason and outcome of the visit. This will ensure that the medical needs of the people living in the home are met. 8. OP9 13(2) The medication policy must be written to reflect current practice and that staff adhere to the policies for medicine management. All people moving into the home must be suitably risk assessed as able to self-administer their own medication using a selfadministration risk assessment form and compliance checks performed on a regular basis. Not met Outstanding requirement since 15/05/06 This will ensure that only able people living in the home can administer their own medicines. 15/05/07 9. OP10 12(4)(a) The registered person must ensure that glass panels on DS0000065927.V335186.R01.S.doc 01/07/07 Meadow Lodge Care Home Version 5.2 Page 30 bedroom doors do not compromise the privacy and dignity of people living in the home. All bathroom and toilet doors must have the appropriate locks maintained in working order. This will ensure that the privacy and dignity of people living in the home is maintained. 10. OP12 16(2)(n) a) The home must have an activities plan. (Previous timescales of 31/07/06 and 01/01/07 not met.) b) People living in the home that are unable to join these activities must have an individual activities plan. (Previous timescales of 31/05/06, 31/07/06 and 01/01/07 not met.) This will ensure that the social and recreational needs of the people living in the home will be met. 11. OP15 18(1)(a) 16(2)(i) Staff must be assured that the meal sizes are appropriate to the needs of the people living in the home. The record of food eaten must indicate the actual food eaten and where required an indication of how much was eaten. A record of snacks available should be kept. (Previous timescales of 31/07/06 and 01/01/07 not met.) The registered person must ensure that there is a variety of Meadow Lodge Care Home DS0000065927.V335186.R01.S.doc Version 5.2 Page 31 01/07/07 01/06/07 foods during the day. This will ensure that the nutritional needs of the people living in the home are met and can be monitored. 12. OP19 OP21 23(2)(d) Areas in need of upgrading must be attended to. This will ensure that a comfortable and homely environment is provided for the people living in the home. 13. OP26 13(3) Tablets of soap and people living in the home personal toiletries must be removed from communal washing facilities. The odour and damp identified in one bedroom must be remedied. This will ensure that people living in the home are safeguarded from cross infections. 14. OP30 18(1)(c)(i ) All care staff must receive the mandatory training and updates as prescribed. This will ensure that care will be provided to the people living in the home by staff who have the appropriate skills. 15. OP37 17(1)(b) All personal records must be stored in compliance with date protection regulations. This will ensure that information about the people living in the home is seen only by those who need to see it. 16. OP38 37, 12(1)(a) All accidents and incidents affecting people living in the DS0000065927.V335186.R01.S.doc 01/10/07 01/06/07 01/08/07 01/06/07 01/06/07 Version 5.2 Page 32 Meadow Lodge Care Home home must be reported to the Commission by the regulation 37 process. (Previous timescales of 17/06/06 and 01/01/07not met.) This will ensure that the safety of the people living in the home can be monitored. 17. OP38 13(4)(c) The registered person must ensure that all emergency alarms are attended to. This will ensure that the people living in the home will be given the help they need. 18. OP38 13(4)(c) Staff must follow the moving and 01/06/07 handling procedures identified for each person living in the home. This will ensure that the people living and working in the home are safe. 01/06/07 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 OP31 OP31 Good Practice Recommendations The manager completes the Registered Managers Award. An application for registration of the manager is forwarded at the completion of the probationary period. Meadow Lodge Care Home DS0000065927.V335186.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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.V335186.R01.S.doc Version 5.2 Page 34 - 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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