Inspection on 27/09/06 for Meadow Lodge Care Home

This inspection was carried out on 27th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Meadow Lodge Care Home 07/06/10

Meadow Lodge Care Home 17/03/10

Meadow Lodge Care Home 04/02/10

Meadow Lodge Care Home 14/09/09

Meadow Lodge Care Home 01/04/09

Meadow Lodge Care Home 02/04/08

Meadow Lodge Care Home 08/10/07

Meadow Lodge Care Home 24/04/07

Meadow Lodge Care Home 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 Jill Brown Unannounced Inspection 27th September 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Meadow Lodge Care Home DS0000065927.V314435.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.V314435.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadow Lodge Care Home Address 445 Hagley Road Edgbaston Birmingham West Midlands B17 8BL 0121 429 5983 0121 434 3516 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Coseley Systems Limited Miss Gillian Goode Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Meadow Lodge Care Home DS0000065927.V314435.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. 16th June 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, twelve single, one shared bedroom with an en suite and two singles with en suites. The home has two lounges and two dining areas. Shower and toilet facilities are provided on the ground floor. On the first floor there are two bathrooms one with a bath seat lift and the other a level access shower. There is a stair lift in the home but this does not fully access the first floor. To the rear of the home there is a large garden that residents can use. To the front of the home is a loose gravel forecourt that can accommodate some car parking. The home has a ramped access available. The home states that they charge between £314-£346 per week. Meadow Lodge Care Home DS0000065927.V314435.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors completed a key inspection on a day in September where the majority of the National Minimum Standards were looked at. One inspector stayed at the home for 6 hours the other for approximately 8 hours. Prior to the inspection the Commission received an anonymous phone call asking for a visit. On arrival the inspectors found that the home was amidst refurbishment of the kitchen and that plans had not been put in place to ensure that this did not impact on residents’ care. This also impacted on a number of standards that were assessed. During the inspection two residents were spoken with and several residents that had communication difficulties were observed during the lunchtime and at other points throughout the day. The inspectors spoke with one of the owners and the Registered Manager. Four resident care files were looked at and five staff files were looked at. A tour of some areas of the building and the garden were undertaken. A number of residents’ medication was looked at to check how this was administered. What the service does well: What has improved since the last inspection? Meadow Lodge Care Home DS0000065927.V314435.R01.S.doc Version 5.2 Page 6 The home has improved its assessment process and is better at collecting information and this will eventually help the home devise in depth care plans that respond to individual residents needs. The home was using screening forms to help them check residents’ risk of gaining pressure sores or whose weight may cause concern. A number of documents that were not available on the last inspection were available this time and this enabled the inspectors to see that checks such as weights of residents and checking that the hot water outlets did not get too hot were being done. The Registered Manager had started supervisions of staff and records were available for these and staff were undertaking the Skills for Care induction pack if they had started work recently. What they could do better: The home has yet to develop the care plans in to working documents that staff look at prior to giving to care to residents and to record what care they have given. This lack makes it difficult for new staff to deliver appropriate care and to determine what has happened on a particular day. The home has a number of residents that have difficulty communicating because of dementia or other illnesses and their care plans do not show what is the best way to approach or manage these residents care. As well as personal hygiene needs the care plans do not show what activities residents like or ensure that these activities take place for individual residents who cannot say that is what they want. The home medication administration was still poor and this is of concern as staff have had some medication administration training. The registered persons were not taking action with staff that repeatedly do not follow the medication administration procedures in the home. A number of residents do not have visitors and it may help the home target their improvement if they tried to involve an advocacy agency to work with some of the residents. The lack of visitors and residents that can speak up for themselves means that the home is not picking up on minor concerns and using them as away of ensuring general improvement. The home has yet to develop a good nutrition strategy for residents in the home. It was difficult to see how individual needs for types of food and when were being catered for. There was inadequate recording of food eaten and residents’ weights were not reflected in nutritional plans. Meadow Lodge Care Home DS0000065927.V314435.R01.S.doc Version 5.2 Page 7 The home has had a number of incidents not all within their control that had the potential to be adult protection issues and did not refer them to the Social Services or discuss them with the Commission and this is poor practice. Whilst the home’s environment is improving, improvements have been pushed ahead without due consideration for the residents or staff and this is not acceptable. The refurbishment of the kitchen left residents without appropriate hot food, the replacing of the fence at the back of the home meant residents could get to an access road at the back, and the lack of signs saying a step had collapsed down to laundry put staff at risk. There were no risk assessments in place and no plans for problems that could be foreseen. This lack of planning put an intolerable amount of pressure on staff. The home’s recruitment practices were improving however a number of staff subsequent to the inspection were found to working in other homes as well and individual staff risk assessments are needed to ensure staff remain competent during the time they are at work. Staff had received some training but a staff team matrix is needed to ensure that all staff have the appropriate level of training. The management of the home has not settled into a good working unit and this of concern. A large number of requirements are about planning for residents, staff and for improvements. The management team are not showing that they are developing the home in an organised way, which clearly sets out expectations of all involved. The Commission have required the home to develop an improvement plan. Lack of improvement will mean that the Commission will take further action. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Meadow Lodge Care Home DS0000065927.V314435.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.V314435.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 & 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the arrangements for collection of information on residents had improved gaps in the areas of mental health, cultural and religious needs could mean that some areas of need are not met. EVIDENCE: Information on collected on new residents had improved and there was a clear assessment process. However information collected on residents’ health conditions that prompted admission in to the home was not detailed. The home was not ensuring that they collected good information on residents’ ethnic background or culture and this meant planning in these areas was poor. The home had little understanding of the need to collect detailed information on residents with mental health conditions and this led to little information on how to keep residents mentally well. The home was not checking that they could meet all the needs of residents that they were admitting. The home did not inform residents or their representative in writing that they could meet residents needs as described during the assessment and this does not involve them in the decision making process. Meadow Lodge Care Home DS0000065927.V314435.R01.S.doc Version 5.2 Page 10 Staff had not had training on dementia, aggression and alcohol awareness and this is outstanding from the previous inspection. Meadow Lodge Care Home DS0000065927.V314435.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home had improved on developing screening assessments for risks but did not always develop care plans to meet these risks. Arrangements for meeting health needs varied and medication administration were poor and this potentially put residents health at risk. A number of plans to ensure a good environment affect the freedom and choices of residents. EVIDENCE: Where care plans had been completed there had been some improvement however care plans were not always totally completed, a number of risks such as smoking were not adequately assessed or determined on an individual resident basis. A number of residents with behaviour that needs management did not have plans in place to do this. Residents care plans were not reviewed on a monthly basis. Meadow Lodge Care Home DS0000065927.V314435.R01.S.doc Version 5.2 Page 12 The home was using a nutritional screening and a skin risk assessment tool and responses to the assessment varied. For example in one case where a resident had been identified as nutritional risk there were identified measures to monitor and improve the residents condition however this was not linked to the resident’s weight records. A number of residents could not be weighed adequately on the scales at the home and this meant a number of residents of low weight could not be checked often enough. Other measures used needed to be linked into residents body mass index to ensure that they could determine residents were losing weight. A falls risk assessment was undertaken but the response to the identified risks did not describe how the resident was to be moved to diminish these risks. Although a relative said that the home had ensured that medical attention had been gained and she had been informed when her relative had fallen. Moving and handling assessments were poor or were not completed. However residents were on observations moved appropriately. Staff encouraged residents to use what ability to move they had and took their time in moving residents from one place to another. One resident signed to say that she was refusing footplates on her wheelchair against the advice of staff in the home. Whilst a number of residents refuse bathing the records of assistance given with bathing did not adequately reflect this nor did it demonstrate that residents were offered bathing and showers and this may be due to the staffing levels in the home. One relative said that there were times when there were not enough staff available. Medication administration records were poor with little follow up being taken on when errors were consistently being made. Medication storage was secured appropriately to walls. A medication was said to have been refused but had not been presented out of its wrapper. There were gaps on the Medication Administration Records (MAR) charts for all the morning medication on one occasion for a particular resident. One resident had a handwritten entry on the MAR but there was no GP prescription to check against. This resident had reportedly received pain relief medication on a date yet the MAR reported this medication, as out of stock meaning that resident had not had any pain relieving medication for a number of days. One medication was on the MAR chart but the home did not have a supply of that medication. A medication for a resident was received and not counted in so it was not possible to audit. All three boxes of the same medication were open and this is poor practice. Stock left over from one MAR was not carried over to the next MAR chart. The home did not have protocols for ‘as required’ medication to ensure that residents are given this medication as needed and not too often to put them at Meadow Lodge Care Home DS0000065927.V314435.R01.S.doc Version 5.2 Page 13 risk. Although discrepancies have been found at medication audits these have not been assigned to individual staff members and so further action has not been taken. A controlled drug no longer needed had been kept in the controlled drug cupboard and had not been returned to the chemist. The home informed the inspectors that all staff that undertake administration of medication have received appropriate accredited training. Whilst residents were assisted well and talked to appropriately by staff the added pressures in the home meant that there was not enough staff to ensure that care was given in a planned and calm way. A number of entries in the communication suggested infringements of residents’ rights. One stating that residents could be put to bed after tea to allow cleaning of the home and that drinks should be restricted. The Registered Person stated that these written comments had been brought to his attention and were not in operation. Screening is available to separate areas in bedrooms that are shared. Meadow Lodge Care Home DS0000065927.V314435.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for activities and meals need to be improved to reflect the needs, wishes and abilities of the residents in the home. The home makes arrangements for residents to have some choice and for visitors. This could be enhanced by increasing the number of visitors residents have. EVIDENCE: Daily records and care plans did not show how residents become involved in activities. Although a number of residents spend their time in their rooms at their request their care plans did not show how staff were to interact with them or have planned one to one time. A number of residents do not get visitors and advocates may assist in giving these residents a voice. A number of the residents have communication difficulties through dementia. A relative thought that staff welcomed her when she came into the home and thought the homes environment had improved. The home does not have a Meadow Lodge Care Home DS0000065927.V314435.R01.S.doc Version 5.2 Page 15 private space for relatives to meet and one of the two dining rooms was often used, relatives were encouraged to visit between the hours of 09:30 and 21:00. Residents are allowed to receive their care and meals in their bedrooms and generally residents have freedom of movement. No resident was seen to have restraints on their ability to walk. One resident said they enjoyed spending much of their time in the garden and that they liked their bedroom. One resident that has difficulty maintaining concentration long enough to eat had no supplements prescribed. There was no planning on how meal times can be arranged to meet the needs of residents that have difficulty eating. At the time of the inspection the main kitchen was out of action due to refurbishment; there was no planning about how meals would be provided in the interim and this was unacceptable. Ultimately a meal was provided at lunchtime and a takeaway had to be arranged for the evening. The inspector visited the following day to find the main kitchen was in use. Food provided by the home still does not show how the appropriate levels of fruit and vegetables are being provided. The home did not have an adequate record of food residents have eaten for the inspectors to be clear that each person had adequate amounts of wholesome nutritious food. It was clear that the upheaval was affecting residents one saying its ok but my tea is cold. The residents received sausage and chips for lunch with no choice and no vegetables and had pizza for tea. Meadow Lodge Care Home DS0000065927.V314435.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The arrangements for managing concerns and adult protection issues was not robust enough to ensure that residents were safe and investigations were robust. EVIDENCE: The home has not kept a record of concerns or complaints made by any individual the responsible individual stated that they had concerns raised about clothing going missing but it was found in other resident’s wardrobes. The lack of recording of small concerns means that the home is not able to use these as part of the homes way of improving. Many of the homes residents do not have visitors and looking at ways of increasing this may assist the home in making improvements. The home has had three incidents that were not raised quickly enough as possible adult protections. Whilst these were not all to do with the home’s practice the failure of the home to refer appropriately gives rise to concern. The home has appropriate policies in place and has used them appropriately previously. Not all staff have had training in adult protection. The home ensures that details of residents’ belongings are recorded on admission to the home and this protects residents. Residents spoken to had no complaints about the home. Residents thought staff were helpful. Meadow Lodge Care Home DS0000065927.V314435.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service Whilst the décor and furnishing in the home had remained improved the changes had not been planned in a way that ensured minimal disruption to residents. The home could improve on the cleanliness of aids that are used to assist residents. EVIDENCE: The home looked well decorated and furnished during the inspection. The home was having the kitchen refurbished at the time of the inspection and this is recorded under standard 15 and 38. The showering and toilet facilities whilst accessible for residents that have disabilities looked tired in comparison to the rest of the home. The semi assisted bathing facility had not been used for some time due to alterations in Meadow Lodge Care Home DS0000065927.V314435.R01.S.doc Version 5.2 Page 18 that room and the home need to look at improvement in this bathroom to make it fully assisted. Shower rails were not always securely fixed to the ceiling. The home were keeping records of water testing to ensure that the water was not too hot for residents and these were available for inspection. Whilst the home was generally clean and fresh a number of home’s equipment needed cleaning. The flooring and ventilation fans in the shower rooms were not clean. The in bath lift and turntables needed a thorough clean. The home has limited amount of housekeeping hours and this needs increasing to manage the needs of a big home with these residents. Two staff were seen using hand antiseptic gel between tasks and this is good practice. Meadow Lodge Care Home DS0000065927.V314435.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staffing levels did not show that the management of the home were responding to the circumstances of the home or the needs of the residents. The homes level of NVQ 2 in care or similar training and recruitment of staff had improved and this gives safeguards to residents. EVIDENCE: The home did not have enough staff on the day of the inspection to meet the needs of the residents. The increase in the number and dependency of the residents means that staff are unreasonably stretched to meet these demands. Rotas show that there is inadequate numbers of staff to provide care, cook and clean. The stability in the staff group is a cause for concern with a large proportion of staff leaving. The home does not have a cook as the previous cook has left. Whilst another cook had been recruited the lack of cooking qualifications was a concern. A number of new staff that have been recruited are overseas nurses and therefore are likely to meet the requirements of NVQ2 in care and this must be checked with one of the local colleges. Subsequent to the inspection a number of staff were found to be working in other homes in addition this home. A check was needed to ensure that staff were working a reasonable number of Meadow Lodge Care Home DS0000065927.V314435.R01.S.doc Version 5.2 Page 20 hours per week that they remained competent to work throughout these hours. The recruitment of staff had improved with only a health declaration and staff being formally given a copy of the General Social Care Councils Code of Practice being outstanding. Induction was being undertaken and staff were being taken through the skills for care packs. The manager must ensure that evidence for each area of skill that the member of staff has completed is collected The home did not have a training matrix available for the inspector to look at. Meadow Lodge Care Home DS0000065927.V314435.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service The management of the home tried to improve environmental standards of the building without ensuring the health and safety of the residents in their care. The management must target their efforts on ensuring that residents’ health and well-being is foremost in the homes operation. The home makes appropriate arrangements for residents’ money. EVIDENCE: The home manager has the training and experience to manage a care home but whilst there has been improvement the service is still inconsistent with some areas being poor. The registered provider needs to demonstrate how the time is to be given for this to be improved. Meadow Lodge Care Home DS0000065927.V314435.R01.S.doc Version 5.2 Page 22 The home did not have in place audits and strategies to ensure improvement in staff performance, for example in medication administration. The responsible persons did not look at the accidents, falls or incidents in the home to see if there are any themes to help prevent this from happening as part of the audits for the home. The home had not developed ways of finding out what residents’ views were of the home and to make it more responsive to the needs of residents. This at times led to inappropriate responses to residents needs or too many responses that made the home feel chaotic. The home has however gained an Investors in People award, which looks at the staff’s understanding of the business they are in. The home responds well to residents that have different needs in how their money is arranged. Records of how residents receive their personal allowance were good. The home tries to get residents on a sound financial footing and where they have worries about residents money try to involve the Social Services Department with varying success. The level of staff supervision had improved since the last inspection and the manager should achieve the recommended six times a year in the forthcoming year. Records were available for inspectors to see on this inspection and this was an improvement from the previous inspection. Many of the main maintenance and inspection records of services such as gas are required yearly and these were checked at the last inspection. The home has had the hoists serviced since the last inspection and were able to produce records of checks for the temperature of the hot water outlets that residents have access to. The Legionella test had shown that the water quality was acceptable. The inspectors found there was little planning to ensure that health and safety risks to residents and staff were reduced as much as possible. As previously said the kitchen refurbishment was not looked at systematically. Although the work was being completed on an evening and night, extra staff hours were not provided for cleaning, cooking and serving residents. Plans were not made as soon as it was obvious that the kitchen was out of action. Staff were attempting to provide meals in a small serving kitchen that posed health and safety risks. The Commission was not informed of the date the kitchen was not in use as required. The home had been required to upgrade the fence to the rear of the building. The fence was removed without a temporary fence being erected. The back of Meadow Lodge Care Home DS0000065927.V314435.R01.S.doc Version 5.2 Page 23 the garden faces an access road which residents could gain access to. No risk assessment was completed. The night before the inspection a step leading down to the cellar collapsed making access to it unsafe. No sign had been placed on the door. The cellar houses the homes laundry. No risk assessment had been completed. Meadow Lodge Care Home DS0000065927.V314435.R01.S.doc Version 5.2 Page 24 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 X X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 X 2 X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 1 Meadow Lodge Care Home DS0000065927.V314435.R01.S.doc Version 5.2 Page 25 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 OP3 Regulation 14(1)(b)( d)(2) Requirement The registered person must ensure a full assessment is carried out on all prospective service users. (This requirement was partly met and had been outstanding since 28/04/06) Timescale for action 31/10/06 2 OP3 14(1)(d) 3 OP3 13(4)(c) The home must include residents cultural and religious needs in assessments to ensure these are met. The registered person must write 31/10/06 to the prospective resident or their representative that the home can meet the residents needs before accepting a resident and a record must be kept. Service users that are being 31/10/06 considered for bed rails must have risk assessment. (This requirement was not assessed and this requirement had been outstanding since 31/01/05) Meadow Lodge Care Home DS0000065927.V314435.R01.S.doc Version 5.2 Page 26 4 OP4 12(4)(b) a) The home must ensure that records enough detail on residents cultural needs for appropriate care to be given by all care staff. b) All staff must receive training in dementia awareness, aggression and alcohol awareness. (Outstanding since the 31/07/06) 30/11/06 Meadow Lodge Care Home DS0000065927.V314435.R01.S.doc Version 5.2 Page 27 5. OP7 15 6. OP8 12(1a) a) All residents must have care plans that clearly detail how staff will meet their individual identified needs. (This requirement remained outstanding since 24/04/05, 31/05/06 and 31/07/06) Including behaviour, communication and night care plans where necessary. (Outstanding since 31/07/06) And mental health issues. b) Care plans must be reviewed monthly. (Outstanding since 28/08/02, 28/02/06, 28/04/06 and 31/07/06) a) All falls must be scrutinised and action be taken to minimise recurrence. (Outstanding since 19/04/05 31/03/06 and 31/07/06) b) Records of personal care given including bathing or showering must be improved to ensure an accurate record of when these have been offered and given. (Outstanding since 17/05/05) 30/11/06 30/11/06 Meadow Lodge Care Home DS0000065927.V314435.R01.S.doc Version 5.2 Page 28 7. OP9 13(2) a) All residents must have enough stocks of pain relieving medication to have such medication when needed. (Outstanding since 31/07/06) b) The home must ensure that all medication is checked into the home by two staff and that this is appropriately signed for. The check must include the amount of medication and the amount must be recorded on the Medication Administration Record (MAR). (Outstanding since 31/07/06) c) Where a resident refuses medication regularly the home must discuss this with the resident’s GP and keep a record of that conversation. (Outstanding since 31/07/06) d) Medication that is prescribed ‘as required’ must have a protocol of what as required means and the maximum dose and the time intervals between doses as a minimum. (Outstanding since 31/07/06) e) Residents that have medication that is given by the district nurses or by the surgery that is stored at the home must have the date due written on the MAR. (Outstanding since 31/07/06) f) All medications must be given when signed for. (Outstanding since 31/07/06) g) All staff administering medication must have the appropriate training and be assessed as competent. 31/10/06 Meadow Lodge Care Home DS0000065927.V314435.R01.S.doc Version 5.2 Page 29 8 OP10 12(4)(a) 9. OP12 16(2)(n) 10 OP15 18(1)(a) 16(2)(i) (Not inspected on this visit) The home must ensure as far as 31/10/06 possible that residents have the freedom to stay in the communal areas as long as they wish. a) The home must have an 30/11/06 activities plan. (Outstanding since 31/07/06) b) Residents that are unable to join these activities must have an individual activities plan. (Outstanding since the 31/05/06 and 31/07/06) 31/10/06 a) The home must ensure that meal times are organised so that residents have the availability of staff to appropriately assist with getting to the table and assisting to eat where this is necessary. (Outstanding since 31/07/06) b) The home must ensure that the food provided for each resident has appropriate amounts of nutrition especially for those residents that do not eat well. (Outstanding since 31/07/06) c) A record of what the resident has eaten and the amount must be kept. (Outstanding since 31/07/06) d) A record of snacks available should be kept. (Outstanding since 31/07/06) e) The home needs to ensure that they have contingency plans in place to ensure appropriate food is available for residents. The home must put systems in place to gain comments about the home and to ensure that complaints are responded to appropriately. (Outstanding since30/04/06) All staff must receive training on adult protection. DS0000065927.V314435.R01.S.doc 11 OP16 22 30/11/06 12 OP18 13(6) 31/12/06 Page 30 Meadow Lodge Care Home Version 5.2 13 OP18 13(6) 14 15 OP19 OP26 23(2)(c) 13(3) 16 OP27 18(1)(a) All incidents that may be of an adult protection nature must be discussed with the Social Services department and the Commission Shower rails must firmly fixed to the ceiling if this is their anchor point. The home must ensure aids and equipment to assist residents are routinely cleaned along with flooring in shower areas and ventilation fans. The home must ensure that cooking and cleaning hours are in addition to the care hours. (Outstanding since 05/05/06and 31/07/06) The registered person must ensure that there are enough staff on duty to manage the care and housekeeping needs of the residents at any time or circumstance. Arrangements must be made to ensure that cooking staff are competent in the work they are employed to perform. The registered person must ensure that they require staff to declare all their paid work and risk assess the impact of this on the care of the residents. The home must ensure that they gain a health declaration from each member of staff that they are fit to work. All staff must be given a copy of the General social care councils Code of practice. A record of this must be kept on the individual staff members file. (Outstanding since 31/07/06) a) All care staff must receive the mandatory training and updates DS0000065927.V314435.R01.S.doc 31/10/06 30/11/06 30/11/06 30/11/06 17 OP27 Working Time Directive 19 Sch2 (6) 30/11/06 18 OP29 30/11/06 19 OP30 18(1)(c)(i ) 31/12/06 Page 31 Meadow Lodge Care Home Version 5.2 as prescribed. (This standard was partially met and other training is planned) b) The registered person must provide the Commission with a matrix of achieved training for the staff team and any planned training in the forthcoming months. The Registered providers and manager must provide the Commission with a joint improvement plan to ensure that all outstanding areas are rectified and the home can demonstrate sustained improvement. The home must seek expert external advice about how practice is to be improved in the home and implement their recommendations. (Partly met with investors in people award) The home must develop systems of auditing on falls, accidents, incidents, concerns raised discussions with residents and so on to improve the service, a) All accidents and incidents affecting residents must be reported to the Commission by the regulation 37 process. (Outstanding since 17/06/06) 20 OP31 24 A 30/11/06 21 OP33 24(1)(b) 30/11/06 22 OP33 24 31/12/06 23 OP38 37, 12(1)(a) 31/10/06 Meadow Lodge Care Home DS0000065927.V314435.R01.S.doc Version 5.2 Page 32 24 OP38 23(2)(b), (4)(c)(v) 13(4)(c) a)The homeowners must check on the requirements left on the five year wiring to see if these are still outstanding and evidence must be sent to the Commission. (This requirement was not inspected) b) The fire risk assessment must have a yearly review to check that the arrangements remain the same. (This requirement was not inspected). c) Fridge and freezer temperatures must be recorded. (This requirement was not inspected) a)The home must ensure that all staff have food hygiene training at the level required and b) a food risk assessment process is put into place. (This remained outstanding since 31/08/06) The Registered persons must ensure that risk assessments are in place for any planned work to ensure the health and safety of residents and staff before that work commences. The registered persons must ensure that there is an adequate amount of staff to ensure that health, safety and comfort of residents during these works. The registered persons must ensure that risk assessments and actions are taken as soon as a risk is identified. 30/11/06 25 OP38 18(1)(c) (ii) 13(3) 30/11/06 26 OP38 13(4)(c) 31/10/06 Meadow Lodge Care Home DS0000065927.V314435.R01.S.doc Version 5.2 Page 33 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 3 4 Refer to Standard OP8 OP13 Good Practice Recommendations It is recommended that the home purchase seated scales to more accurately assess residents’ weights. It is recommended that the home investigate arranging advocates or visitors for residents that have few or no visitors. It is recommended that the shower and bathing areas are scheduled for upgrading. It is recommended that all staff have formal recorded supervision every 2 months. OP21 OP36 Meadow Lodge Care Home DS0000065927.V314435.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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