Inspection on 08/10/07 for Meadow Lodge Care Home

This inspection was carried out on 8th October 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 24/04/07

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 8th October 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.V350994.R02.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.V350994.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadow Lodge Care Home Address 445 Hagley Road Edgbaston Birmingham West Midlands B17 8BL 0121 420 2004 0121 246 8279 romibagga@yahoo.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Coseley Systems Limited vacant post Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Meadow Lodge Care Home DS0000065927.V350994.R02.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. 24th April 2007 Date of last inspection Brief Description of the Service: Meadow Lodge is situated on the Hagley Road a short distance from Bearwood shopping centre. Bearwood has a variety of facilities including banks and public houses, shops and a library. Public transport into the City Centre is available directly outside of the home. The home was originally two dwellings and has been converted to provide accommodation for up to 22 older people. The home has three shared and twelve single bedrooms. One shared bedroom with an en suite and two singles with en suites. The home has two lounges and two dining areas. Shower and toilet facilities are provided on the ground floor. On the first floor there are two bathrooms with bath seat lifts. There is a stair lift in the home. To the rear of the home there is a large garden that people living in the home can use. To the front of the home is a forecourt that provides some car parking. The home has a ramped access available. The service user guide/welcome pack states that the fees at the home are per regional Social Service/Council body contracts and the fee for people who are paying privately is £365 per week. Meadow Lodge Care Home DS0000065927.V350994.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this unannounced key inspection over one day in October 2007. The home had been asked to complete and return an Annual Quality Assurance Assessment prior to the inspection and although the inspection was carried out before the date it was due back it had not been returned by the time this report was written and therefore information provided in it was not able to be used to inform this inspection. As part of the inspection process the inspector spent some time with the owner of the home, the new acting manager, looking at care and staff files, speaking to staff and five of the people living in the home and having a look around the home. During the day two staff surveys were completed and given to the inspector and four people living in the home were assisted by staff to complete surveys which provided the inspector with some information. There had been no complaints about the home and though two adult protection issues had been raised the home had acted appropriately when dealing with them. What the service does well: There was information available to people thinking about moving into the home to help them make the decision about whether to move in or not. The medical needs of the people living in the home were being met and staff acted promptly in the event of a fire in the home. Visitors were able to visit the home at all reasonable times. People living in the home were able to come and go as they pleased as long as there were no risk assessments in place that prevented this. The people living in the home said that the food was good and there was a variety of meals available. There were facilities in the home that assisted people with mobility difficulties. There appeared to be good relationships between the staff and people who lived in the home. The people living in the home were able to express their views openly if they were unhappy about anything. Meadow Lodge Care Home DS0000065927.V350994.R02.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The care plans needed to have more information in them that made them individualised and that helped the care staff to know what help was needed to be given to the individuals whilst maintaining their independence. The management of medicines needed to be improved to ensure that there was a clear audit trail of medicines received into the home. Compliance checks needed to be carried out regularly and individuals who were taking responsibility for their own medicines needed to be risk assessed. The home needed to consult with the people living in the home regarding activities and making arrangements to ensure that individual needs were met either in a group setting or on a 1:1 basis. The home needed to pay more attention to assessing and meeting the cultural needs of people wanting to move into the home. Where these needs could not be adequately met individuals should not be admitted to the home. Some areas of health and safety needed to be met proactively, for example, windows being propped open by pieces of wood. It is important that the home has a registered manager who is able to ensure that the needs of the people living in the home are met in a person centred way and that staff are monitored in respect of work practices. Meadow Lodge Care Home DS0000065927.V350994.R02.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.V350994.R02.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.V350994.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was a clear assessment process in place and people moving into the home were given an opportunity to see the home and decide whether to move in on a temporary basis. Some improvements were needed to the assessment process. EVIDENCE: The files of two people recently admitted to the home were sampled during this inspection. There was evidence that a pre-admission visit to the home had been carried out during which time an assessment was also carried out. A brief social background record of the person moving into the home was made and this gave a short overview of the individuals life, individuals important to them and things that they liked to do such as carry their handbag or always wear a waistcoat. Meadow Lodge Care Home DS0000065927.V350994.R02.S.doc Version 5.2 Page 10 On one of the files it was noted that the placing authority’s assessment had been carried out several months earlier but it was not faxed to the home until after the individual was admitted to the home. The registered person needed to ensure that they had this information before an individual was admitted to the home so that a decision on whether to offer a placement could be made with all the information about the individual’s needs available to the home. The pre-admission assessment needed to be expanded to include issues such as sight, hearing, oral and foot care, social interests, hobbies, religious and cultural needs. The information gathered during the assessment was used to write up the initial care plan. The assessment process needed to make clear how the communication, social and dietary needs of individuals were to be met by the home. Both of the files looked at had contracts in place, one was for someone paying for their own care and the other was for someone whose care was being paid for by the local authority. At the time of the inspection it was noted that spare copies of the updated statement of purpose were available and the owner stated that each person being admitted to the home was given a copy. It is recommended that a record is made of issues such as a key to the bedroom being offered, a choice being given to the occupants of double rooms whether to share the bedroom with someone new or whether to have a single room and that a copy of the statement of purpose has been given. The files sampled did not evidence that a 28 day review had been carried out however one of the people had only just been living in the home for a month. The registered person needed to pursue the placing authority for a review of the placement. Meadow Lodge Care Home DS0000065927.V350994.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care plans and risk assessments had improved however, more detail was needed to ensure that they were person centred and informed the staff on how care was to be provided. The health care needs of the people living in the home were being met but the administration of medicines and recording of professional visits needed some improvements to ensure that their needs were being met. EVIDENCE: The care plans for two individuals were looked at and two others were looked at for specific documents. At the time of the last inspection it was noted that there were a variety of care plans in place and that this could be confusing for the staff. It was pleasing to note that the four files seen were much better organised with old documents having been archived. The inspector was told that all the files had been updated and new care plans had been put in place. Meadow Lodge Care Home DS0000065927.V350994.R02.S.doc Version 5.2 Page 12 The care plans sampled were split into three parts. The first part being a tick box section, followed by an ‘actions’ section, followed by a review section. There were care plans in place that covered: moving and handling, safe environment, nutrition, communication, mental health, skin, elimination, breathing, personal hygiene and sleeping. There was some information on the care plans however, they were not personalised to the individual, did not tell the staff how to help them maintain their independence and provide help where help was needed. For example, on one of the files the communication care plan stated that the individual did not understand English and that there were head and hand gestures. There was no information regarding what the gestures were or what they meant and what the staff were to do if the individual was in distress or pain and how they would get assistance in understanding the individual. The difficulty in communication was confirmed when it was not possible for staff to assist the individual to complete a survey as requested by the inspector. For personal care it merely stated the individual was self-caring, preferred a shower and needed minimal assistance. There was no information about hair, skin, foot or oral care or what the minimal assistance needed consisted of. Care plans did not include information on how the individuals’ social, cultural and religious needs were to be met. Some care plans were inconsistent between sections. For example, for one individual the tick box section indicated that there was some confusion, they were passive, unable to comprehend, non-questioning and non-talkative giving the reader an indication that they may be depressed or had a level of dementia. However, the actions section said that there were no actions to be taken. In this instance the individual could have been referred for psychological or psychiatric assessment or had plans put in place to give the individual opportunity to converse in their own language. In this way it could have been determined whether there was a mental health issue or whether they were confused and isolated due to the lack of interactions because of communication difficulties and not having their cultural and social needs met. Some of the care plans needed to be updated. For example, for one individual the care plan stated that no assistance was needed when eating however, the individual was observed to be assisted at lunchtime and the daily records indicated that the individual was not eating well on occasions. For another individual it was noted that the admission assessment stated that they managed their own medicines however, during an audit of medicines it was noted that the staff were administering the medication. There were no care plans in place for medication and therefore no record in the care plans that the individual was not now managing their own medicines. It was also noted that Meadow Lodge Care Home DS0000065927.V350994.R02.S.doc Version 5.2 Page 13 there was no risk assessment for this individual to determine that they were able to manage their own medicines. There were risk assessments in place and these covered falls, nutrition and pressure areas however for one individual the Waterlow assessment indicated that the person was at risk but there was no corresponding management plan in place. One of the manual handling assessments seen did not record the hoist to be used or the sling size to use. During the day staff were observed to undertake transfers without the use of the hoist. There was evidence that the medical needs of the people living in the home were being bet. People were being registered with a local doctor to ensure that visits could be arranged to the home if required. Hospital appointments were being attended. There were visits from the dentist, district nurses and chiropodist. Sheets had been placed on files to record visits by visiting professionals however in one instance it could not be determined whether the chiropodist had been called to attend to the feet of one of the people living in the home. The home was using a monthly blister pack system. There were photographs of the people for whom the medication was intended available with the medication administration records (MAR charts). There was also a signature list of the individuals who administered medicines and the inspector was told that only individuals who had completed the medication training could administer medication. An audit of the blister packs indicated that there was at least one occasion when the tablet had been signed as given but the tablet remained in the blister pack. An audit of the boxed medicines indicated that were some discrepancies. For one individual there were two medicines where it was possible that the individual had been given too many tablets or that tablets were being lost. However, as there was no record that any medicines had been dropped or spoilt it had to be assumed that too much was being given on some occasions. There were no controlled medicines in the home at the time of the inspection and the record showed that they had all been returned to the pharmacist. There were no medicines that needed to be stored in the fridge and there were no homely remedies. There was one bottle of eye drops that had not been dated on opening and there were some creams in individual’s bedrooms that were not identified as being self medicated. One of these had not been dated on opening and the other had been open since July 2007. This would indicate that the cream was not being applied as prescribed. Meadow Lodge Care Home DS0000065927.V350994.R02.S.doc Version 5.2 Page 14 At the time of this inspection the bedroom doors could not be locked. This was because the fire brigade had had to enter the bedrooms forcibly following a fire at the home in order to determine that there was no one in the bedrooms behind the closed doors. This had led to some instances of people wandering into other peoples bedrooms. There were workmen in the home at the time of the inspection replacing the doors and locks would also be replaced. All glass panels in bedroom doors had privacy curtains in place and all shared rooms had curtains in place. Meadow Lodge Care Home DS0000065927.V350994.R02.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The social and dietary needs of some of the people living in the home were being met but the needs of others were not. EVIDENCE: As at the last inspection individual care plans for the provision of social activities for the people living in the home were not in place. There was an activities plan on display in the lounge this indicated that on Sunday and Wednesday afternoons there were games such as cards and dominoes available, Monday and Thursdays there was bingo and skittles, Tuesdays and Fridays there was a movie and on Sundays there was a sing a long. This programme appeared to be repetitive. The activity book showed that some people did get involved in the activities however, there were periods of time where nothing appeared to happen. Some of the people living in the home went out but these appeared to be the more able individuals or those who had family/friends who took them out. Meadow Lodge Care Home DS0000065927.V350994.R02.S.doc Version 5.2 Page 16 There was no evidence to show how this programme had been formulated. There had been no meetings for the issue of activities to be discussed with the people living in the home. During the inspection the inspector observed the staff offering the people living in the home a choice of meal at lunchtime. The people living in the home appeared to enjoy the meals. One told the inspector that ‘he had had a lovely steak pie for lunch’. Surveys completed by the people living in the home indicated that they were happy with the food. There appeared to be a better variety of meals available in the home than at the last inspection. The records of what was eaten by the individuals were kept on individual files. There were no records kept of snacks that were available. One person was observed to ask for a cup of coffee and biscuits during the evening. These were provided. Appropriate assistance was given at mealtimes however, the provision of culturally appropriate meals needed to be improved to ensure that the dietary needs of people of different cultures were met. Where this cannot be provided individuals should not be admitted to the home. There did not appear to be any rigid rules in the home. People living in the home told the inspector that they could go to their bedrooms during the day, they could go to bed and get up at a time that suited them. The relative of one of the people living in the home acted as an advocate for the people living there. Meadow Lodge Care Home DS0000065927.V350994.R02.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home were listened to and the appropriate actions taken however, where individuals indicated dissatisfaction with any aspect of the service steps needed to be taken to try to address this. EVIDENCE: There were no recorded complaints in the complaints folder about the service and none had been received directly by the Commission since the last inspection. One of the people spoken to during the day was not happy with the fact that his medication was not being given to him for him to administer. The inspector was informed that this decision had been made with the placing authority. The person living in the home was clearly not happy with the situation and the registered person needed to organise a review with the social worker to discuss the issues. Two allegations had been made since the last inspection that alleged one of the people working in the home had physically hurt someone and that another person had been psychologically affected by them. The person alleged to have been responsible had left the home and the home had taken the appropriate actions once they had been made aware of the allegations. Meadow Lodge Care Home DS0000065927.V350994.R02.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The premises were in need of a deep clean due to the effects of a fire however efforts were being made to ensure that the home was as homely as possible. Cleanliness and hygiene practices could be improved. EVIDENCE: Since the last inspection there had been a fire at the home that had been caused accidentally by one of the people living there. Significant smoke damage had occurred in the home so that the carpets throughout the home were stained and needed to be deep cleaned or replaced. The locks, frames and bedroom doors had been damaged when the fire service had to forcibly open the doors that were locked shut, when the individuals were evacuated from the home, to ensure that no-one was left in the home. Meadow Lodge Care Home DS0000065927.V350994.R02.S.doc Version 5.2 Page 19 Not withstanding the fire damage during a tour of the building there were two windows that were seen to have broken sashes and therefore they were propped open with a piece of wood. This was a potential risk to people who could get injured if the props were inadvertently moved out of place and fingers were caught in the window. Several bedrooms did not have bedside lights or a lockable facility available to the individuals occupying them. One of the people living in the home was able to make drinks in the bedroom however had to use dried milk as they could not keep fresh milk in the bedroom. It was advised that a small fridge was provided to enable the individual to maintain this independence and safely store fresh milk in the bedroom. In one of the bedrooms an old towel had been ripped up to make a face towel. This was not appropriate. Since the last inspection refurbishment of the bathroom on the first floor had begun. The flooring needed to be put down and it was advised that the flooring in the toilet in the adjoining room was also replaced at the same time as the flooring had split. The toilet also needed a small wash hand basin to promote good hygiene practices in the home. The area around the base of one of the toilets was very black and needed cleaning. In one of the communal washing areas there was tablet of soap although liquid soap was available. The inspector was told that the soap belonged to one of the people living there. Staff must ensure that soap belonging to individuals in the home is returned to their bedrooms after use to minimise cross infection. During the tour of the building one quilt was seen to be stained and the wall in the toilet on the ground floor needed to be cleaned. The clean towels stored in the shower, next to the incontinence waste bin in the shower room needed to be removed. In one of the bedrooms a body cream was seen that belonged to another person living in the home. There were pots of cream in two bedrooms for individuals who were not self medicating their creams. The decor and comfort of the bedrooms was variable. The refurbishment of the home was ongoing. Some new bedroom furniture had been purchased. There was an emergency call system, new stair lifts, grab rails and raised toilet seats available in the home. Meadow Lodge Care Home DS0000065927.V350994.R02.S.doc Version 5.2 Page 20 One of the kitchens had been gutted to form a smoking area for the people who lived in the home. The walls had been plastered but this was work in progress and the room was very cold. Meadow Lodge Care Home DS0000065927.V350994.R02.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): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were adequate numbers of staff on duty to meet the needs of the people living in the home and appropriate training was being provided. EVIDENCE: There were two care staff on duty during the day in addition to a senior care. There was a cook and domestic assistant available five days a week. There appeared to be sufficient staff on duty during, however two of the surveys completed by the people living in the home indicated that although there were always staff available they were busy sometimes when they needed something. During the day it was observed that care staff were undertaking domestic duties such as vacumming therefore reducing the amount of time during the day when staff were available to sit and talk and carry out social activities with the people living in the home. Staff were observed to go into one of the lounges to empty the bins and paid little attention to the people sitting in there. One of people sitting in the lounge commented to the inspector ‘no time for introductions’. The recruitment files of four staff were seen. Two of the files were for staff who had worked at the home for several years but two were for people Meadow Lodge Care Home DS0000065927.V350994.R02.S.doc Version 5.2 Page 22 recently employed in the home. The files showed that the appropriate checks were being undertaken prior to employment however, it was important that one of the references was from the most recent or current employer. There was evidence that inductions were being undertaken by new starters to the home. It was evident that training was being undertaken in the home. Since the last inspection several staff had undertaken moving and handling, dementia awareness, fire, food hygiene and first aid training. Twelve of the staff had completed NVQ Level 2 training or equivalent, the remaining 8 were undertaking this training. Some of the staff had completed NVQ level 3 also. Staff were undertaking the training but were not always following the instructions provided in the care plans, for example, moving and handling and this could potentially put themselves and the individuals being assisted at risk of injury. This was an issue that had been identified at the last inspection. Staff surveys indicated that improvements had been seen in the service and confirmed that training was being provided at the home. Meadow Lodge Care Home DS0000065927.V350994.R02.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): 31,32,33,35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management of the home was adequate. It was important to ensure that someone was registered to ensure that the people living in the home are confident that there is someone who will ensure that their views are taken into account whilst managing the home. EVIDENCE: No application for registration had been received for the acting manager in post at the time of the last inspection. On the day of this inspection a new manager was starting her employment at the home. The new acting manager needed to undertake the Registered Managers Award and submit an application for registration to the Commission. Meadow Lodge Care Home DS0000065927.V350994.R02.S.doc Version 5.2 Page 24 Improvements had been made to the organisation of care the files in the home and although a start had been made on improving care plans work was still needed to make them person centred. Files containing the care plans were not being stored in compliance with data protection regulations. This issue was raised at the last inspection. The home managed some monies for some of the people living in the home and the records of these were found to be satisfactory. The home had been informing the Commission about events occurring in the home. Accident records were checked and it was possible to audit the notifications sent to the Commission and follow up on queries that the inspector had. The home had unfortunately had an accidental fire that had resulted in some smoke damage and damage to bedroom doors due to the need for the fire service to ensure that no-one had been left in the bedrooms. The staff had acted appropriately and ensured that everyone who could be evacuated safely from the home was taken out and ensured that the fire service were summoned. The servicing and maintenance of equipment in the home was well organised. Fire tests in the home were being carried out on a regular basis. Staff had received training in health and safety, fire, food hygiene and moving and handling since the last inspection. Auditing of the medicines in the home indicated that some errors were occurring and the staff were not always following the moving and handling assessments in care files. The home had not carried out any meetings with the people living in the home, quality surveys or staff meetings since the last inspection. The quality assurance process had not progressed. Meadow Lodge Care Home DS0000065927.V350994.R02.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 2 3 X 2 2 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 1 X 3 X X 2 Meadow Lodge Care Home DS0000065927.V350994.R02.S.doc Version 5.2 Page 26 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 OP4 Regulation 12(4)(b) Requirement The home must ensure that it records enough detail on people living in the home in relation to cultural needs for appropriate care to be given by all care staff. (Previous timescales given 01/08/07) This will ensure that all the needs of the people living in the home will be met. 2. OP7 15 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. (Previous timescales given 28/08/02, 28/02/06, 28/04/06, 31/07/0), 01/01/07 and 01/08/07) This will ensure that the needs of the people living in the home will Meadow Lodge Care Home DS0000065927.V350994.R02.S.doc Version 5.2 Page 27 Timescale for action 01/12/07 01/12/07 3. OP7 15(2)(b) be met in a way that is individualised and acceptable to them. The care plans must be kept under review and updated as required. This will ensure that changing needs are monitored and planned for. Risk assessments and corresponding strategies to manage the identified risks must be in place for all the people living in the home. 01/12/07 4. OP8 12(4)(c) 01/12/07 5. OP9 13(2) All people moving into the home 01/12/07 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. Previous timescale given 15/05/06 and 15/05/07 The registered person must ensure that the people living in the home receive their medicines in line with the prescribing instructions. Eye drops must be dated on opening and taken out of use 28 days after. Creams must be applied as prescribed. This will ensure the people living in the home to receive their medication as prescribed. a) the activities plan should be varied and be formulated following discussions with the people living in the home. 6. OP12 16(2)(n) 01/12/07 Meadow Lodge Care Home DS0000065927.V350994.R02.S.doc Version 5.2 Page 28 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, 01/01/07 and 01/07/07 not met.) This will ensure that the social and recreational needs of the people living in the home are met. A record of snacks available should be kept. (Previous timescales of 31/07/06, 01/01/07 and 01/06/07 not met.) The registered person must ensure that the dietary needs of people of different cultural backgrounds are met. This will ensure that the nutritional needs of the people living in the home are met and can be monitored. Areas of the environment in need of upgrading must be attended to. A refurbishment plan, with timescales for completion must be forwarded to the Commission. This will ensure that a comfortable and homely environment is provided for the people living in the home. The registered person must ensure that broken sash windows are repaired so that they can be left open safely. This will ensure that people living in the home can ventilate their bedrooms safely. Staff must ensure that practices DS0000065927.V350994.R02.S.doc 7. OP15 18(1)(a) 16(2)(i) 01/12/07 8. OP19 23(2)(d) 01/01/08 9. OP25 13(4)(c) 01/12/07 10. OP26 13(3) 01/12/07 Page 29 Meadow Lodge Care Home Version 5.2 in the home promote good infection control practices. This will ensure that people living in the home are safeguarded from cross infections. The registered person must 01/03/08 ensure that there is a system in place that takes into consideration the views of people using the service when making plans about the service. This will ensure that the service is developed with the views of the individuals living in the home being taken into consideration. All personal records must be stored in compliance with data protection regulations. Previous timescale of 01/06/07 not met. This will ensure that information about the people living in the home is seen only by those who need to see it. 13. OP38 13(4)(c) Staff must follow the moving and 01/12/07 handling procedures identified for each person living in the home. Previous timescale of 01/06/07 not met. This will ensure that the people living and working in the home are safe. 11. OP33 24 12. OP37 17(1)(b) 01/12/07 Meadow Lodge Care Home DS0000065927.V350994.R02.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations The pre-admission assessment should include information on oral care, foot care, social, religious and cultural needs. This will ensure that all the needs of the individual will be planned for leading to person centred care. A 28 day review should be carried after admission to the home to ensure that the individuals needs can be met by the home. This will ensure that both the home and the person living in the home are happy for the arrangement to continue. The home should make a record of issues such as the bedroom key being offered, a copy of the service user guide being given and whether a positive choice has been made to continue to share a double bedroom after one person leaves. This will ensure that individuals are helped to make choices and their rights maintained. The registered person must ensure that all bedrooms have a lockable piece of furniture and bedside light available. This will ensure that people have somewhere to lock away private items and have lighting accessible to them from their beds to read or get up safely during the night. The manager completes the Registered Managers Award. An application for registration of the manager is forwarded at the completion of the probationary period. 2. OP7 3. OP14 4. OP24 5. 6. OP31 OP31 Meadow Lodge Care Home DS0000065927.V350994.R02.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-56 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.V350994.R02.S.doc Version 5.2 Page 32 - 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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