Inspection on 14/11/05 for Meadow, The

This inspection was carried out on 14th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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, The 06/09/07

Meadow, The 02/08/06

Meadow, The 25/07/05

Meadow, The 05/10/04

Meadow, The 01/06/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Meadow, The Meadow Drive Muswell Hill London N10 1PL Lead Inspector Mr David Hastings Unannounced Inspection 14th November 2005 10:00 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, The DS0000010726.V259020.R01.S.doc Version 5.0 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, The DS0000010726.V259020.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Meadow, The Address Meadow Drive Muswell Hill London N10 1PL 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) 020 8883 2842 020 8442 1394 jeffrey.crnell@mha.org.uk Methodist Homes for the Aged Mr Jeffrey Carnell Care Home 40 Category(ies) of Dementia - over 65 years of age (0), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (0), Old age, not falling within any other category (0), Physical disability over 65 years of age (0) Meadow, The DS0000010726.V259020.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Limited to 40 people Of either gender who fall into the category of old age (OP) and who may also have a mental disorder (MD(E)) and who may have physical disabilities (PD (E)) Specialised Unit Up to 16 people with dementia (DE (E)) can be accommodated in the specialised unit. 25th July 2005 Date of last inspection Brief Description of the Service: The Meadow is a residential home run by Methodist Homes for the Aged. There are two floors, the ground floor provides care and support to sixteen older people with dementia and the first floor provides care and support to older people. All rooms are single and have en-suite facilities. There is a lift to the first floor. The dementia unit is within a safe area, which includes a spacious and easily accessible garden. The first floor has a balcony and sun terrace and is divided into smaller wings, each with a separate dining area. There is a large communal lounge. The home is decorated to a high standard and is well maintained. The aim of the home is; To improve the quality of life for older people inspired by Christian concern. The home bases its care service on seven core principles Privacy, Dignity, Independence, Choice, Rights, Fulfilment and Spirituality. Meadow, The DS0000010726.V259020.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Monday 14th November 2005 and lasted five hours. The inspectors spoke with six staff and nine residents. A partial tour of the premises took place and care records were inspected. The assistant manager assisted the inspectors and was open and helpful throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better: Two requirements issued at the last inspection relating to minor carpet replacement and risk assessments have been restated. Six new requirements relating to medication have been issued and two requirements have also been issued relating to fire procedures. The inspectors are confident that all these requirements will be complied with by the manager within the timescales given. Meadow, The DS0000010726.V259020.R01.S.doc Version 5.0 Page 6 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, The DS0000010726.V259020.R01.S.doc Version 5.0 Page 7 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, The DS0000010726.V259020.R01.S.doc Version 5.0 Page 8 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 (6 not applicable) Detailed pre-admission assessments are carried out for all new service users to ensure that their needs are identified and can be appropriately met by the home. EVIDENCE: Three service user files were examined from service users who had recently moved into the home. All files contained pre-assessment information, which covered all the elements of Standard 3.2 of the National Minimum Standards for Older People. This was a requirement from the last inspection that has now been complied with. Meadow, The DS0000010726.V259020.R01.S.doc Version 5.0 Page 9 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 and 11 Care plans detail service user ‘s strengths as well as weaknesses and how staff are to meet the health, personal and social care needs of service users. The home promotes service user’s health through regular contact with a variety of health care professionals. The service users are protected by the home’s medicines policies and procedures. The adherence by staff to these procedures is mainly satisfactory. Service users are treated with respect and their right to privacy is upheld. EVIDENCE: Six care plans of service users were examined. All files contained a photograph of the service user together with care plans and risk assessment documents. Care planning documents included information on emotional needs and how they will be met, care of pressure areas and moving and handling risk assessments. Care plans also clearly detailed individual strengths and weaknesses and described how staff are to meet the care deficits of service users. There was evidence that these plans were being reviewed monthly. This was a requirement from the last inspection that has now been complied with. Meadow, The DS0000010726.V259020.R01.S.doc Version 5.0 Page 10 Individual risk assessments contained clear information regarding the potential risk. Some of these plans did not give staff information about reducing the potential risk and some plans were not dated or being reviewed on a regular basis. A requirement was issued at the last inspection relating to risk assessments. This requirement has been amended and restated. There was evidence on service users files that they have good access to health care professionals such as doctors, district nurses, opticians, chiropodists and dentists. A community psychiatric nurse was observed visiting a service user and attending to them in a private room. Feedback from service users on the quality of care offered to them and the attitude of staff to their care was very positive. One service user commented that the staff were, “very kind and caring”. Staff interviewed by the inspectors were able to give examples of how they maintain service users’ privacy and dignity. Staff were observed assisting service users in a supportive and respectful manner. Lunchtime was relaxed and unhurried with staff providing discreet assistance where required. A requirement relating to maintaining the respect and dignity of service users, issued at the last inspection, has been complied with. The CSCI pharmacist inspector visited the home on 26th October 2005 the following is a summary of her findings. The medicines policy is complete, except that a section on the possibility of disguising medication had been omitted. No service users were having their medication disguised at the time of the visit and the service users, according to the medication records, were taking their medication appropriately. One service user is taking responsibility for all their own medication and another service user is managing her own Senna medication. Assessments have been carried out to ensure the service users are capable of administering their medication but no agreement forms have been signed. The records for the administration of medication were satisfactory although a few gaps in the recording were seen on two of the upstairs units. Medication received during the monthly cycle was not being signed for on the medication administration charts. The disposal of medication record was satisfactory. The eye drops for one service user were apparently being given for longer than 28 days from the same eye drop bottle according to the pharmacist’s label on the bottle. There was no date of opening on the bottle. The manager stated that the bottle had been changed at the beginning of the medication monthly cycle. The medication is stored in a medication room on each of the two floors. The downstairs medication room also contained the Controlled Drug Cupboard. The temperature of the areas where the medication was stored exceeded 25oC on hot days. There was a refrigerator dedicated to the storage of medication requiring refrigeration. The temperature was being maintained between 2-8 oC. Meadow, The DS0000010726.V259020.R01.S.doc Version 5.0 Page 11 The home had Temazepam for several service users. The stock found for the tablets agreed with the Controlled Drug Register but there was an overage of approximately 75ml. in the liquid Temazepam for one service user. The Controlled Drugs Register was not being filled in correctly, in that the records for all service users on Temazepam were being entered consecutively and not one page for each service user. Also the receipt of the Temazepam was not being entered correctly. Medication training had been given by the local pharmacist and this was being reinforced currently by managerial staff who had been on extra medication training. The rest of the medication standard was being complied with. As a result of the pharmacist’s visit six requirements have been issued in the relevant section of this report. All care plans examined contained information regarding the service user s’ wishes in the event of their death. Care plans also stated if service users did not want to discuss this issue. This was a requirement from the last inspection that has now been complied with. Meadow, The DS0000010726.V259020.R01.S.doc Version 5.0 Page 12 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 and 15. Service users can choose from a range of activities and visitors to the home are encouraged. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome, appealing and balanced diet. EVIDENCE: A requirement was issued at the last inspection that records must be maintained of service user’s wishes and decisions regarding activities. The inspectors saw service users’ likes and dislikes regarding activities recorded on their individual care plans. The requirement has been complied with. Written comments from relatives seen during the inspection indicated that the range and frequency of activities available to service users have improved. The inspectors spoke with the activities coordinator who has recently undertaken some dementia training. During the inspection service users were taking part in an exercise programme on the first floor and some of the service user from the dementia unit were taking part. In the dementia unit a volunteer was playing the piano and staff and service users were singing along. The home has an open visiting policy and the inspectors saw a number of visitors during the inspection. The record of visitors indicated that service users could see visitors at any reasonable time. Meadow, The DS0000010726.V259020.R01.S.doc Version 5.0 Page 13 During a tour of the building inspectors were able to see a number of service users’ rooms. The inspectors were very impressed that all rooms had an individual feel and contained service users’ own furniture and belongings. It was clear that each service user is encouraged to make their room their own. Service users that the inspectors spoke with said they were able to exercise choice in a number of ways including menus and activities. One service user commented that, “there is always a choice, we get asked what we like”. The inspectors were able to observe lunch being served to service users. The inspector observed that some service users had alternatives to the set menu such as a ham salad and a cheese salad. Service users confirmed that they were enjoying their meals and that the portions were very generous. The kitchen was inspected and found to be very clean and all health and safety practices were being followed appropriately. Meadow, The DS0000010726.V259020.R01.S.doc Version 5.0 Page 14 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 and 18 Service users have confidence in the home’s complaints system. They consider that their concerns will be listened to and addressed. Service users are cared for in a safe environment where staff have the relevant training to safeguard them from abuse. EVIDENCE: The home has a satisfactory complaints policy and procedure, which includes timescales for action and reference to the CSCI. Discussions with service users revealed that they had no complaints and were happy with the current standard of care. The inspectors are satisfied that service users have no reservations about addressing their complaints to the management of the home. The inspectors were informed that all staff had received adult protection training in March 2005. There are also plans for one of the deputy manager to do a trainer of trainers course in adult protection. Staff that the inspectors interviewed were able to describe the different forms abuse could take in a residential care setting and what they would do if they suspected abuse was occurring at the home. Meadow, The DS0000010726.V259020.R01.S.doc Version 5.0 Page 15 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 and 26 The home is decorated to a high standard and provides a safe, comfortable and hygienic living environment for service users. EVIDENCE: A requirement was issued at the last inspection that a number of carpets on the first floor and in service users’ rooms need to be replaced. The assistant manager informed the inspectors that an estimate for the replacement of carpets had been obtained. The requirement has been restated. Apart from this minor issue the home was well maintained and decorated and furnished to a high standard. There were no offensive odours detected throughout the home on the day of the inspection. There appeared to be sufficient domestic staff working at the home to maintain a clean and hygienic environment. Meadow, The DS0000010726.V259020.R01.S.doc Version 5.0 Page 16 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 and 30 Service users’ needs are met by a supportive and well trained staff team. EVIDENCE: On the day of the inspection there appeared to be sufficient staff to meet the needs of service users at the home. Service users that the inspectors spoke with confirmed that there were enough staff to meet their needs. The staffing rota was satisfactory. Service users were very positive regarding the care they received from staff at the home. Training records that were examined indicated that staff have undertaken appropriate training and staff interviewed were able to give examples of recent training they had attended and how the training had informed their work practices. The inspectors did note that the training records were being maintained in a range of folders and made finding appropriate certificates rather complicated. The inspectors recommended that the storage of training certificates should be centralised in one folder in order to make identifying individual training needs easier. Meadow, The DS0000010726.V259020.R01.S.doc Version 5.0 Page 17 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 and 38 Service users are able to have a say in how the home is run. Service users’ financial interests are protected by clear policies and procedures. The health and safety of service users and staff are generally well promoted and protected. EVIDENCE: The manager was not present on the day of the unannounced inspection however he has been registered with the CSCI. Staff were positive about the manager and the support they receive from him. The organisation carries out a service user survey every three months. The survey is sent to the organisation’s head office and a report is given to the home from the service manager. The inspectors saw a notice to relatives of a forthcoming relatives’ meeting displayed throughout the home. The minutes of the last service users’ meeting were examined and the assistant manager was Meadow, The DS0000010726.V259020.R01.S.doc Version 5.0 Page 18 able to give examples of how the issues brought up in the meeting have influenced the running of the home particularly with regard to menus. The assistant manager informed the inspectors that a few service users manage their own finances but the majority have their finances managed by either their family or the local authority. Small amounts of money are held by the home on the service user’s behalf to pay for hairdressing and other minor purchases. Random samples of individual accounts were inspected. All money is held separately and each account contained a clear audit trail with receipts. A requirement was issued at the last inspection that a Legionella check must be carried out for the home. A certificate was seen issued on 11/03/05. The requirement has been complied with. A satisfactory electrical installation certificate was seen dated 13/03/05. The fire emergency plan examined made reference to a “stay put” policy. This had not been reviewed and a requirement that the emergency plan is reviewed and sent to the local fire officer has been issued in this report. The inspectors also noted that although fire drills were taking place on a regular basis, night staff need to undertake fire drills every three months. A requirement relating to this has been issued in this report. Meadow, The DS0000010726.V259020.R01.S.doc Version 5.0 Page 19 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 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 Meadow, The DS0000010726.V259020.R01.S.doc Version 5.0 Page 20 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 OP8 Regulation 13(4), 15 Requirement The registered persons must ensure that risk assessments contain detailed and accurate information relating to service users needs. These must be dated and show consultation with service users or their relatives where appropriate. The risk assessments must contain action to be followed in order to reduce the identified risk. (Timescale of 25/10/05 not met) This requirement has been amended and restated The registered persons must ensure that carpets on the first floor hallways and some service user bedrooms are replaced. (Timescale of 25/10/05 not met) This requirement has been restated. The registered manager must ensure that a section on the disguising of medication is added to the medication policy. A standard agreement form must be designed for use if medication is disguised for a service user. It must be signed by the service user’s GP, the service user’s DS0000010726.V259020.R01.S.doc Timescale for action 01/01/06 2. OP19 23(2)(d) 01/03/06 3. OP9 13(2) 01/02/06 Meadow, The Version 5.0 Page 21 relative or advocate and the home’s manager. 4. OP9 13(2) The registered manager must ensure that an agreement form is completed for all service users who administer their own medication. It must be signed by their service user, their GP and the home’s manager. The agreement must be reviewed regularly. The registered manager must ensure that all medication received for service users is signed for on the medicine administration record to check that there is no mishandling. [Requirement made]. All administration of medication must be signed for or non administration coded as to the reason why it was not administered. The registered manager must ensure that all areas where the medication is stored is maintained at 25 oC or below. The registered manager must ensure that the date of opening is written on all eye drop bottles to ensure that they are not used after the time stated on the label by the pharmacist. The registered manager must ensure that the stock record for the liquid temazepam agrees with the stock of temazepam in the Controlled Drug Cupboard. The Controlled drug register must record the receipt administration and disposal of all Controlled Drugs separately for DS0000010726.V259020.R01.S.doc 01/02/06 5. OP9 13(2) 01/02/06 6. OP9 13(2) 01/02/06 7. OP9 13(2) 01/02/06 8. OP9 13(2) 01/02/06 Meadow, The Version 5.0 Page 22 each service user. 9. OP38 23(4)b The registered manager must ensure that the fire emergency plan is reviewed in consultation with the fire officer. The registered manager must ensure that night staff undertake fire drills every three months. 01/02/06 10. OP38 23(4)c 01/01/06 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 OP30 Good Practice Recommendations It is recommended that the registered manager review the storage of training certificates in order to better highlight staff training requirements. Meadow, The DS0000010726.V259020.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Meadow, The DS0000010726.V259020.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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