Inspection on 02/08/06 for Meadow, The

This inspection was carried out on 2nd August 2006.

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 14/11/05

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 Key Announced Inspection 2nd August 2006 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, The DS0000010726.V305474.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, The DS0000010726.V305474.R01.S.doc Version 5.2 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 home.fxg@mha.org.uk Methodist Homes for the Aged Mr Jeffrey Carnell Care Home 40 Category(ies) of Dementia - over 65 years of age (40), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (40), Old age, not falling within any other category (40), Physical disability over 65 years of age (40) Meadow, The DS0000010726.V305474.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Specialised Unit Up to 16 people with dementia (DE (E)) can be accommodated in the specialised unit. 14th November 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. One of the units on the first floor is currently admitting service users with mild dementia. Staffing levels have increased and it is the expectation that as a service user’s dementia becomes more progressive they could be moved to the ground floor unit with the minimum of disruption and distress. 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. The current scale of charges range from £561 to £648 per week. A copy of this report is available on the CSCI website or/and from the home. Meadow, The DS0000010726.V305474.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Wednesday 2nd August and lasted seven hours. The inspector spoke with six staff, three visitors and twelve residents. A partial tour of the premises took place and care records were inspected. The inspector spent over two hours observing residents and staff in the dementia unit. Staff were interviewed in private. The registered manager assisted the inspector 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: There were two medication errors noted during an examination of medication recording at the home. As a result two requirements have been amended and are restated. Unmet requirements impact upon the welfare and safety of service users. Failure to comply by the revised timescales will lead to the Meadow, The DS0000010726.V305474.R01.S.doc Version 5.2 Page 6 Commission for Social Care Inspection considering enforcement action to secure compliance. One new requirement and one recommendation have been issued as a result of this inspection. The fly screen in the kitchen needs to be either repaired or replaced. It is recommended that toilet seats in the dementia unit be replaced with ones with a contrasting colour to the toilet. The inspector is confident that the registered manager will comply with these requirements within the timescales given. 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.V305474.R01.S.doc Version 5.2 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.V305474.R01.S.doc Version 5.2 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) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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: Two 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. Meadow, The DS0000010726.V305474.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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. These risk assessments detailed how identified risks were to be minimised. This was a requirement from the last inspection that has now been complied with. Care planning documents included information on emotional needs and how they will be met, care of pressure areas and moving and handling risk Meadow, The DS0000010726.V305474.R01.S.doc Version 5.2 Page 10 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. 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. 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”. Staff interviewed 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. The CSCI visited the home at the last inspection and issued six requirements in relation to medication. The medication policy contains a section on the covert administration of medication. The home has an agreement form for service users who self administer their own medication. Air conditioning has now been fitted in the medication room and records indicated that the temperature of the room is below 25 degrees. Dates are now recorded of when all eye drop bottles are opened to ensure that they are not used after the time stated on the label by the pharmacist. These four requirements have now been complied with. Two other requirements have only been partly complied with. Although the receipt of medication coming in to the home is now being accurately recorded, records seen indicated that there were a few errors in the recording of the administration of medication. One tablet was still in the blister pack but had been signed for as given. A requirement that the stock record for Temazepam agrees with the stock of Temazepam in the controlled drug cupboard has been complied with. However it was found that the administration of one tablet had not been accurately recorded. The manager informed the inspector that he was aware of this error and had put systems in place to ensure that this does not happen again. Two requirements in relation to medication have been amended and are restated. Apart from these two issues all other records in relation to the receipt, administration and disposal of medication that were examined were accurate. 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. A relative spoke to the inspector about how touched she was that staff attended the funeral of her mother and how they treated her mother with dignity and compassion during her time at the home. Meadow, The DS0000010726.V305474.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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: Service users’ likes and dislikes regarding activities are being recorded on individual care plans. The home employs an activities coordinator who, in the morning of the inspection, was carrying out some gentle exercises with service users on the first floor. Service users who spoke with the inspector were positive about the range of activities available to them and said they could choose to join in or not depending on how they felt. The home also organises religious services for service users. The inspector spent two hours in the dementia unit observing staff interaction with service users. During the morning staff and service users were taking part in a quiz. This seemed to be very stimulating for the service users who were clearly enjoying the activity. The inspector was particularly impressed by the discussion about Nelson Mandela and race issues in general that arose during the quiz. Staff were talking about race in an open manner and service users were interested in how staff felt about these issues. It was clear that even though some of the service users were very confused staff were treating them with respect and valuing Meadow, The DS0000010726.V305474.R01.S.doc Version 5.2 Page 12 their comments. Race can be a challenging topic and the staff are to be commended for their adult and professional approach and the positive effect this had on the atmosphere in the unit. The home has an open visiting policy and the inspector saw a number of visitors during the inspection. The record of visitors indicated that service users could see visitors at any reasonable time. Visitors that the inspector met confirmed that they were always made welcome by staff and one relative commented that the care provided at the home was “exemplary”. During a tour of the building the inspector was able to see a number of service users’ rooms. The inspector was 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 inspector 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”. The inspector was able to observe lunch being served to service users. The inspector observed that some service users had alternatives to the set menu. 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. It was noted that the fly screen in the kitchen had a few tears and a requirement has been issued that this be repaired or replaced. The cook informed the inspector that he regularly speaks to service users and asks them how they enjoyed the meals. Meadow, The DS0000010726.V305474.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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 inspector is satisfied that service users have no reservations about addressing their complaints to the management of the home. The inspector was informed that all staff had received adult protection training. There is a rolling programme of adult protection training for all staff. 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. The home has a satisfactory Adult Protection procedure. Meadow, The DS0000010726.V305474.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is decorated to a high standard and provides a safe, comfortable and hygienic living environment for service users. EVIDENCE: A requirement was restated at the last inspection that a number of carpets on the first floor and in service users’ rooms needs to be replaced. This has now taken place and the requirement has now been complied with. The home was well maintained and decorated and furnished to a high standard. Unfortunately the back garden has been out of use for some time due to financial problems with the intended contractor. It is expected that a new contractor will be employed to landscape the back garden and provide an appropriate space for service users. On the morning of the inspection one service user’s room had a strong smell of urine. The inspector was informed that this particular service user has a problem with incontinence. Different but appropriate floor coverings were discussed. The inspector suggested that the toilets in the dementia unit be slightly modified to improve recognition. A recommendation has been issued in the relevant section of this report. The room in question was Meadow, The DS0000010726.V305474.R01.S.doc Version 5.2 Page 15 shampooed and no odour was detectable. All other parts of the home were clean and there appeared to be sufficient domestic staff working at the home to maintain a clean and hygienic environment. Meadow, The DS0000010726.V305474.R01.S.doc Version 5.2 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, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ needs are met by a supportive and well trained staff team. Service users are supported and protected by the home’s recruitment policy and practices. 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. The home has had a number of problems with NVQ level 2 training. The previous training organisation had lost training folders belonging to staff and as a result the number of staff trained to NNVQ level 2 does not meet this standard. The manager informed the inspector that around twenty-five staff are currently undertaking this training with a new training organisation. The inspector is satisfied that when these staff have completed the training this standard will be fully met. Four staffing files were examined. All these files contained the information required by The Care Homes Regulations 2001 including proof of identity and two written references. 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. Meadow, The DS0000010726.V305474.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has the skills and experience required to run the home in a professional and competent manner. 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 promoted and protected. EVIDENCE: The manager has been registered with the CSCI and has the required qualifications to meet this standard. Both staff and service users were very positive regarding the manager and staff commented that he gives the home direction. Another staff member described the manager as “fantastic”. The organisation has developed a clear and detailed quality assurance system. The home also has regular service user and staff meetings. A comment book kept at reception contained very positive remarks from relatives and visitors to Meadow, The DS0000010726.V305474.R01.S.doc Version 5.2 Page 18 the home. Service users that the inspector spoke with confirmed that they had a say in how the home is run. The assistant manager informed the inspector 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. Records in relation to fire safety were examined. These records indicated that staff have undertaken regular fire drills and night staff are undertaking fire drills every three months. This was a requirement from the last inspection that has now been complied with. The fire emergency plan has been reviewed in January 2006 and a copy sent to the local fire officer. This was also a requirement from the last inspection that has now been complied with. Satisfactory certificates were seen for gas safety, electrical installation and Legionella checks. Meadow, The DS0000010726.V305474.R01.S.doc Version 5.2 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Meadow, The DS0000010726.V305474.R01.S.doc Version 5.2 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 OP9 Regulation 13(2) Requirement The registered manager must ensure that all administration of medication is signed for or nonadministration coded as to the reason why it was not administered. (Timescale of 01/02/06 not met) This requirement has been amended and restated. The registered manager must ensure that the administration of all controlled drugs are accurately recorded. (Timescale of 01/02/06 not met) This requirement has been amended and restated. The registered manager must ensure that the fly screen in the kitchen is either repaired or replaced. Timescale for action 10/09/06 2. OP9 13(2) 01/09/06 3 OP19 23(2) c 01/10/06 Meadow, The DS0000010726.V305474.R01.S.doc Version 5.2 Page 21 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 OP19 Good Practice Recommendations It is recommended that the registered manager replace the toilet seats in the dementia unit with ones that have a contrasting colour to the actual toilet. Meadow, The DS0000010726.V305474.R01.S.doc Version 5.2 Page 22 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.V305474.R01.S.doc Version 5.2 Page 23 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!