Inspection on 25/07/05 for Meadow, The

This inspection was carried out on 25th July 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Meadow, The 06/09/07

Meadow, The 02/08/06

Meadow, The 14/11/05

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 THE MEADOW Meadow Drive Muswell Hill London N10 1PL Lead Inspector Georgia Chimbani Announced 25 July 2005 @ 10:20 am 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 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. THE MEADOW G59 S10726 The Meadow V221375 25.07.05 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service The Meadow Address Meadow Drive, Muswell Hill, London, N10 1PL Telephone number Fax number Email 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 Belinda Morrow of Methodist Homes for Aged Mr Jeffrey Carnell PC - Care Home 40 beds Category(ies) of DE(E) - Dementia - over 65 registration, with number ME(E) - Mental disorder - over 65 of places PD(E) - Physical disability - over 65 OP - Old age THE MEADOW G59 S10726 The Meadow V221375 25.07.05 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1. Limited to 40 people of either gender who fall into the category of old age (OP) 2. and who may also have a mental disorder (MD(E)) and who may have physical disabilities (PD (E)) 3. Up to 16 people with dementia (DE (E)) can be accommodated in the specialised unit. Date of last inspection 5 October 2004 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 up 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 MEADOW G59 S10726 The Meadow V221375 25.07.05 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was five hours in duration. Present was the registered manager Mr Jeffrey Carnell and the two deputy managers. As part of the inspection process the inspector was able to speak to 8 service users and 3 visiting relatives. The inspector received 30 comment cards sent to service users and relatives before the inspection. Feedback on the quality of care offered by the home was very positive. Issues of concern raised, such as the lack of an activities co-ordinator had been resolved by the home. 6 requirements were issued at the last inspection and all were met. Following this inspection, 8 requirements are issued relating to pre-admission assessments, care plans, risk assessments, activities, service user respect and dignity, health and safety checks and maintenance issues. The inspector is confident that the home will meet the requirements within the stated timescales. What the service does well: The Meadow is a comfortable and well-decorated home that provides a good standard of care for service users. The home makes a concerted effort to meet requirements issued by the CSCI, as requirements made at the last inspection had been fully met. Service users looked happy and well cared for and those interviewed were able to confirm this. There have been some changes to staff working at the home. Service users have benefited from the recruitment of new staff as the increased levels of competent and committed staff have improved the standards of care. The living and working environment is very comfortable with a good rapport between service users, management and staff. The inspector observed that the manager has a relaxed and open style of management and it is the inspector’s opinion that this has a positive effect on staff morale and service user confidence. THE MEADOW G59 S10726 The Meadow V221375 25.07.05 Stage 4.doc Version 1.20 Page 6 What has improved since the last inspection? What they could do better: The home must ensure that pre-admission assessments are available for all service users before the move into the home. Care plans must be reviewed monthly. Risk assessments must be detailed and contain accurate information on the service user’s current situation. Risk assessments must be dated and show consultation with service users or where appropriate their relatives. Service users must be consulted regarding their social interests and their wishes in the event of their death. Records must be maintained of their decisions. Staff must ensure that any contact with service users maintains their respect and dignity. Carpets must be replaced on the first floor, mainly in some bedrooms and the hallways. Checks must be carried out on water storage tanks and for legionella. THE MEADOW G59 S10726 The Meadow V221375 25.07.05 Stage 4.doc Version 1.20 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. THE MEADOW G59 S10726 The Meadow V221375 25.07.05 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection THE MEADOW G59 S10726 The Meadow V221375 25.07.05 Stage 4.doc Version 1.20 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Pre-admission assessment information must be sought for all service users to ensure their needs are identified and can be appropriately met. EVIDENCE: Seven service user files were examined. Three files of service users who had moved to the home recently were examined. All three service users had been privately placed therefore there was no pre-admission assessment from the placing authority. The home had carried out a pre-admission assessment for two out of the three service users. No pre-admission assessment was available for the third service user. This is required. THE MEADOW G59 S10726 The Meadow V221375 25.07.05 Stage 4.doc Version 1.20 Page 10 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 standard(s) 7, 3, 10 and 11 The inconsistencies in current care planning documentation casts doubt on how well service user’s needs are identified and subsequently met. The home promotes service user’s health through regular contact with a variety of health care professionals. Staff must do more to ensure that service user’s dignity is maintained at all times. The home must seek the views of service user regarding their wishes in the event of their death. This will give them the assurance that their decisions are valued and will be respected. EVIDENCE: Seven care plans of service users with varying needs were examined. All files contained a photograph of the service user together with care plan 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. THE MEADOW G59 S10726 The Meadow V221375 25.07.05 Stage 4.doc Version 1.20 Page 11 Six out of seven files had evidence of monthly risk assessments however on one file it was indicated that the care plan was reviewed every two months. One care plan described the service user, as suffering from swollen ankles and arthritis but this was not mentioned in the risk assessment. A recent review of the moving and handling risk assessment also did not mention the service user’s swollen ankles and arthritis that would clearly have a bearing on their mobility. Another risk assessment contained contradictory information. Another service user was described as fully continent however in the same document the action for meeting this need was to ensure that there are plenty of pads in their room. This information was clearly contradictory and would result in inconsistent levels of care to the service user. Some risk assessments were not dated and showed no evidence of consultation with service users or their relatives where appropriate. The registered persons must ensure that all care plans are reviewed on a monthly basis. Risk assessments must contain detailed and accurate information relating to service user’s needs. These must be dated and show consultation with service users or their relatives where appropriate. 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 district 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. A service user’s friend visiting at the time of the inspection expressed their satisfaction with the care provided by the home and stated, “it has exceeded my expectations.” They informed the inspector that staff were always welcoming and supportive of their friendship. The inspector was able to observe staff feeding two service users. One member of staff sat next to the service user and fed them at their pace. The second member of staff proceeded to feed the service user while standing next to them at a table occupied by other service user. When this member of staff had finished feeding the service user, they gave them a drink and left them sitting at the table with food dripping from their bib. The registered persons must ensure that staff assist service users in a way that maintains their respect and dignity. The inspector held a brief discussion with the relatives of a service user who had died a few days previously. They confirmed that they were happy with the care given to their relative before and after their death. They had also been given ample time to clear their relative’s room. Four files did not contain information on service user’s wishes in the event of their death. This is required. THE MEADOW G59 S10726 The Meadow V221375 25.07.05 Stage 4.doc Version 1.20 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 standard(s) 12 and 15 The current level and variety of activities in the home does not cater for individual needs and tastes resulting in low levels of satisfaction. There is a high level of satisfaction with the food as service users’ dietary needs and tastes and well catered for by the home. EVIDENCE: The home has an activities co-ordinator who started work in May 2005. The inspector was able to hold a detailed discussion with them regarding the activities offered in the home. Feedback questionnaires received from service users and relatives through comment cards received before the inspection revealed that activities were cited as an area that needed improvement. The inspector was shown records on current activities and the level of individual service user participation. There were however no clear records on individual service user social preferences. The activities timetable was viewed and it contained a very limited range of activities such as music/keep fit and skittles. The inspector noted that there were three days [including Sundays] when there were no activities. Service users interviewed seemed unable to give a clear view on activities in the home. The activities co-ordinator acknowledged that she needed to be more imaginative regarding activities however she felt that support from management and other members of staff was lacking. The registered persons must ensure that records are maintained of service users’ THE MEADOW G59 S10726 The Meadow V221375 25.07.05 Stage 4.doc Version 1.20 Page 13 wishes and decisions regarding activities. It is recommended that the registered persons review the current systems of support available to the activities co-ordinator. Interviews with service user revealed that there was general satisfaction with the food. The inspector was able to observe lunch being served to service users. A number of service users seemed unaware of what was on the menu despite the menu being prominently displayed in the home. A service user stated that they were not consulted on their meal preference however a member of staff disputed this. The member of staff stated that service users were asked their meal preferences the day before however it was not uncommon for service users to forget that they had been consulted or what they had chosen to eat. The inspector observed that some service users had alternatives to the set menu such as a corned beef salad and a cheese salad. Two service users confirmed that they were enjoying their meals and that the portions were very generous. THE MEADOW G59 S10726 The Meadow V221375 25.07.05 Stage 4.doc Version 1.20 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 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: According to information supplied to the inspector by the manager, the home has received 4 complaints in the last 12 months. Of these 4 complaints, 1 was fully substantiated and three were partly substantiated. The inspector asked a service user how well staff treated them. The service user replied, “sometimes staff were alright but sometimes they did what suited them.” The service user was then asked what they would do if they were not happy about their treatment by staff? The service user stated they would tell the member of staff and if the situation did not improve they would not stand for it and would speak to the manager. The inspector asked the same service user whether they had confidence that management would deal with their complaint? The service user felt the response would depend on the individual manager as some manager tend to take sides. However this service user stated they had never had to make a complaint. Discussions with other 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 in March 2005. There are also plans for one of the deputy manager to do a trainer of trainers course in adult protection. THE MEADOW G59 S10726 The Meadow V221375 25.07.05 Stage 4.doc Version 1.20 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 standard(s) 19 and 26 The home provides a safe, well-decorated and hygienic living environment for service users. Additional refurbishments are required to ensure the comfort and attractiveness of facilities is not compromised. EVIDENCE: A tour of the home revealed that it is well maintained, brightly decorated and comfortably furnished. However the inspector identified some areas that need attention. Two chairs in the garden wing lounge require cleaning. Carpets in some areas of the home mainly the first floor hallway and some bedrooms on this floor needs to be replaced as their condition can no longer be maintained by regular cleaning. General cleaning of service user’s rooms was still in progress when the inspection commenced. No offensive odours were detected. THE MEADOW G59 S10726 The Meadow V221375 25.07.05 Stage 4.doc Version 1.20 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29 Staff recruited to work at the home are subject to criminal records bureau check before they start work. This minimises the risk of harm and abuse to service users. EVIDENCE: At the previous inspection the registered persons were required to ensure that original criminal records bureau check [CRB] are available for each staff member. The manager advised that new staff are subject to an enhanced CRB check before commencing work. The original disclosure notice is kept on file by the organisation’s head office and the home is sent confirmation of the outcome of the CRB check. In light of this, an agreement was reached with the previous inspector that each time a new member of staff is recruited, a copy of their CRB is sent to the CSCI. This arrangement is still in place and the inspector was able to confirm receipt of CRB checks for recently recruited members of staff. THE MEADOW G59 S10726 The Meadow V221375 25.07.05 Stage 4.doc Version 1.20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The home undertakes regular health and safety checks. Checks of water storage tanks and legionella must be carried out to ensure a high standard of safety for service users. EVIDENCE: At the previous inspection a requirement was made for COSHH [control of substances hazardous to health] chemicals to be kept locked when not in use. During a tour of the home the inspector was shown a locked cupboard use to stored COSHH chemicals. The inspector observed that while cleaning was in progress in various parts of the building, no cleaning trolleys where left unattended. During a discussion with management and the home’s maintenance person the inspector was able to confirm that most health and safety checks were up to date. Documentary evidence was also available confirming this. There was evidence to indicate that checks of water storage and tanks and legionella had been carried out on 12/7/04 but checks for this year were still outstanding. The inspector brought this to the attention of the THE MEADOW G59 S10726 The Meadow V221375 25.07.05 Stage 4.doc Version 1.20 Page 18 manager and maintenance man and has confidence that this will be completed within the set timescales. THE MEADOW G59 S10726 The Meadow V221375 25.07.05 Stage 4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 x 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x 3 THE MEADOW G59 S10726 The Meadow V221375 25.07.05 Stage 4.doc Version 1.20 Page 20 No Are there any outstanding requirements from the last inspection? 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 3 Regulation 14 Requirement The registered persons must ensure that pre-admission assessment information is available for all service users before they are admitted to the home. The registered persons must ensure that all care plans are reviewed on a monthly basis. The registered persons must ensure that risk assessments contain detailed and accurate information relating to service user’s needs. These must be dated and show consultation with service users or their relatives where appropriate. The registered persons must ensure that staff assist service users in a way that maintains their respect and dignity. The registered persons must ensure that service users wishes in the event of their death are sought and recorded. The registered persons must ensure that records are maintained of service users’ wishes and decisions regarding activities. The registered persons must Timescale for action 25/10/05 2. 3. 7 8 15 13(4), 15 25/10/05 25/10/05 4. 10 12(4)(a) 25/10/05 5. 11 12(3) 25/10/05 6. 12 12(3), 16(2)(m) (n) 23(2)(d) 25/10/05 7. 19 25/10/05 Page 21 THE MEADOW G59 S10726 The Meadow V221375 25.07.05 Stage 4.doc Version 1.20 8. 38 13(4) ensure that carpets on the first floor hallways and some service user bedrooms are replaced. Two chairs in the lounge of the garden wing must be cleaned. The registered persons must ensure that checks are carried out on water storage tanks legionella. 25/10/05 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 12 Good Practice Recommendations It is recommended that the registered persons review the current systems of support available to the activities coordinator. THE MEADOW G59 S10726 The Meadow V221375 25.07.05 Stage 4.doc Version 1.20 Page 22 Commission for Social Care Inspection 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 THE MEADOW G59 S10726 The Meadow V221375 25.07.05 Stage 4.doc Version 1.20 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. 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