Inspection on 14/12/06 for Meadow View Care Centre

This inspection was carried out on 14th December 2006.

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

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

Other inspections for this house

Meadow View Care Centre 13/05/08

Meadow View Care Centre 20/06/07

Meadow View Care Centre 02/12/05

Meadow View Care Centre 20/06/05

Meadow View Care Centre 09/03/05

Meadow View Care Centre 15/09/04

Meadow View Care Centre 03/02/04

Meadow View Care Centre 16/07/03

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

CARE HOMES FOR OLDER PEOPLE Meadow View Care Centre Wharrage Road Alcester Warwickshire B49 6QY Lead Inspector Sandra Wade, second inspector Lesley Beadsworth Key Unannounced Inspection 14th December 2006 07:30 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 View Care Centre DS0000043254.V322845.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 View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadow View Care Centre Address Wharrage Road Alcester Warwickshire B49 6QY 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) 01789 766739 01789 763440 info@prime-life.co.ukwww.prime-life.co.uk Prime Life Limited Mrs Melanie Oliver Care Home 42 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (42) of places Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users Service users placed in the bungalows must be assessed by social services and the Registered Manager as suitable for the bungalow style of living and not have primary diagnosis of dementia. Service users in the bungalows must have one member of staff available at all times, this member of staff clearly identified on the staff duty rota. 25th May 2006 2. Date of last inspection Brief Description of the Service: Meadow View Care Centre is a purpose built care home, situated in the town of Alcester. Meadow View can accommodate up to 42 older people including 25 older people in the dementia care category. The service provider offers long and short-term accommodation and services associated with meeting the personal care needs of service users in the above categories. The accommodation is on one level in two wings. The complex also includes several privately owned bungalows and a separate annex called Poppies. All clients are offered single bedroom accommodation with en-suite toilet and shower facility. Meadow View is spacious with a long wide corridor leading from the entrance to the communal and accommodation areas. The communal areas consist of a large lounge dining room with two smaller sitting rooms off the main room plus a lounge, which is based at the far end of a corridor. There are also seating areas in the corridors. The gardens are landscaped and very attractive and can be accessed by wheelchairs. The care centre is registered to provide personal care services only. The visiting district nurses treat residents needing nursing care. All placements at the Meadow View Care Centre are contracted through Warwickshire Social Services. The range of fees are from £324.54 to £379.51 per week. Extra charges are made for Chiropody only, which is £12.00. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the second key inspection to the Meadow View Care Centre for this inspection year. The inspection process consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. This inspection took place between 7.30am and 7.35pm. Four residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (if possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Records examined during this inspection, in addition to care records, included, staff recruitment records, training records, social activity records, staff duty rotas, health and safety records and medication records. A pre inspection questionnaire, resident and relative comment cards were requested at the last inspection to the home in May 2006, these were therefore not requested again for this inspection. What the service does well: Meadow View is a purpose built home which is spacious, well maintained and has good quality furnishings. There is a pleasant garden and there are various seating areas around the home, which visitors, residents and their relatives can sit in if they do not wish to use the lounges or bedrooms. All bedrooms within this home have an en-suite shower and residents have been able to furnish their rooms with personal possessions to make them more homely. Visitors are made welcome to the home and there is an open visiting policy. A hot drinks machine is located in the reception area of the home for visitors. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 6 Formal staff supervision has been commenced by the manager to help and support staff in meeting the policies and procedures of the home for the benefit of the residents. What has improved since the last inspection? What they could do better: Actions taken to address the requirements to the last inspection remain outstanding in many areas. Systems need to be introduced to ensure these are addressed in a timely manner. The Service User Guide provided to prospective residents needs to contain all of the required information so that they can make an informed choice about whether to stay at the home. Assessment records need to be clearly identifiable from the care plans and show the care needs of the residents. Care plans and risk assessments require further review to ensure these are upto-date so that staff know what is required of them to meet the care needs of the residents safely. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 7 Specialist care needs of residents, including dental care, needs to be clearly identified in care plans and acted upon promptly to ensure the health care needs of residents are not compromised. A further review of medication management is needed to ensure these are managed effectively to safeguard residents. The privacy and dignity of residents is still in need of attention including attention to personal care needs and how residents are dressed. Although some progress has been made in regard to the provision of social activities for residents, it was evident that further work is required to ensure all residents are able to enjoy some form of social interaction and stimulation regularly. A review of the provision of drinks is required to ensure all residents are receiving these regularly and in accordance with their wishes. Some attention is needed in regard to record management. This applies to providing clear contact information in the complaints procedure so that both residents and visitors to the home know how to raise a complaint formally and in ensuring accidents and incidents are reported to the Commission with actions taken so that the Commission know the home are taking appropriate actions to safeguard residents. Some attention to lighting is needed so that all areas are sufficiently bright to support those residents moving around the home safely. Some actions are required in regard to the environment, some doors are heavy for residents to open and some residents like to keep their doors open but there are insufficient actions being taken to ensure they can do this safely and within fire precautions. The recruitment process is in need of review to ensure the required information is obtained for new staff and is fully considered to safeguard residents. Staffing arrangements for the home remain in need of review to ensure the staffing of the home fully supports the needs of the residents. Training information needs to be kept readily available to confirm those staff who have completed training and those who need to attend training to show that the home have sufficiently trained staff on duty at all times. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 8 Records relating to quality monitoring need to show that sufficient actions have been taken to address issues raised to demonstrate these have been taken seriously and have been acted upon effectively. 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 View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 9 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 View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 10 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): 1,3,4 Quality in this outcome area is adequate. Prospective residents do not have all of the information they need to make an informed choice to stay at the home and assessment records are not sufficiently clear to ensure residents care needs can be fully met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A Service User Guide is available and provides information about some of the care and services provided. A copy of the Terms and Conditions for selffunding residents is available within this document but the summary inspection report for the home was not included to enable prospective residents to make more informed choices about whether to stay at the home. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 11 There has been no change to the assessment records from the last inspection in that it remains difficult to identify when an assessment of residents needs has been carried out and which of the records in place form part of this assessment. Some of these records viewed had not been dated. The manager said that she does carry out an assessment of residents needs prior to their admission so that she knows whether the home can meet their needs and the assessment records are distributed amongst the care plan records. This matter was discussed with a view to ensuring clear pre-assessment and assessment on admission records are in place. It was not evident from the records in place that a resident recently admitted received written confirmation that the home could meet their needs. The manager advised that this was due to the speed in which the resident was admitted. The manager showed the inspector a copy of a letter that had been devised since the last inspection, which she said she would usually use. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 12 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): 7,8,9,10 Quality in this outcome area is poor. Resident’s health, personal and social care needs care are not always met. The residents are not treated with dignity and respect at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plan records for four residents were reviewed to identify how care needs were being addressed. Care records showed that assessments had been completed but the care plans had not consistently been completed showing the care needs and the staff actions required to address these. The admission details for one resident said that they had a shortened leg. The general assessment dated September 2005 stated that this resident wore a built up shoe and was at low risk of falls. The assessment said that this resident needed minimal assistance and could move under supervision with a walking aid. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 13 This resident was not wearing a built up shoe during the inspection. No built up shoe was available in this resident’s room and the daily records did not show that this resident was wearing their shoe. Staff spoken to said that the shoe had gone to the laundry and had been washed but had been thrown away. The manager confirmed that the shoe was old and had disintegrated. Staff said that this resident had been without the shoe for some time and the resident had been complaining of leg and back pain. Daily records did not say that this resident has been complaining of pain. The manager said that a referral had been made to the doctor to organise for another shoe but none of the information relating to the shoe was evident in the residents care plan. It was not evident that the resident had been reassessed in regard to their risk of falls at the time the shoe was no longer available. The manager found a communication book showing that the doctor had been contacted on 27.11.06 about the shoe; the manager said that the member of staff should have transferred this information into the care plan file. An eating and drinking assessment had been completed but this was not dated. It stated that the resident enjoyed a well balanced diet but it was evident the resident had lost weight between May and July. This residents’ weight was not recorded for August but in September the resident had put on a 1lb. No weight had been recorded for October and in November the records stated that the resident had refused to be weighed. Staff said that this resident slept a lot and records showed that this aspect of the residents care had last been reviewed in August when the records stated “no change”. It was not evident from reading the daily records that this person was sleeping most of the time. At lunchtime this resident was not in the dining room, staff confirmed the resident was in bed. Another residents’ care records showed that they were not eating well. This resident was observed to be thin and frail. The records showed that this residents’ care needs were last evaluated in October 2006 and staff were to “monitor diet intake”. There were insufficient records being kept to show the precise food and fluid intake for this resident. Records showed that this resident weighed 5 stone 8lb. On speaking to this resident and a relative it was not possible to establish whether the resident liked the food or was eating meals regularly. This matter was discussed with the manager and advice given. One resident was noted during the inspection to have aggressive outbursts. Staff confirmed that the resident could hit out and had struck other residents as well as staff. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 14 On viewing the care records for this resident it was not evident that there was a care plan in place stating that this resident could be aggressive and detailing the staff actions on how to manage this to ensure the safety of residents as well as staff. It was also not evident that staff were recording all of these aggressive outbursts to give a full picture of how often this was happening and if there were any triggers causing this, which staff could avoid. The dependency of residents was discussed with a member of staff; she identified that one resident had a serious medical condition, which had affected their skin, speech and mobility and had not been eating well. The doctor had been contacted and had prescribed fortified meal supplements. Care plan records did not show that fluid and dietary intake for this resident was a concern and there were also no clear records of what she had eaten and/or drank. Daily records contained entries such as “ fluids offered regularly” there was no other evidence to show that this was being monitored, creating the risk of the resident becoming dehydrated and undernourished. It was apparent from discussions with the manager and staff, the examination of daily records and observations made, that a resident was spending 24 hours a day in bed due to their deteriorating condition. This was not reflected in a care plan to demonstrate how this personal care needs were to be met. A review of medication was undertaken. No controlled drugs were in use to be able to assess compliance with the previous requirement made relating to the management of controlled drugs. Meadow View uses a blister pack monitored dose system. The manager was administering medication during breakfast time. Observations made showed that she was carrying out a safe procedure of administration. Medication was in a locked trolley, which was taken to each individual as medicines were offered. The registered manager ensured that the medication was taken before signing the Medication Administration Record (MAR) sheets and moving on to the next resident requiring medication. The trolley was kept in view at all times. The senior member of staff on duty keeps the medication keys and the registered manager and senior care advised that only trained staff have any responsibility for medication. There are two medication trolleys due to the amount of blister packs for the whole home being stored in them. However this increases the risk of error as was demonstrated on the day of the inspection. An audit of the tablets showed there were two boxes of the same medication, but for two different people and both had an extra tablet missing when audited against the MARs. Two boxes in the second trolley, for two other people, had one tablet too many in each. It would seem that the tablets had been used from the first trolley as that had been the one in use when those residents were available to have their medication. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 15 The medication policy and procedure shown by the senior care assistant whilst the medication was being inspected, was brief and lacking the amount of detail required to ensure that staff are aware of what is expected of them. The senior carer was not aware of the full details of how medication is ordered although was able to confirm that the prescriptions are seen, copied and checked by the home before going to the pharmacy. Information provided by the carer regarding the receiving of medication demonstrated that this was being carried out safely. A sample of MARs was checked and no unexplained gaps were seen but one MAR for a resident who was self-administering her medication did not have any record of any monitoring of this by staff. Two MARs had the code “F” written on them but this was not defined to show what this meant. The senior carer said the “F” was to indicate that the resident was asleep. For one resident this meant they had been asleep each time a particular medicine had been brought to them. There was no record that this had been reported or referred to the doctor or that any other actions had been taken to ensure that the medication could be taken as prescribed. The medication was stored in a satisfactory manner apart from there being a large excess stock of Lactulose. One bottle was dated July 2006 for the resident who had been asleep on most occasions that she has been offered it. Discussion with senior staff and observations made revealed that the manager and senior care staff had been trained by the district nurse to monitor blood sugar and to give insulin via the ‘pen’ syringe. There was no documentation or certification to support that this training has been undertaken or that the staff are competent to carry out these procedures. It was not evident that the privacy and dignity of residents is being maintained although staff were seen to knock on doors before entering bedrooms and refer to residents by the preferred name in their records. During the inspection there were two residents wearing clothes over their nightclothes and one resident had unkempt hair throughout the day. A visitor spoken with said that laundry was an on going problem with delays in clothes being returned and items being lost. A large box of ‘lost property’ was noticed in the laundry with a larger box kept in the staff room. It was also noted that items of laundry had been returned to the wrong person. It was noticed that some of the residents’ clothes were labelled with the room number rather than the person’s name, which does not reflect personal autonomy, respect for personal belongings or account for if a person changes room at any time. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 16 One resident was found standing in the corridor on two occasions waiting for a member of staff to give them some incontinence pads. The manager said that this resident had only just been assessed so that they could receive a supply of their own pads. One resident’s teeth were noted to be in need of attention. There were no records to suggest a dentist had been approached or records to suggest the resident did not want treatment. Residents were noted during the inspection to drink hot tea out of plastic beakers as opposed to cups or mugs. Staff said that they did not have a sufficient supply of cups to allow all residents to have a cup due to them getting broken. Apart from this creating a risk of scalding this is not age related or dignified. The staff and manager said that more had been requested two weeks previously. In one room there was no underwear available in a residents drawer for them to wear. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 17 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): 12,13,14,15 Quality in this outcome area is poor. The lifestyle experienced in the home by residents does not match all of their expectations and preferences although residents are able to maintain contacts with family and friends. Residents are able to exercise some choices but these are limited and therefore impact on the resident’s opportunities to maximise their independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans each included an activity log but these were only completed once a month. Activities recorded included bingo, colouring, drawing, and creative mobility. Some craft items made by the people living at the home were on display outside the bedrooms. The manager advised that they try to devise a programme of activities each month and carers will then provide these activities in the afternoons each day. The activity schedules seen show that activities are usually provided from Monday to Friday. Staff confirmed that activities are provided but this depended on staff availability for each shift. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 18 There is no Activity Co-ordinator employed at this home to consult with residents on social activities or to plan and provide these. Carers have been allocated to do this but this has to be done within their carer shifts, which places limitations on their time. The provision of activities and social stimulation is an important aspect of care for older people and particularly those with dementia. The activity programme for December showed a pamper afternoon, visit to a pub, arts and crafts, sing-a-long, trip to see Christmas lights and baking. In November 2006 residents were taken out for a drive to the countryside in the homes minibus. Names of residents attending activities had been recorded. One resident spoken to said that they tended to stay in their room and kept themselves occupied with knitting, reading and doing word searches. During the inspection there was minimal activity and social interaction observed with residents in the communal areas of the home. A visitor spoken with said that she was always made welcome at the home and that there were no restrictions to her visits. Other visitors were observed in the home throughout the day and those spoken to also confirmed they are made welcome. Residents are able to exercise some choices over their lives such as times they get up and go to bed. They are also given choices of meals. The housekeeper had made teapots available on the tables for those residents who could independently use them to promote choice and to maximise their independence. The staff however do need to be wary of those residents with dementia and confusion who could scald themselves if this arrangement is not managed safely. Choices in other ways are not respected in that many doors automatically lock preventing the residents from getting into their rooms unless a member of staff unlocks it for them. The manager was able to give an explanation as to why two of the doors are being kept locked but it was not clear why other doors are being kept locked. The manager advised that some of the doors have had their locking mechanism disabled to allow some residents to get into their rooms. Residents had no choice but to use plastic cups and disposable cups due to insufficient crockery being available. It was observed during the inspection that resident choices can be restricted due to staff not being available to assist. For example, several residents at various times during the day would have liked a drink but had to wait until staff were available to provide these for them. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 19 At the beginning of the inspection several residents were sitting in the seating areas in the corridor and all expressed that they were thirsty and had not had a drink since getting up. Tea was eventually given to some of them and was served in thin disposable cups, which can be difficult for some residents to handle and could also present a burn risk if the tea is hot. Drinks were provided during the day but it is not evident these are being provided often enough for the residents. Several residents throughout the inspection asked for drinks. Both breakfast and lunch were observed for a period of time. The dining room was pleasantly decorated and furnished, with a wooden floor that the registered manager said had been treated with a non-slip finish, giving the people living at the home a pleasing setting for their meals. However a fourfoot high statue of a headless waiter seemed a rather inappropriate item to be in a dining room and with a client group that included a large percentage of confused and possibly disorientated people. At least 14 residents had been seated at the table waiting for breakfast for some time prior to breakfast being served. The housekeeper for the home was observed to take a trolley round to each table and ask residents what they would like for breakfast. This was a lengthy process and it took some time to get round all of the tables. A choice of weetabix, fruit and fibre, cornflakes or grapefruit was given as well as toast. A choice of drinks was given including tomato juice, orange juice or cranberry juice. Tea was also served, for those residents served last, the tea was found to be lukewarm. It was not clear why residents could not be given their breakfast when they came into the dining room. Cooked breakfasts are not provided during the week, the senior carer said that they had provided them in the week but this did not prove successful so they now provided bacon sandwiches on a Saturday and a full cooked breakfast on Sunday. No care staff were present in the dining room during breakfast to assist or to supervise residents either during the time the housekeeper was serving the breakfast or afterwards. A resident almost choking on a drink illustrated the need for this and another resident with dementia was constantly interrupting and disturbing other residents. Furthermore the registered manager came in to administer medication at 09.05am. The process was time consuming and often interrupted by residents, as there was no other care staff available to assist. The manager had to be the person ensuring that assistance was given to each resident to both take their medication and any other assistance required. At lunchtime the Senior Carer (who was covering as cook) and the driver (who also assists in the kitchen) brought a food trolley into the lounge to serve meals to the residents. There were also up to three carers assisting in the dining room to take meals to the tables for residents. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 20 Choices given were omelette or Cornish pastie with cabbage, beans, carrots, mash potato and gravy. Meals looked appetising and were appropriately presented with the exception that the gravy was automatically put onto the meals prior to taking them to the residents without asking them first if they wanted this. Residents observed were able to eat independently. One resident said that the food was “very good” and there was “far too much choice”. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 21 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): 16,18 Quality in this outcome area is poor. Complaints procedures are in place but records are not always sufficiently detailed to show these have been investigated and resolved in line with the homes procedures. The policies and practices for the protection of vulnerable people at the home are not sufficient to maintain the safety of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no complaints received by the Commission in regard to this home. The home had received four informal complaints since the last inspection and actions had been taken to document these. Complaints detailed were as follows:The absence of a wastepaper bin in a bedroom - this was upheld and resolved by a waste paper bin being provided. A broken toilet seat in an en-suite bathroom and a missing TV aerial - the complaint was upheld. A noisy toilet in an en-suite bathroom, which was recorded as being resolved. Concern about insufficient care to a resident’s leg by district nurses to which no outcome or action taken was recorded. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 22 Although records of complaints had been kept, these were not all sufficiently detailed to be sure they had been fully investigated and resolved within acceptable timescales. A visitor said that she knew who to go to about concerns but had not always had the feedback she would have expected without asking for it. A resident said that they had no complaints about the home. Due to the dementia care needs and confusion of those residents spoken to it was not possible to obtain their thoughts on the complaint processes. Staff had not undertaken training in the identification and prevention of abuse and those staff spoken to were unable to confirm the types of abuse to be able to effectively report these to the manager. One member of staff felt they would have difficulty reporting any incidents of neglect, as they would not be listened to. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 23 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, 21, 25, 26 Quality in this outcome area is adequate. Service users live in a wellmaintained environment and have access to suitable toilets and washing facilities. Not all areas are being kept clean to maintain hygiene and some areas have poor lighting, which could compromise the safety and comfort of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is spacious in that there is a large dining area and wide long corridors with various seating areas. Resident accommodation is in two wings plus independent bungalows. All bedrooms have an en-suite shower and toilet and there are also 3 communal toilets and one assisted bathroom. Small communal lounge areas are available off the dining area and there is a small lounge at the end of one of the corridors with armchairs for seven people. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 24 The manager advised at the last inspection that a hearing loop was available in one of these lounge areas to assist those residents with hearing aids. A tour of the home was undertaken and random bedrooms were selected. Some of the bedrooms were in the process of being redecorated. Workmen were in the home and had moved items of furniture around in some rooms so that they could be painted. They explained that they started painting the rooms early in the morning when residents where up. One resident who clearly suffered with confusion went back into their room despite the wet paint. One resident sat at their bedroom door clearly anxious that things had been moved in their room and because they could not go into their room. There was an obvious smell of paint in these rooms but the workmen said that low odour paint had been used. Bedrooms seen had been personalised to make them homely. Some rooms were clean and others were in need of cleaning. One was found to be in need of a thorough clean and had a strong unpleasant odour and the lighting was dim, another had a food-stained cushion and the arms of the chair were dirty. One resident spoken to said that they were “quite happy” in their room and had no complaints. Other residents whose rooms were viewed were unable to comment on their room due to their confusion or dementia diagnosis. Hot water in resident areas was operating at safe levels to prevent scald risks and radiators were suitably guarded to prevent any burn risks. Bedroom doors were labelled with the residents name and some included a photograph of the occupant or other personal item to assist those with dementia to locate their room. Many of the doorknockers had disposable gloves or some other material, attached to prevent the knocker banging when the door was opened or closed. This looked unsightly defeated the purpose of the door knockers. It was clear that the doorknockers were not sufficiently heavy to prevent them from banging each time the doors are opened and closed and this could disturb residents particularly at night. It was noted that this matter had been raised by relatives/residents as part of the quality review process and they had suggested they be removed. Several bedroom doors were wedged open by various different implements. This practice was highlighted at the last inspection as it does not meet with the fire precautions and creates a potential risk to residents in the event of a fire. For those residents who wish to keep their doors open, suitable door retainers should be fitted which are linked to the fire alarm, which automatically close if the fire alarm goes off. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 25 Scarves made of different materials were tied in various places on the handrails in the corridors. The manager advised were to provide tactile materials for those residents with dementia. No other sensory or tactile aids were seen to be openly available to those residents with dementia. All furniture and furnishings were domestic in appearance and of good quality but not all areas of the home offered sufficient brightness, particularly the dining room, bedrooms and bedroom corridors. The home was warm and comfortable in most areas but although the reception area provided a pleasant sitting area this was very cold on the day of inspection. Tea and coffee facilities were available in the reception area for visitors. Staff were wearing white disposable aprons and plastic gloves in the kitchen area and when handling food to support good infection control practice. On several occasions staff were seen to be wearing protective aprons and gloves around the home without removing them in between attending to different residents. This can create a risk of cross infection from one resident to another and to contamination around the home. The laundry area was clean and tidy and well organised although the door of the previously locked cupboard storing detergents and cleaning materials was broken off its hinges. The laundry assistant advised that this was when staff wanted to access the washing powder when she was not on duty and they did not have a key. Hand washing facilities were available in a nearby laundry room. Items to be washed are brought to the laundry room in black plastic bags and then sorted into the appropriate labelled baskets- i.e. whites, colours. Tablecloths and sheets are kept separately as they are sent out to contractors to launder. The laundry floor was impermeable and therefore easy to clean to minimise cross infection. The laundry assistant was wearing a tabard as protection but was not aware that a plastic apron should be worn when handling dirty laundry to prevent cross infection. It was noted that the laundry room was the staff thoroughfare to access the patio used by them when smoking. It was established that this was preferable to access through the kitchen, which was also used. During the inspection both the doors to the laundry and kitchen were open creating a risk of contamination of cigarette smoke. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 26 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): 27,28,29,30 Quality in this outcome area is poor. Service user needs are not being met by current staffing arrangements in the home and the safety of residents is not fully supported by the homes recruitment practices. Staff training could not be fully evidenced to confirm residents are in safe hands at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Duty rotas show that the home aim to have six carers on duty from 8am to 8pm to care for 42 residents, many of which, suffer with confusion or dementia. Evidence from the last inspection as well as this inspection suggests that staffing arrangements for the home continue to be ineffective in addressing the needs of the residents. Throughout the inspection residents were seen to frequently need the assistance of a member of staff whether this be to make a drink for them, assist them to get dressed or replenish their stock of pads. One resident came out of their room at 9am in a thin nightdress and became upset and distressed. They asked the inspector what time it was and asked if they had missed breakfast. The resident said she could not find her dress. The inspector found it difficult to locate a member of staff to assist this resident because they were busy in other parts of the home. Locating staff was also an issue identified at the previous inspection. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 27 One resident who came to sit in one of the lounges said they were very hungry and thirsty. Their mouth looked dry and this person had laboured breathing. A member of staff was not at hand to fetch this resident a drink so the inspector went to the kitchen to get a drink for the resident and the resident drank this straight back. Throughout the inspection a resident was constantly shouting, “help me” which was distressing the other residents, several shouted “shut up” even though the resident was in their bedroom. One resident became visibly upset and was looking for some reassurance from staff that everything was all right. This was not forthcoming and the inspector therefore advised the resident that the person shouting was all right and the resident then calmed and thanked the inspector for telling them. Inspectors went to see the resident who was shouting to check they were being attended to. The resident was found sitting on a mattress on the floor in their room, which had been placed there for their protection. The resident was shaking, hot to touch and distressed and it was evident this resident was in need of increased staff support such as one to one attention. The manager and staff advised that they had hoped to achieve this by requesting continuing care via the social worker three days previously but this additional support had still not been approved. When asked if an extra member of staff could have been brought in whilst awaiting this approval, the manager said that the organisation would not approve payment for this. This was despite the obvious inability for staff to meet the needs of this resident and the negative impact on the other people living at the home. Throughout the day the manager strived to get some extra help and support to manage this resident by making contact with the residents doctor and organising a visit from a psychiatric consultant who visited during the day and agreed this resident required additional support. A hospital admission was arranged later in the day. Discussions with staff, residents and visitors suggested that there are frequently insufficient staff on duty as sickness and other absences are not always covered. Staff confirmed that the home had been without a cook for some time and care staff, the driver and staff from other homes in the organisation have covered this post. On the day of inspection the senior carer on duty was working as cook in the kitchen with the assistance of the driver who also works in the kitchen. The manager was working on the floor and administering medications which she felt was necessary due to the heavy workload. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 28 Duty rotas listed staff in first names making it difficult to clearly identify staff, this also prevents there being a clear audit trail. Since the last inspection, the manager has taken action to ensure the duty rotas show the member of staff allocated to work in the bungalows which is a condition of registration. It appeared from the duty rotas that the manager had been working several shifts on the floor as opposed to working in a supernumerary capacity as required. This suggests staffing in the home cannot be effectively maintained resulting in the manager having to cover shifts. It was evident from talking with staff that there was some discontentment amongst them associated with a heavy workload expected of them as well as trying to manage the highly dependent residents effectively in the home. Staff said that due to the high sickness and absence levels they have to look at the duty rotas daily as changes are made to their shifts at short notice. They added that this made making plans at home difficult and contributed to their feelings of discontentment. It was established that some staff feel there is no teamwork and poor communication between staff and shifts. It was observed during the inspection that some of the carers seemed to be busier than others and the manager was constantly busy throughout the day dealing with matters linked to residents which meant she had little time to attend to any management tasks. Three night staff were on duty at the beginning of the inspection and time was spent talking to them about their role and the home. They said that they had got eight residents up that morning. Their shift was 20.00hrs to 08.00hrs and the day staff worked 08.00hrs to 20.00hrs. Day staff looked tired and weary and some admitted that they were. It was evident that staff were feeling the impact of the long shift patterns and constant demands made on them by the large number of people with dementia or confusion, several of whom displayed episodes of aggressive behaviour. This may also account for the discontentment amongst staff, which could impact, on the wellbeing of residents’ as well as the standard of the service given. One recently appointed senior care assistant was under 21 years of age and therefore should not be left in charge of the home. She said that she had offered her resignation of this senior post that day because she felt too young for the responsibilities she had to undertake. Duty rotas showed that there were only two senior care staff to support the management of the home and provide cover where necessary. This would not allow for effective management of the home particularly during times of annual leave, rest days and sickness. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 29 Duty rotas showed there were three domestic assistants to clean the home and do the laundry 6 days a week. No person was indicated to complete the cleaning or laundry on a Sunday. The duty rotas did not show the hours the driver worked in the kitchen and the time spent driving so that it was clear what support there is available in the kitchen each day. Duty rotas also showed a carer on the caring rota as well as being a cook on the ancillary rota so it was not clear which duties this person was doing and when. The manager advised that there were 25 carers and of these nine had completed a National Vocational Qualification in Care and eight other staff had almost completed it to help them provide more effective care to the residents. The manager said that recent training had included moving and handling, basic food hygiene, use of the hoist and Control of Substances Hazardous to Health (COSHH). A member of staff spoken to confirmed they had completed all of the statutory training required within the last 12 months. The manager advised that she was in the process of updating the training information for staff and agreed to forward this to the inspector to confirm training completed and outstanding. At the time this report was written, this information had not been received to evidence that all staff are appropriately trained to carry out their work effectively and safely. Staff files were reviewed; one contained all the required information. A second file reviewed showed that only one written reference had been received and the Protection of Vulnerable Adult (POVA) check and criminal record bureau check had not been completed prior to the employment of the member of staff as required. New staff complete a period of induction training which the manager confirmed usually takes place over a period of two to three days. Although the induction training is linked to the National Training Organisation standards it was evident that staff are not receiving the comprehensive training required over a sixweek period, which enables them to develop their competence. Records kept should demonstrate staff competence for each section of the training completed. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 30 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, 33, 35, 38 Quality in this outcome area is poor. Service users live in a home, which is run by a manager who is qualified and registered ‘fit’ to be in charge. Systems are in place to monitor the quality of care and services but it is not evident actions have been fully implemented to ensure these can be provided safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has worked in the home since August 2003 and has attained a HND in Care and Practice Management and the Registered Managers Award qualifications. In addition to these qualifications the manager has continued to update her knowledge and skills by attending other training including dementia and the safe handling of medicines. The manager said that it was her intention to complete a degree in Dementia Care over a 2 year period. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 31 The registered manager was very busy throughout the day, and had little time to carry out any managerial duties. The inspection process identified that there remains numerous issues requiring attention in the home to ensure the health and wellbeing of residents can be maintained. It was evident that the manager had attempted to address some matters from the last inspection but had found it difficult to find sufficient time to address other matters due to the demands and needs of the home. Due to minimal senior or administrative support the manager spent most of the day organising medical and social work attention for a resident whose behaviour was creating a distressing time for staff and other residents. A visitor spoken with said that the registered manager was not always available to talk to about her relative as she works evenings as well as days. There are clear lines of accountability between the manager and the directors and senior managers of the organisation but what autonomy the manager has was not clear, for example in increasing staff to meet the needs of service users or of making ad hoc purchases when the urgent need arose as in the need for new cups and a temperature probe for the food. Since the last inspection the manager has introduced a quality assurance system and had circulated questionnaires to residents or their advocates to assess their views on care and services provided by the home. Forty-three questionnaires had been sent out and 23 received back. Most of the responses received were positive, some of the comments made included, bedroom doors being too heavy to open, door knockers needing to be removed, laundry and missing clothing needing to be found quicker, communication books needing to be written in more often to keep relatives upto-date with what is happening. The manager acknowledged that actions needed to be taken to address the issues raised. The manager had also compiled a performance monitoring report in relation to care standards in the home. This had been completed in September 2006. Although actions had been listed in regards to some areas it was not clear that sufficient actions had been identified consistently. For example the manager identified there were 25 falls in the home within the 3 months preceding the report. Actions listed stated “to continue to audit”, there were no actions listed to explore the reasons for these falls or if any actions could be taken to try and prevent them. The manager advised that resident’s finances continue to be managed by their families; advocacy services are approached as required for those residents who do not have someone to manage their money. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 32 The manager advised that she has made progress with undertaking formal staff supervision with the care staff, having had one session with most members of staff since the last inspection. She said that she plans to carry out these sessions every two months. There were several concerns that would affect the health and welfare of the people living and working at the home, some of which have already been mentioned, such as bedroom doors being wedged open creating a potential risk in the event of a fire; issues relating to infection control in the kitchen, laundry and in the use of protective clothing. Staff advised that the home has a ‘no-lifting’ policy. One resident was observed to be using a mattress placed on the floor to sleep to minimise any impact from falling out of bed. During the inspection this resident was found on the floor and the moving and handling of this resident was observed when staff assisted the resident off the floor and back on to the mattress. A hoist was used for this purpose, which caused distress to the resident and was a difficult manoeuvre for staff. Following this, staff lifted the resident and used the bed sheet she had been placed on to slide her up the mattress. To reduce the anxiety of the resident the manager should carry out a risk assessment and consider whether an alternative method of moving and handling could be used such as a slide sheet instead of a hoist. Accidents and incidents had been recorded in a book kept in the home but these had not been reported to the Commission as required. The manager was advised that action must be taken to ensure accidents and incidents are reported so that it can be confirmed appropriate actions are being taken to safeguard residents. The manager was requested to forward details of resident accidents/incidents that had occurred since April 2006. At the time of writing this report, this information had not been received. The temperature of hot water accessed by residents is controlled by the use of thermostatic mixing valves so that the water does not get too hot and scald residents. Temperatures are monitored each month and records had been kept, these showed the range of temperatures to be from 39.9°C and 42.2°C. The recommended guideline for hot water is around 43°C and the taps operating at the lower temperatures could be considered too cool for washing and shaving. There is only one hoist in the home and according to staff several residents need the use of a hoist for transfers. Records showed the hoist was serviced in May 2006 and was due to be serviced again in October 2006. There was no documentation to confirm this service but the manager advised this had been carried out on 7th December 2006. The assisted bath had also been serviced on this date. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 33 Legionella testing records showed that this was usually carried out monthly but had not been done since October 2006. Records showed that Gas safety maintenance had not been carried out by a registered Corgi contractor since July 2005 to ensure gas appliances in the home were safe. Electrical portable appliance testing had been carried out on 11th August 2006. Records confirmed that fire alarm checks were being carried out weekly and emergency lighting monthly. The most recent fire drill had taken place in June 2006. The fire risk assessment in place was brief but the registered manager advised that this had been seen by the Fire Officer who had deemed it acceptable. At the last inspection it was identified that staff struggled to get in and out of the dining room with the medication trolley due to the heavy doors. During this inspection it was noted that the doors were wedged open all day, which does not meet with fire precautions. One door contained a notice requesting staff to leave the door open because the resident in the room could not open the door independently. Actions had not been taken to provide this resident with a suitable door retainer to ensure the door could be held open safely and in line with fire precautions. On arrival to the home inspectors were able to access the building without calling upon a member of staff. It was advised during the last inspection that open entry to the home be reviewed during certain times to ensure the security of the home and safety of the residents could be maintained. On this occasion staff noted the inspectors entering the home and asked for identification. The kitchen was inspected and found to be in some disorder. Bread, butter and ham had been left out and uncovered on the worktop and there was food debris on worktops and in the sink. Open shelving storing paper napkins and tray cloths were very untidy, two packets of dried food produce were opened as opposed to being stored in sealed containers to keep them fresh and pest proof. A care assistant was washing the afternoon cups and beakers as opposed to being available on the floor to care for the residents. The cleaning rota for the kitchen was dated 4.12.06 and had not been completed from this date to show that the kitchen was being cleaned on a daily basis. The freezer and fridges held a good variety of food and whilst all opened food in the fridges was dated this was not the case with food in the freezers. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 34 Records of fridge and freezer temperatures had been kept and were within accepted levels but records had only been completed up to 27.11.06. Records dated from 4.12.06 were blank although thermometers were on view and therefore any change in temperature could have been noticed promptly. Food temperatures had not been taken since 12.11.06. Records from this date stated “awaiting probe” and staff confirmed that the food probe had not been available for some time. It was evident that the home had not been carrying out appropriate food temperature testing to ensure this was safe to receive into the home and for residents to eat. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 35 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 2 X 2 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X 3 X X X 2 2 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 2 1 Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 36 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. N o. 1. Standard OP1 Regulation 5 Requirement The registered person must ensure that all of the required information is available in the Service User Guide. The registered person must ensure assessment documentation is clearly dated and identifiable to demonstrate the residents needs have been identified and can be met. (Outstanding from May 2006) The registered person must ensure that care plans and risk assessments are regularly reviewed and updated to reflect each resident’s current needs and situation. Care plans must be developed for each identified need including confusion; leg ulcers etc to ensure staff meet these needs. The oral care needs of residents must be addressed effectively. Timescale for action 31/03/07 2. OP3 14 31/01/07 3. OP7 15 31/01/07 Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 37 Care plan records must contain sufficient information to confirm the care needs identified are being met (e.g. the completion of daily records linked to care needs). (Above outstanding from May 2006) The registered person must ensure that issues relating to care as identified in the body of this report are addressed promptly. The registered person must be able to demonstrate that the nutrition of residents is being monitored and maintained effectively to secure the health and wellbeing of residents. A record of any pressure sores must be kept with sufficient details of locations, treatment, monitoring and preventative measures implemented. The registered person must ensure that clear policies and procedures in place with regard to the management of medication. This includes the adoption of safe procedures for the administration of insulin. A review of medication management must be undertaken to address matters as detailed in the body of this report. The registered person must ensure that the privacy and dignity of residents is respected. (Outstanding from May 2006) Issues as detailed in the body of this report are to be addressed. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 38 4. OP8 12,13 31/01/07 5. OP9 13(2) 31/01/07 6. OP10 12 (4) 31/01/07 7. OP12 12 The registered person must ensure there is evidence the home consult with service users regarding social activities so that these can be included in the programme of social activities provided in the home as appropriate. Having regard to the needs of service users, the registered person must be able to demonstrate that the social needs of all residents regardless of their capacities has been considered and met. The registered person must ensure that residents are given choices (as far as possible) in regard to how they are cared for and how services are delivered. This includes taking sufficient actions to respect resident choices to keep their bedroom doors open and unlocked safely. (Outstanding from May 2006). The registered person must ensure there are sufficient drinks provided to residents at times reasonably required by them. Drinks must be provided in suitable cups to maintain resident safety. The complaints procedure must be clear in terms of contact information and the investigation process. Records must demonstrate timescales and outcomes consistently. (Outstanding from May 2006) 31/03/07 8. OP14 12 28/02/07 9. OP15 16,12 31/01/07 10. OP16 22 31/03/07 Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 39 11. OP18 13 (6) The registered person is to ensure staff are sufficiently trained in the prevention and identification of abuse. (Outstanding from May 2006) The registered person must ensure that the environmental issues raised throughout this report are dealt with and that proper systems are in place to monitor the environment and make changes where required. 31/03/07 12. OP19 13, 23 31/03/07 13. OP25 23 14. OP26 23(2)13 (3)16(2) This includes a review of door closures to ensure residents (where appropriate) can open their doors independently and safely. (Outstanding from May 2006) The registered person is to 28/02/07 review lighting in the home to ensure this is sufficiently bright in service user areas. The registered person must 31/01/07 ensure that all areas of the home remain clean consistently and are free from unpleasant odours. The registered person must ensure that issues related to the management of infection control in this report are addressed. The registered person must review the staffing arrangements in the home to ensure there are sufficient staff available at all times to meet the needs of the residents. Duty rotas must accurately reflect details of staff who carry out ancillary duties. (Outstanding from May 2006) 15. OP27 18 31/03/07 16. OP28 18 The registered person must DS0000043254.V322845.R01.S.doc 31/03/07 Version 5.2 Page 40 Meadow View Care Centre 17. OP29 19 demonstrate that there are sufficient numbers of suitably trained care staff for the health and welfare of the residents. The registered person is to undertake a review of staff files to ensure all of the required information is available. Staff must not commence duties until a Protection of Vulnerable Adult (POVA) check or Criminal Record Check has been received. (Outstanding from May 2006) The registered person must ensure that staff complete suitable induction training to ensure they are sufficiently competent to meet the care needs of residents. The registered provider must ensure that the manager of home is able to fully discharge her duties. This includes taking sufficient actions to ensure compliance with the care home regulations. The registered person must be able to demonstrate regular quality reviews are being carried out to address ongoing issues relating to care and services provided. Records must demonstrate that sufficient actions have been taken in response to issues raised following quality monitoring carried out. The registered person must ensure that accidents are incidents are reported to the Commission as required. 31/03/07 18. OP30 18 31/03/07 19. OP31 10, 12 31/03/07 20. OP33 24(1) 31/03/07 21. OP37 37 31/01/07 Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 41 22. OP38 12,13 The registered person is to review health and safety matters as detailed in the body of this report and take sufficient actions to safeguard residents. 31/01/07 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 manager should produce an assessment and careplanning format that considers all of the needs of a person with dementia and whether the home can meet their needs. Meadow View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 42 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 View Care Centre DS0000043254.V322845.R01.S.doc Version 5.2 Page 43 - 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!