Inspection on 20/06/05 for Meadow View Care Centre

This inspection was carried out on 20th June 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 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 14/12/06

Meadow View Care Centre 02/12/05

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 Jo Johnson Unannounced 20 June 2005 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. Meadow View Care Centre E53 S43254 Meadow View Care Centre V233828 200605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Meadow View Care Centre Address Wharrage Road Alcester Warwickshire B49 6QY 01789 766739 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) Prime Life Limited Mrs Melaine Oliver PC Care home only 34 Category(ies) of DE(E) Dementia (17) registration, with number OP Old Age (17) of places Meadow View Care Centre E53 S43254 Meadow View Care Centre V233828 200605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Allocation of Care Staff Care staff allocated to either the Dementia or Older Persons areas of the care home must not at any time during the same shift carry out duties in any other area of the care centre such as Day Care or Close Care cottages. 2. Day Care Centre Service users accomodated at Meadow View Care Centre who wish to attend the Day Care Centre known as Poppies for social reasons can be accompained by a member of care staff from the homes complement at that time. Date of last inspection 9 March 2005 Brief Description of the Service: Meadow View is a purpose built care home, situated in the town of Alcester. The entrance to the home is from Wharrage road, just a few metres from the local hospital. Meadow View care home can accommodate up to 17 service users over the age of 65years with dementia and up to 17 service users who are in the older persons 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 Day Care centre called “Poppies”. This day centre is currently being redevoped to provide additional bedrooms. All clients are offered single bedroom accommodation with en-suite facilities. 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 smaller sitting rooms off the main room. The gardens are landscaped and very attractive. There is a path suitable for wheelchair users leading around the gardens to the day care centre. The care home is registered to provide personal care services only. Meadow View Care Centre E53 S43254 Meadow View Care Centre V233828 200605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took eight hours over two days and was unannounced. This was the first visit of the inspection year. There were thirty-two residents at the home during the inspection. A majority of the inspection was spent talking with and observing the people who live at the home. Care records were inspected. The inspection also involved the Senior Carer, as the manager was on holiday. Four staff, and seven of the thirty-two residents were spoken to. What the service does well: What has improved since the last inspection? What they could do better: There are a number of areas that need to be improved on to ensure that the residents get the care that they need. Care plans and areas of risk need to be reviewed and updated so that the staff are able to know what to do for each resident. The safety of footstools propping open bedroom doors needs to be addressed. Staff should seek more information about good practice in dementia care. Meadow View Care Centre E53 S43254 Meadow View Care Centre V233828 200605 Stage 4.doc Version 1.30 Page 6 People with dementia should be given visual choices of food and drinks. Staff should ensure that they have things for them to do and are kept occupied. The most serious concern from this inspection is that for the third inspection running there have been issues with the practices of the administration of medication. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Meadow View Care Centre E53 S43254 Meadow View Care Centre V233828 200605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Meadow View Care Centre E53 S43254 Meadow View Care Centre V233828 200605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4 and 5 The assessments completed by the placing care managers and the manager at the home, prior to residents moving in, ensure that residents’ personal, health and social care needs can be met by the staff working at the home. The dementia care skills and knowledge of the staff group are not sufficient to satisfactorily meet the needs of the residents with dementia who live at the home. The skills and knowledge base of the staff group ensure that the needs of the older people without complex dementias are met. Residents and or their families have the opportunity to visit the home in order to decide the suitability, quality and facilities of the home. EVIDENCE: Assessments completed by staff at the home were seen in all six residents’ care records and examined. Care management assessments were seen in all the care records seen. Some residents with dementia were unsettled and anxious in certain situations during the inspection. Staff managed the situations sensitively. Meadow View Care Centre E53 S43254 Meadow View Care Centre V233828 200605 Stage 4.doc Version 1.30 Page 9 However, they had little understanding of how to problem solve, be creative, keep people occupied and be person centred in the ways in which they work with individuals who have dementia. Further accredited training in dementia care must be provided. Staff should have access to information about good practices in dementia care. The senior carer and staff acted quickly on any recommendations offered during the inspection. Staff spoken with are very keen to increase their basic knowledge of working with people with dementia. They acknowledged that they would benefit from further dementia care training. Residents spoken to said that they had visited the home, spent time with the staff and had a tour of the home prior to making a decision to move in. Staff said that families also visit prior to residents moving in. Meadow View Care Centre E53 S43254 Meadow View Care Centre V233828 200605 Stage 4.doc Version 1.30 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) 7,9 and 10 Some important elements of care plans or risk assessments have not been completed, reviewed or updated to safely ensure that staff have the current information to meet the resident’s needs. The shortfalls in the recording of administration of medication potentially leave the residents at risk. Residents who wish to self-administer medication are supported to do so. Residents are mainly treated with dignity and respect and their right to privacy is upheld. EVIDENCE: Six residents care plans were seen. All of the care plans seen need reviewing and up dating to reflect residents current needs. In all of the care plans seen there were specific objectives that had been met but no further objectives or plans had been made. Elements of the care plans had not been completed or followed up, so it was difficult to establish whether residents had access to health care and other professionals. Meadow View Care Centre E53 S43254 Meadow View Care Centre V233828 200605 Stage 4.doc Version 1.30 Page 11 From observations and discussions with staff important changes to residents needs had not been identified and plans adapted to meet these changing needs. One resident is choosing to push a chair to assist with his mobility, rather than use a frame. From discussions with staff, and observing the resident, this is due to his dementia. This situation has not been risk assessed, and the fact that this is happening is not reflected in his care plan. He is at increased risk of falling and/ or injuring himself by using this method of support. It is acknowledged that he is not willing to use a frame to assist with his mobility. A resident who presents risk of harm to other residents does not have any management strategies in place nor has this been risk assessed. Staff managed a situation of behaviours that challenge very well and calmly. However, it would be better for the individual and other residents if a clear management strategy is in place and the resident is not placed in situations that may cause distress, confusion or distress. Medication errors or practices have been the subject of requirements at the previous two inspections. On the first day of the inspection ‘Oramorph’ was not been treated as a controlled drug. The Senior Carer amended this immediately. However, controlled drugs were being recorded and countersigned on loose-leaf records. All controlled drugs records must be kept in a bound book or register with numbered pages. There were a number of gaps in the administration of medication records. So there is not accurate record of whether residents have been administered the correct medication. Staff must sign the medication administration records to demonstrate whether medication has been refused, administered or the resident was absent. One resident self-administers her medication. The current practice is that staff dispense the weeks medication into an easy to use dispenser for the resident. Arrangements that are place appear to be safe although they contradict the Royal Pharmaceutical guidelines. Following discussion with staff and the resident the arrangements are due to be changed to system from another pharmacist that does not involve staff double dispensing. Making a requirement to cease the practice would have a disabling effect on the resident, so a judgement has been made to allow this practice to continue until the arrangements are changed. Confirmation must be sent to The Commission when these arrangements are in place. Residents spoken with said that the staff respect their privacy and dignity. Staff gave personal care in private. Meadow View Care Centre E53 S43254 Meadow View Care Centre V233828 200605 Stage 4.doc Version 1.30 Page 12 Mainly staff assisted residents who needed assistance to eat and drink in a discreet and sensitive way. Staff did not routinely sit down next to the residents to assist them to eat and drink. One member of staff was observed to stand over a resident to feed them at lunchtime. Staff should sit down next the residents when assisting them to eat and drink to maintain their dignity and make the experience more relaxing. Residents said they can choose to spend time alone in their bedrooms and their privacy is respected. Meadow View Care Centre E53 S43254 Meadow View Care Centre V233828 200605 Stage 4.doc Version 1.30 Page 13 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) 15 Food and drink is varied plentiful and well presented. Practices in offering visual choices, how and where people eat and the types of food for people with dementia need further development. Residents with dementia may be nutritionally at risk if practices do not change and develop in line with current good practice. EVIDENCE: It was a very hot day on the first day of inspection. Staff offered residents lots of drinks and encouraged people to drink. However, there were not enough glasses to go round all of the residents. More glasses should be purchased so staff do not have to hunt for them when residents want a drink. There was no menu displayed on the first day of inspection and residents did not know what was for lunch. The menu was displayed on the second day of inspection. Residents are given a verbal choice at mealtimes. Residents who are able to make these choices said that they are happy with the arrangements. Residents with dementia were not given visual choices of food and drinks. People who have a dementia and particularly those in the later stages are not able to make choices based on verbal information. Visual or photographic choices of food and drinks should be given to people with dementia. Meadow View Care Centre E53 S43254 Meadow View Care Centre V233828 200605 Stage 4.doc Version 1.30 Page 14 A resident who found the dining room environment stressful and confusing became extremely upset and disruptive by the experience on both occasions observed during the inspection. Following recommendations, Staff assisted the resident to eat elsewhere in the home that evening and the following day. Staff said that the resident had a much more relaxed mealtime and had eaten better. Residents who find mealtimes in the dining room should be supported to eat in alternative areas. Meadow View Care Centre E53 S43254 Meadow View Care Centre V233828 200605 Stage 4.doc Version 1.30 Page 15 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) not assessed at this inspection EVIDENCE: Meadow View Care Centre E53 S43254 Meadow View Care Centre V233828 200605 Stage 4.doc Version 1.30 Page 16 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) 9 and 26 The home is clean, pleasant, and hygienic and residents live in a wellmaintained environment. The lack of specific risk assessments on the environment potentially places the residents at risk of harm. EVIDENCE: The home was purpose built and designed specifically for the needs of older people. The décor and furnishings are of a high standard.The home is spacious with a number of sitting areas for residents. There is a central garden and safe walking area with raised beds. Residents said that they enjoy spending time in the garden. Residents were in and out of the gardens throughout the inspection. A number of residents like to have their bedroom doors open during the day. These bedroom doors are propped open with footstools as the doors automatically swing shut and lock. Residents are at an increased risk of falling having to negotiate and push the footstools out of the way. Risk assessments must be completed for the use of footstools and other means of propping open doors. The home was clean, well maintained and free from offensive odours during the inspection. Meadow View Care Centre E53 S43254 Meadow View Care Centre V233828 200605 Stage 4.doc Version 1.30 Page 17 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) 27 The number and skill mix of the staff is sufficient to meet the needs of the residents. Staff appear committed and have personal qualities that are important to the residents. Staff do not currently have skills base needed to meet all of the dementia care needs of the residents. EVIDENCE: Since the last inspection the night staff on duty has increased to three staff on duty from 8pm to 8am. During the inspection there were six staff on duty from 8am to 8pm plus the senior care assistant. Staff were also supporting two service users who live in the adjoining bungalows. Discussions with staff and observation showed that they are a reasonably established team that are sensitive to individuals needs and are in sufficient numbers to meet the needs of residents. As previously stated staff would benefit from additional dementia care training to better enable them to meet the complex needs of people with dementia. All of the residents spoke very highly of the staff at the home, they said that they are ‘all very kind’, ‘help you’ and ‘are wonderful’. There were very positive relationships, touch and interactions between residents with dementia and staff. Meadow View Care Centre E53 S43254 Meadow View Care Centre V233828 200605 Stage 4.doc Version 1.30 Page 18 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 health, safety and welfare of the residents and staff are promoted and protected. EVIDENCE: All electrical, water and heating systems have been serviced. Specialist bathing and hoisting equipment has also been serviced. There are good systems in place for the regular maintenance and testing of equipment etc in the home. Fire records and test were up to date. Meadow View Care Centre E53 S43254 Meadow View Care Centre V233828 200605 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x 3 Meadow View Care Centre E53 S43254 Meadow View Care Centre V233828 200605 Stage 4.doc Version 1.30 Page 20 yes 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 4 and 27 Regulation 18 Requirement All care staff must be provided with the minimum of one days accredited dementia care training. The training must provide staff with information and skills on person centred practices, problem solving, communication and keeping people occupied. Care Plans must be reviewed and updated to reflect each residents current needs and situation. Include a current photograph of each resident in their care plan Risk assess the use of an alternative walking aids by a resident. Risk assess the potential harm to others and put in place management strategies for one individual. Accurate records of the administration of medication must be kept. Records must show whether medication has been administered/not administered, refused or the resident was absent. Confirmation that the practice of double dispensing medication has ceased must be sent to the E53 S43254 Meadow View Care Centre V233828 200605 Stage 4.doc Timescale for action 1st February 2006 2. 7 15 1st September 2005 1st August 2005 3. 7 13 4. 9 13 19th July 2005 Meadow View Care Centre Version 1.30 Page 21 Commission. 5. 6. 9 19 13 13 Controlled drugs records must be kept in a bound book or register with numbered pages. Risk assessments must be completed for the use of footstools and other means of propping open doors. 19th July 2005 1st September 2005 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 4 Good Practice Recommendations Staff should use the information in residents life histories to provide things for people to do and to keep residents occupied. Staff should have access to information about good practices in dementia care. Staff should sit down next the residents when assisting them to eat and drink to maintain their dignity and make the experience more relaxing. More glasses should be purchased so staff do not have to hunt for them when residents want a drink. Visual or photographic choices of food and drinks should be given to people with dementia. The nemu board should be completed on a daily basis. Residents who find mealtimes in the dining room should be supported to eat in alternative areas. Alternative means of propping open bedroom doors should be investigated for those bedrooms where residents are using footstools to prop open their doors. 2. 3. 4. 5. 6. 10 15 15 15 19 Meadow View Care Centre E53 S43254 Meadow View Care Centre V233828 200605 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Meadow View Care Centre E53 S43254 Meadow View Care Centre V233828 200605 Stage 4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!