Inspection on 20/06/07 for Meadow View Care Centre

This inspection was carried out on 20th June 2007.

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

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

Other inspections for this house

Meadow View Care Centre 13/05/08

Meadow View Care Centre 14/12/06

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 Michelle O`Brien Key Unannounced Inspection 09:40 20th June and 14th July 2007 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.V343343.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.V343343.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.V343343.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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. 14th December 2006 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 £331.44 to £387.10 per week. Meadow View Care Centre DS0000043254.V343343.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection visit which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents. This report uses information and evidence gathered during the key inspection process which involves a visit to the home and looking at a range of information. This includes the service history for the home and inspection activity, notifications made by the home, information shared from other agencies and the general public and a number of case files. Two inspectors visited the home on 20th June 2007 between 9.40am and 6.40pm. A further visit was made by one inspector on 14th July 2007 between 2.10pm and 4.10pm to assess the home’s management of medicines. 39 people were living in the home on the day of the first visit. It was the assessment of the home manager that the majority of people living in the home had low or medium dependency care needs. Inspectors had the opportunity to meet several residents by visiting them in their rooms, spending time in the communal lounges and talking to them about their experience of the home. Inspectors were present during residents’ midday meal. Inspectors observed working practices and staff interaction with the people living in the home. The inspectors also spoke to several staff. Documentation maintained in the home was examined including staff files and training records, policies and procedures and records maintaining safe working practices. A tour of the building and several bedrooms was made. The home manager, deputy manager and the organisation’s Director of Elderly Services were present throughout the day of the first visit and inspectors spent time with them giving feedback about their findings. The care of four people living in the home was identified for close examination by reading their care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ where evidence of the care provided is matched to outcomes for the people using the service. A pre-inspection questionnaire was completed by the manager and returned to us on 30th April 2007. Seven survey forms were returned by relatives of people living in the home and their comments are reflected in this report. Meadow View Care Centre DS0000043254.V343343.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Arrangements must be made to ensure prospective residents have a full assessment of their needs and abilities recorded before they move into the home. This is to make sure that prospective residents can be confident that the home can meet their needs. Systems must be in place to identify any risk to the health or well being of people living in the home and must include details of how any identified risk can be reduced. This must include the risk of weight loss and poor nutrition. Meadow View Care Centre DS0000043254.V343343.R01.S.doc Version 5.2 Page 7 This is to make sure that risks to the health or well being of residents are identified and reduced. Systems must be in place to identify any risk to the health or well being of people living in the home and must include details of how any identified risk can be reduced. This must include the risk of weight loss and poor nutrition. This is to make sure that risks to the health or well being of residents are identified and reduced. Arrangements must be made for all staff to have training in recognising and responding to abuse. This is to ensure that people living in the home are safeguarded form the risk of abuse. Accurate records of the staff duty rota must be kept showing which staff are on duty at any time during the day and night and in what capacity. Records must show the actual hours worked by each staff member in the care home. Staff hours undertaken in Meadow View Bungalows Domiciliary Care service must not be reflected as staff hours in the care home. This is to make sure we can establish the actual staff hours available for meeting the needs of residents in the care home. Arrangements must be made for all staff to have up to date mandatory training in Fire Safety and Manual Handling. This is to ensure that people in the home are protected from the risk of harm. Arrangements must be made to check the safety the Gas Appliances in the home. A current Gas Safety certificate confirming safety must be available for inspection in the home. This is to promote the safety of people in the home. Systems must be in place to ensure that all parts of the home to which residents have access are so far as reasonably practicable free from hazards to their safety. Unnecessary risks to the health and safety of residents must be identified and as far as possible eliminated. This is to make sure that people living in the home are protected from harm. 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.V343343.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Meadow View Care Centre DS0000043254.V343343.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3 were assessed. Quality in this outcome area is adequate. People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Service User’s Guide contains information about the service people can expect to receive when they move in to the home and copies were available in the home. Some minor updates are necessary, for example, the recent change of address and telephone of the Commission for Social Care Inspection office. The case files of four people identified for case tracking were examined to assess the pre-admission assessment process. Meadow View Care Centre DS0000043254.V343343.R01.S.doc Version 5.2 Page 10 One person’s file did not contain any evidence of a pre admission assessment completed by staff from the home but did contain a copy of a social services assessment. One person’s file contained an assessment from a previous admission to the home. This assessment was not reviewed before the person was readmitted. This means the home cannot be sure whether the person’s needs have changed and cannot be sure that they can meet the person’s needs. Each of the remaining files examined contained information about all of the person’s needs and abilities which had been gathered before their admission. This enables the home to confirm they can meet the needs of these individuals. There was evidence in one file that the home writes to residents or their representatives offering placement and confirming the home can meet their needs. The home offers opportunities for prospective residents and their families to visit before making the decision to move in. Comments from relatives about the Choice of Home include: • ‘My relative moved into Meadow View right at the start when it opened so was able to go to the open day.’ • ‘My father and I visited the home before my mother’s placement.’ • ‘Another relative had been a resident until she had to go to a nursing home so I knew this was the place I wanted my husband to reside.’ • ‘We were shown around and made to feel welcome. Nothing was too much trouble.’ • ‘We visited before Mum moved in and were made very welcome and at ease.’ Meadow View Care Centre DS0000043254.V343343.R01.S.doc Version 5.2 Page 11 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): Standards 7, 8, 9 and 10 were assessed. Quality in this outcome area is adequate. People living in the home are treated respectfully and are protected from harm by the safe management of medicines. However, care plans do not consistently describe the actions necessary to meet the identified needs of people living in the home which puts them at risk of not having their needs met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Observations during the key inspection visit found that most people living in the home looked well cared for and were clean, their hair had been combed and nails were trimmed and clean. They were well presented and wore clothes that were suited to the time of year. One female resident identified for case tracking looked unkempt despite her care plan recording that she enjoyed being well groomed having a smart appearance and wearing jewellery. Meadow View Care Centre DS0000043254.V343343.R01.S.doc Version 5.2 Page 12 One relative commented, ‘The care and support is excellent.’ Each person had a care plan, daily records and monitoring records. Care plans were generally based on information secured during the initial care needs assessment. Care plans varied in the quality of information they contained to give staff direction on what they need to do to meet each identified need. Evidence of good practice seen included: • The service uses risk assessments for falls, nutrition and pressure sores and care plans are generally developed to minimise risks identified. The care plans for one person had been reviewed and updated following a sudden deterioration in their condition resulting in a change of needs. Evidence was available in case files that the care planned for people living in the home is discussed and reviewed with their relatives or representatives so they are aware of and can agree the care the service gives to their loved one. Relatives made positive comments about the way the home keeps them informed of their loved one’s wellbeing saying, ‘If there are any problems with Mum there is always someone around to talk to or ask for guidance.’ and ‘We are always kept informed.’ • • Evidence of shortfalls included: • Records for one person document a persistent weight loss over several months. This was reflected in a review of the person’s nutritional risk assessment which was assessed as ‘very high risk’. There was no care plan developed to address the increased risk and give staff direction of the action they needed to take. This leaves the individual at continued risk of weight loss. One person admitted to the home in April 2007 did not have their weight recorded. The person had refused to be weighed on their admission but staff had not returned and asked again at a later time. This means the home is unable to monitor the person’s weight which is important in monitoring their general well being. One person was observed to have very sticky eyes. Examination of their records showed that they had been seen by the GP in May 2007 and was prescribed eye cream. There was no care plan available to give staff directions about eye care including how to clean the eyes. There was no evidence of a further referral to the GP although the person’s eye’s continue to have a sticky discharge one month later. DS0000043254.V343343.R01.S.doc Version 5.2 Page 13 • • Meadow View Care Centre The care plans, daily records and other documentation held showed that people have access to other health professionals such as GPs, community nurses, hospital outpatient appointments and community psychiatric nurses. The home’s systems for the management of medication was assessed on 14th July and has improved to a good standard since the last inspection with some minor shortfalls to address. Medicines are administered by staff who have undertaken training specifically for the task. Three senior staff administer medicines on day duty. There is currently no-one on night duty who is trained to administer medicines but the inspector was told that two senior members of night staff have recently been nominated for training. All regular medication is administered by staff on the early or late shift but ‘as required’ medicines, such as painkillers, may be required by residents overnight. A monitored dosage (‘blister packed’) system is used. Medication is safely stored in locked trolleys in a locked room and records of the room temperature are maintained to show that medicines are stored within recommended temperature limits. A medicines fridge is available with daily recordings of the temperature which is within recommended limits. The home is not currently storing any controlled drugs (CD) for residents. The CD storage cupboard is secure and complies with legislation. The controlled drug register was accurately maintained but staff should remember to record the balance of a controlled drug to zero (0) when the existing stock of a controlled drug is collected and signed for by the pharmacist. Most residents have a completed medication profile recording the name and action of each medicine prescribed for the person along with their specific needs for taking their medicine. There was evidence that the manager undertakes monthly medicine audits and action is taken for any anomaly. For example, where a staff member has not signed a medicine administration sheet (MAR) accurately this identifies a training need and counselling is given with the potential for disciplinary action. Prescriptions are ordered for the medication required each month and are returned to the home to check for discrepancies before they are sent to the pharmacy for dispensing. The medicines of three residents identified for ‘case tracking’ were examined. The inspector undertook audits comparing the number of tablets recorded as received into the home, the number of tablets signed as administered and the number of tablets remaining in stock:- Meadow View Care Centre DS0000043254.V343343.R01.S.doc Version 5.2 Page 14 • • • • • Medicines in the MDS containers (‘blister packs’) were found to be administered accurately. A course of trimethoprim tablets were found to be administered correctly Paracetamol tablets prescribed ‘as necessary’ were found to be administered correctly. The amount of senna liquid remaining for one resident did not accurately reflect the audit indicating that doses were signed for but not given 500mls of lactulose is prescribed for one person each month. The dosage prescribed is 15mls twice a day which amounts to a total of 840mls in 28 days. The doses of lactulose are signed for but it is evident that the amount required is not available throughout the month indicating that doses are signed for but not given. Findings indicate that tablets are administered accurately but liquid medicines are not always administered accurately. The majority of MAR sheets are printed by the pharmacy, but some interim medicines necessitate staff to hand write the instructions for administration. Hand written MAR sheets did not accurately reflect the instructions on the label of some medicines For example, one instruction for ‘one tablet to be taken twice a day’ was recorded as ‘one to be taken 2 a day’. Hand transcribed instructions on MAR sheets must accurately reflect the medicine label to avoid confusion and potential administration errors. The home does not store excess medication. Arrangements are in place with the pharmacy to safely collect and dispose of medicines that are no longer required. Accurate records are kept of medicines returned to the pharmacy. Arrangements are in place for some residents to self medicate. None of the residents self medicate all of their prescribed medicines, only inhalers and indigestion remedies. Evidence was available of risk assessments for individuals wishing to self medicate and records of compliance checks to ensure residents took medication safely. The home’s systems for residents to self medicate support the independence and safety of people living in the home. One person is prescribed insulin injections to manage their diabetes. The deputy manager told the inspector that nominated care staff had been trained to administer insulin by the district nurse. People living in the home were observed to be treated with respect and their dignity maintained; for example, personal care was provided in private and residents were spoken to respectfully. During observation of working practice it was evident that staff are knowledgeable about the likes and dislikes of people living in the home and were kind, caring and attentive towards them. Meadow View Care Centre DS0000043254.V343343.R01.S.doc Version 5.2 Page 15 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): Standards 12, 13, 14 and 15 were assessed. Quality in this outcome area is good. People living in the home are supported to maintain their independence and enduring interests which enhances their quality of life. Residents benefit from a varied and nutritious diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each of the residents’ files examined contained a ‘Getting to know you’ section which was completed with the person’s life history, their enduring interests and relationships. This should assist staff to deliver ‘person centred’ care. Staff spoken to were familiar with the preferences of residents and the type of activities that might engage and stimulate each individual. A record of group and individual activities is maintained in the home. The home provides a programme of activities with at least one planned group activity each day. On the inspectors’ arrival several residents were gathering in the reception area and looking forward to the outing arranged by the home for that day. A craft session took place in the afternoon. Other activities include bulb planting, reminiscence and manicure. Meadow View Care Centre DS0000043254.V343343.R01.S.doc Version 5.2 Page 16 Some residents enjoy undertaking domestic tasks as it gives them a sense of purpose. One lady helped set the tables for lunch. Car Washing and Baking are included in the home’s activity programme. The inspector observed two ladies enjoying cuddling their doll or soft toy, they appeared quite happy and contented with the task of ‘looking after baby’! Comments from relatives about the lifestyle experienced by people living in the home include: • ‘With physical and mental problems not all of the activities the home arrange are suitable for my relative.’ • ‘The activities for residents are excellent and the photos taken during these times are great. I really enjoy looking at them.’ • ‘Mum thoroughly enjoys the outings.’ The home has an open visiting policy. People are encouraged to maintain links with their family, friends and local community; trips to the local shops are offered and a church minister holds a Holy Communion service in the home each month Residents spoken to said their visitors were always made welcome. Inspectors spent time observing practice during the midday meal service. Meals arrive from the kitchen in a heated trolley so that meals are still hot when they are served. Residents were offered a choice from shepherds pie or chicken accompanied by broccoli, carrots, new potatoes and gravy. Dessert was a choice of apple pie and cream, ice cream or yoghurt. Staff offered each resident a choice of meal at the table; those people who found it difficult to choose were assisted by staff who brought the meal to them as a visual prompt. Residents made positive comments about the food they were offered in the home and told the inspector that if any choice of the main meal was not their preference an alternative was offered. Staff offered assistance to those people who required it in a sensitive and discreet manner. When one resident refused both choices of meal, staff offered various alternatives until the person decided upon a snack of their choice. Comments from relatives about the quality of the food served to people living in the home include: • ‘My relative has never complained about any of the meals and she thinks that the food is excellent.’ • ‘The food is excellent and my father has many times eaten with my mother on his visits. This does not mean that patients like what they eat.’ Meadow View Care Centre DS0000043254.V343343.R01.S.doc Version 5.2 Page 17 • • • ‘The meals always look great when I see them. The kitchen is always clean and tidy and the staff are friendly and caring.’ ‘Excellent food; in fact, at times too much.’ ‘I can see when I am there that the food is top quality and is prepared and served to a high standard.’ A satisfactory Food Safety Hygiene report was issued by Stratford and Avon District Council in September 2006. Meadow View Care Centre DS0000043254.V343343.R01.S.doc Version 5.2 Page 18 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): Standards 16 and 18 were assessed. Quality in this outcome area is adequate. People living in the home can be confident that their concerns will be listened to and acted. Staff receive training so they can recognise and respond to abuse but risk are not always identified. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a formal complaints policy which is accessible to service users and their families. People are encouraged to raise their concerns with the manager. We have received no concerns or complaints regarding this service since the last key inspection. A record of complaints received by the home is maintained along with the action taken by the home regarding each issue raised. Evidence was available that the provider makes a timely and objective response to concerns raised. The service has recorded four complaints since the last key inspection: • a complaint about weeds in flower beds was resolved by having them removed by the gardener Meadow View Care Centre DS0000043254.V343343.R01.S.doc Version 5.2 Page 19 • • concerns about missing laundry and care practices around assistance with breakfast in bed were resolved by meeting with relatives and agreeing a solution. two complaints about the heating not working in two of the bedrooms were resolved the same day Comments from relatives about the way the home manages concerns or complaints include: • • • • ‘The staff are always available when I need to talk to them.’ ‘I have no problems contacting the right person (to raise concerns)’ ‘I have never been unhappy with any aspect of the home, but I’m sure if I were any of the staff would be pleased to assist me.’ ‘Staff always take on board your comments and help if they can; if not immediately then later.’ It is evident from the home’s records of events that senior staff in the home are familiar with Adult Safeguarding procedures to protect people living in the home from the risk of abuse. Staff receive training in recognising and responding to suspicion or allegations of abuse during their induction. Since the last Key Inspection there have been two referrals for investigation under Adult Protection Procedures, which have been led by Social Services with the co-operation of the service. Both referrals related to the risk of harm to residents because of the challenging behaviour other residents. The outcome of one investigation resulted in strategies implemented in the home to monitor and respond to challenging behaviour to reduce the risk to other residents. This has been successful. The outcome of the other investigation resulted in the home acknowledging they could no longer meet the needs of the person with challenging behaviour and an alternative placement was arranged. Management of the home demonstrated good practice in suspending two staff members following an allegation that they were in possession of an illegal drug in December 2006. The incident was referred to the police and both staff members were dismissed and referred to the PoVA register when the results of investigation upheld the allegation. Evidence was available in the case file of one resident identified for case tracking documenting a safeguarding referral before their admission to the home. The information indicated that the person could still be at risk but the home had not recognised the risk or implemented any safeguarding strategies. This means the person was potentially still at risk of harm from abuse. Meadow View Care Centre DS0000043254.V343343.R01.S.doc Version 5.2 Page 20 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): Standards 19, 25 and 26. Quality in this outcome area is adequate. Residents have clean, attractive, well furnished and comfortable surroundings to live in and enjoy but the lack of risk management strategies for some environmental hazards do not promote the safety of people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The large reception area in Meadow View is bright and welcoming, visitors can only access the building if a staff member opens the door to them. The building surrounds a central garden which is attractively landscaped with seating and a pond with water feature. The garden can be accessed through several doors into it. Meadow View Care Centre DS0000043254.V343343.R01.S.doc Version 5.2 Page 21 The differing designs of communal spaces in the home create a variety of atmospheres so people living in the home can choose to use an area that suits how they feel and where they feel most comfortable. There are two seating areas off the reception area and one of these recreates a cosy ‘sitting room’ area with a fireplace as a focal point and fibre optic lighting; the other features leather sofas and coffee tables and has a contemporary, ‘coffee shop’ feel to it. There is one large dining area which is bright and airy, but quite functional. Off the dining area is one space that is used as a craft area and has a small kitchenette in it. In another area there is a small lounge with a television, armchairs and contemporary sideboards. In a wide space where the corridors join is a small seating area with bistro type tables and chairs that has a ‘café’ feel to it. Finally, there is another good sized lounge and dining area with sofas, dining furniture and a kitchenette. This conservatory type room is quite homely. Residents were observed to ‘potter’ around the home and garden quite freely and the majority of spaces were used by people living there. People have the opportunity to socialise with other residents or to be on their own, as to their preference. Each resident is accommodated in single rooms with ensuite facilities. There is the facility to accommodate a married couple or partners. Each room has it’s own front door and a back door leading to a walkway that goes around the building. Some residents have chosen to have their doors locked. Inspectors asked one resident if they would mind showing us their room. The resident stated that a staff member needed to unlock it because their preference was to have it locked. However, the resident was distressed to find that their door had been left unlocked. Inspectors looked at some of the bedrooms of the people involved in case tracking. They were clean and well furnished. Some residents had taken the opportunity to personalise their room with their own belongings. Some residents are accommodated in ‘Poppies’, a separate building that can only be accessed through the central garden area. ‘Poppies’ has been converted from its previous use as a day centre and provides bedrooms, a small lounge, kitchen and bathroom. The inspectors met one respite resident in the lounge area of ‘Poppies who seemed quite isolated and ‘lost’, she was unsure of where she should go, asking inspectors ‘is it alright if I sit in here?’ A staff member accompanying the inspectors took her to the main building. Meadow View Care Centre DS0000043254.V343343.R01.S.doc Version 5.2 Page 22 Accommodation can also be provided in bungalows on the site. The bungalows have a lounge area, bedroom, bathroom and kitchenette. Meadow View has successfully created an environment that allows people living in the home, including those with dementia, to maintain independence and mobilise freely. However, the management have overlooked potential environmental risks and the absence of management strategies to minimise the risks puts people at risk of harm. Examples of environmental hazards include: • There was a broken lock to the door of the boiler room in ‘Poppies’ was giving access to an area housing potentially hazardous equipment. The unlocked boiler room door also allowed residents access to the outside of the building via a ‘push bar’ type fire door. This presents a risk of residents with dementia leaving the building without the knowledge of care staff. The garden has a very attractive water feature and pond but this presents a risk of drowning if a resident were to fall in it. The manager must implement risk management strategies to minimise this risk. The kitchenettes in the dining rooms have electric kettles available in them for making hot drinks. These are freely accessible to residents. There was no evidence that a risk assessment had been undertaken for the potential risk of scalds to residents. Additionally, the abilities of people living in the home are variable. There should be individual risk assessments made and recorded for each person who has access to the electric kettle. Inspectors viewed one of the bungalows accommodating a person with dementia and found the gas hob in the kitchenette could be switched on. This presents a potential risk of burns or a fire, particularly for a person with dementia who has an impaired cognitive ability. The inspector questioned whether a risk management strategy was in place but was told there was not. The manager responded by having the gas supply to the hob cut off immediately to reduce the risk. The home has no formal method of keeping a check on the whereabouts and well being of residents considering there is so large a space and various buildings for people to use. This was discussed with the manager who explained there is a reliance on staff to know where residents are. Staff are not allocated responsibility for a specific group of residents during their shift so it is difficult to see how this works in practice and puts people living in the home at risk of having their needs overlooked. • • • • • Meadow View Care Centre DS0000043254.V343343.R01.S.doc Version 5.2 Page 23 • One of the corridors in the home had limited natural light but was lit with fluorescent lighting. A notice was pinned to the light switch indicating that lights should be switched off to conserve energy. On 20th June only half of the fluorescent lights in the corridor were switched on which provided dim lighting and increases the risk of falls for people who may have a cognitive or visual impairment. The manager should assess the level of lighting in this area to ensure it is sufficiently bright. Systems are in place for the management of dirty laundry and control of infection. The inspector discussed with the manager that practice could be improved by using alginate bags for transporting soiled laundry to the laundry room, this would minimise handling and reduce the risk of cross infection. Protective clothing such as plastic gloves and aprons were available and hand washing facilities were available. Comments from relatives about the home’s environment include: • • • ‘All parts of the home are fresh, clean and looked after.’ ‘My relative is rather messy and I often have to sweep their room with a dustpan and brush.’ ‘On a couple of occasions my relative has had no hot water in her room when I have visited.’ Meadow View Care Centre DS0000043254.V343343.R01.S.doc Version 5.2 Page 24 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): Standards 27, 28, 29 and 30 were assessed. Quality in this outcome area is adequate. There are sufficient numbers of staff on duty most of the time to meet the needs of people living in the home but further training is needed to make sure people are cared for by competent staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager confirmed that the usual staffing complement for the home is: 8am – 2pm 6 care staff (plus 1 allocated to the bungalows) 6 care staff (plus 1 allocated to the bungalows) 2 care staff (plus 1 allocated to the bungalows) 2pm – 8pm 8pm – 8am Four weeks of the home’s duty rota between 12th March – 8th April 2007 was examined and demonstrated that the staffing levels set by the home (in the table above) are usually achieved. Meadow View Care Centre DS0000043254.V343343.R01.S.doc Version 5.2 Page 25 The duty rota shows that the manager has at least 3 supernumerary days each week and ‘works the floor’ for the remaining days. There are sufficient laundry, catering and cleaning staff to ensure that care staff do not spend undue lengths of time undertaking non-caring tasks apart from the weekends when there are no domestic staff on duty. Administrative support is provided through the organisation’s Central Services Unit to assist the home with issues such as administration, recruitment, staff training and maintenance. Meadow View incorporates four private bungalows and provides domiciliary care to the people living in these. Meadow View Bungalows is registered as a Domiciliary Care Agency with the Commission for Social Care Inspection. There is one member of care staff allocated to provide care to the people in the bungalows over each 24 hr period. When the staff member is not providing care in the bungalows they assist in the care home. The duty rota does not give sufficient detail of the actual times during the day and night the one care staff spends undertaking domiciliary care duties or working in the care home to establish the actual hours available to residents in the care home. It is of concern that a group of staff discussed with the inspector that on occasions where a person in the bungalows requires the assistance of two people then a member of staff allocated to providing care in the care home will go and assist. There is currently one person in the bungalows who requires the assistance of two people in the mornings. This means that there are times when the staffing complement for the care home is depleted and puts residents at risk of not having their needs met. The service must be able to demonstrate the actual number of hours worked by staff in the care home and accurate records must be available for inspection. It was evident from the general appearance of people living in the home that there are sufficient staff on duty to meet their personal care needs. During a tour of the home at 11am the inspectors observed that there were no care staff present in communal areas. Care staff may have been attending to people’s needs in their rooms but this left people in the communal areas without supervision or anyone to make a request for a need to be met. For example, one gentleman sat alone in the quiet area in the corridor from reception calling out for a cup of tea; lady dressed in nightclothes opened the door to her room and called for assistance and in the empty dining room another resident was attempting to clean a spillage on the floor. Meadow View Care Centre DS0000043254.V343343.R01.S.doc Version 5.2 Page 26 The home does not have a specific method of deploying staff care staff during their shift, it is reactive to the needs of the people living in the home on a day to day basis. Care staff are not allocated responsibility for meeting the needs of a specific group of residents; rather, all care staff are responsible for the needs of all residents. Inspectors discussed with the manager that a review of the way staff are deployed to meet the needs of residents could result in a more ‘person centred’ approach. Eight of the 29 care staff employed in the home have a National Vocational Qualification in Care (NVQ) at level 2 or above which, at 28 , is below the National Minimum Standard for 50 of staff to be qualified. However, a further seven members of care staff are currently working towards this award which should mean that people living in the home are cared for by competent staff. The personnel files of two recently recruited staff were examined and both contained evidence that satisfactory checks such as Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA) and references are obtained before staff commence employment in the home. Robust recruitment procedures and pre-employment checks should protect the vulnerable people living in the home. Staff training records demonstrate that staff complete an induction programme and receive mandatory training including food hygiene, fire safety, first aid, Control of Substances Hazardous to Health (COSHH) and moving and handling. Most staff have had moving and handling training in the last year and are due an annual update scheduled for July 2007. However, 3 care staff have not had an annual update in the last year and 4 care staff have no evidence of any moving and handling training. This puts people at risk of harm from the use of incorrect moving and handling techniques. Comments from relatives about the attitude of staff in the home include: • ‘Staff are always giving us information and listening to our thoughts.’ • ‘All the staff are very supportive.’ • ‘All the staff work extremely hard to make it feel like home.’ Meadow View Care Centre DS0000043254.V343343.R01.S.doc Version 5.2 Page 27 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): Standards 31, 33, 35 and 38 were assessed. Quality in this outcome area is adequate. The home is managed by a competent person to provide direction and guidance to ensure residents receive consistent quality care. The absence of risk assessments for potential hazards fails to ensure the safety of people living in the home. 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. Relatives made positive comments about the way the home is run, saying, Meadow View Care Centre DS0000043254.V343343.R01.S.doc Version 5.2 Page 28 ‘I only have praise for Meadow View at all points eg. Management, all staff and the building – a lovely bright warm and friendly place.’ and ‘The manager or care staff are always willing to help you.’ Prime Life undertook it’s own Quality Assurance Review of the service in May 2006 which included surveying the opinion of residents and relatives. An action plan was developed to address areas where the review identified potential for improvement. There was no evidence that the action plan had been implemented or reviewed. The manager told us that a further Quality Assurance Review of the service is scheduled for later this year. The personal monies of people living in the home are kept securely in separate bags and accurate records of income and expenditure are kept. An audit of three residents’ personal monies was found to be correct. The inspector recommended that receipts for any transactions were kept with the accounts. The home has effective systems for maintaining equipment and services to the home to promote the safety of people in the home. A sample of service and maintenance records were examined and were up to date: • • • • • • • • The hoist was serviced in June 2007 The annual fire extinguishers checks were made in December 2006 The Fixed Electrical Installation Certificate (‘5 year electrical check’) was issued in June 2003. Water outlet temperature checks undertaken in May 2007 recorded water temperatures within the recommended limits of 40 - 43°C Emergency lighting was tested in May 2007 Warwickshire Fire and Rescue Service assessed the home as ‘satisfactory’ in January 2006 and an assessment of fire doors was made in May 2007 which identified some remedial work which has been authorised for completion Portable Electrical Appliance testing is next due in 2008 The Annual Gas Safety Certificate available for inspection was issued in July 2005. The provider sent us a copy of the most recent gas safety inspection after the inspection visit. This confirmed the safety of the gas appliances in the home and was issued in July 2006. The manager and provider must identify the potential risks to the well being of people living in the home as detailed in the ‘Environment’ section of this report and develop strategies to minimise the risks to further promote the Health and Safety of people living in the home. The home’s programme of mandatory training further protects the safety of people in the home but staff training must be brought up to date to make sure this is consistent. Meadow View Care Centre DS0000043254.V343343.R01.S.doc Version 5.2 Page 29 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 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X 2 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 1 Meadow View Care Centre DS0000043254.V343343.R01.S.doc Version 5.2 Page 30 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 OP3 Regulation 14 Requirement Arrangements must be made to ensure prospective residents have a full assessment of their needs and abilities recorded before they move into the home. This is to make sure that prospective residents can be confident that the home can meet their needs. Systems must be in place to identify any risk to the health or well being of people living in the home and must include details of how any identified risk can be reduced. This must include the risk of weight loss and poor nutrition. This is to make sure that risks to the health or well being of residents are identified and reduced. Systems must be in place to identify residents’ risk of harm from abuse and strategies developed to minimise any risk identified. DS0000043254.V343343.R01.S.doc Timescale for action 31/08/07 2 OP8 12 31/08/07 3 OP18 13(6) 31/08/07 Meadow View Care Centre Version 5.2 Page 31 4 OP27 17 This is to ensure that people living in the home are safeguarded form the risk of abuse. Accurate records of the staff duty rota must be kept showing which staff are on duty at any time during the day and night and in what capacity. Records must show the actual hours worked by each staff member in the care home. Staff hours undertaken in Meadow View Bungalows Domiciliary Care service must not be reflected as staff hours in the care home. This is to make sure we can establish the actual staff hours available for meeting the needs of residents in the care home. Arrangements must be made for all staff to have up to date mandatory training in Fire Safety and Manual Handling. This is to ensure that people in the home are protected from the risk of harm. Systems must be in place to ensure that all parts of the home to which residents have access are so far as reasonably practicable free from hazards to their safety. Unnecessary risks to the health and safety of residents must be identified and as far as possible eliminated. These must include the potential risks identified in the ‘Environment’ section of this report. This is to make sure that people 31/08/07 5 OP30 18 31/08/07 6 OP38 13 (4) 31/08/07 Meadow View Care Centre DS0000043254.V343343.R01.S.doc Version 5.2 Page 32 living in the home are protected from harm. 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 OP7 Good Practice Recommendations Care plans should be available for each of the identified needs of people living in the home and contain details of the actions required to meet each need. This should make sure people get the care they need. The lighting in the corridor identified during the inspection should be reviewed to make sure it is sufficiently bright. This is to make sure areas used by residents are sufficiently bright to avoid accidents. The service should be able to demonstrate that 50 of care staff have a National Vocational Qualification in Care at level 2 or equivalent. This is to ensure that people living in the home are cared for by competent staff. The service should be able to demonstrate the review of working practices and quality of care delivered to people living in the home. Records should demonstrate that sufficient actions have been taken in response to issues raised following quality monitoring. This should ensure that the home is run in the best interests of people living in the home. 2 OP25 3 OP28 4 OP33 Meadow View Care Centre DS0000043254.V343343.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Birmingham Local Office 1st Floor, Ladywood House 45-46 Stephenson Street Birmingham West Midlands B2 4UZ 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.V343343.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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