Inspection on 29/06/09 for Meadow View Care Centre

This inspection was carried out on 29th June 2009.

CQC found this care home to be providing an Adequate service.

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 12/01/09

Meadow View Care Centre 09/05/07

Meadow View Care Centre 13/09/06

Meadow View Care Centre 20/01/06

Meadow View Care Centre 27/07/05

Similar services:

Ashlea Mews Residential Home

Harwood House

South Chowdene Care Home

Farmborough Court

St Albans Place (14)

Bisley Drive (18)

Carrdale

Ransdale House

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Meadow View Care Centre Kibblesworth Gateshead Tyne and Wear NE11 0YJ Lead Inspector Glynis Gaffney Key Unannounced Inspection 29th June 2009 10:00 DS0000063769.V376244.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Meadow View Care Centre DS0000063769.V376244.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Meadow View Care Centre DS0000063769.V376244.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadow View Care Centre Address Kibblesworth Gateshead Tyne and Wear NE11 0YJ 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) 0191 4103488 0191 4109908 mveuropeancare@aol.com www.europeancare.co.uk European Care (England) Ltd Mrs Susan Hodgeson Care Home 22 Category(ies) of Dementia - over 65 years of age (21), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (2), Sensory Impairment over 65 years of age (3) Meadow View Care Centre DS0000063769.V376244.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th January 2009 Brief Description of the Service: Meadow View is a large, older building, which has been converted for use as a residential care home. There is an extension to the rear of the building. The home is registered to provide up to 21 places for older people with dementia that require assistance with personal care needs. It is also registered to provide care to older people who may have a sensory impairment or mental health needs. Nursing care is not provided. Single bedroom accommodation is provided. Six bedrooms have en-suite facilities. There are three lounge areas all of which include dining facilities. The home has a large landscaped garden area to the front of the building and there is level access to the rear. There are local shops, a public house and a bus route within walking distance. The weekly fees are £400 to £430:00 per week depending upon care needs. Additional charges are made for chiropody, hairdressing and personal items such as toiletries and newspapers. Copies of the home’s inspection reports are available on request. Meadow View Care Centre DS0000063769.V376244.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. How the inspection was carried out: Before the visit: We looked at: • • • • Information we have received since the last key inspection visit on the 12 January 2009, including details of action taken by the provider following a random inspection carried out in May 2009; How the service dealt with any complaints and concerns since the last visit; Any changes to how the home is run; The manager’s view of how well they care for people. The views of relatives, staff and people using the service. The Visit: An unannounced visit was made on the 29 June 2009. During the inspection we: • Carried out a Short Observational Framework Inspection (SOFI). A SOFI is carried out where people who live in a care home find it difficult to communicate with an inspector. This tool, developed with the University of Bradford, helps us to find out what people think of the care they receive; Talked with the manager; Looked at information about the people who use the service and how well their needs are met; Looked at other records which must be kept; Checked that staff have the knowledge, skills and training to meet the needs of the people they care for; DS0000063769.V376244.R01.S.doc Version 5.2 Page 6 • • • • Meadow View Care Centre • • Looked around the building to make sure it was clean, safe and comfortable; Checked what improvements had been made since the last visit. We told the manager what we found. What the service does well: The SOFI showed that staff generally interact with people in a warm, reassuring and positive manner. Staff are polite, respect people’s dignity and treat them in an age appropriate manner. A range of care plans have been devised for each person. Those looked at address people’s needs in a range of areas such as mobility, nutrition and personal care and are usually reviewed monthly. A range of preventative healthcare risk assessments have been completed. This will help to ensure that people receive the healthcare support they require. What has improved since the last inspection? Copies of people’s social services assessments are obtained before a decision is made to offer a place at the home. This helps to ensure that staff have access to the information they need to provide people with safe care that meets their needs. Improvements have been made to the way in which important information is shared during staff shift handovers. This will help to ensure that staff have access to the information they need to keep people safe. Arrangements have been made for staff to complete Mental Capacity Act training. The provider is piloting a mental capacity care plan which will enable staff to meet people’s needs in this area. Arrangements have been put in place to ensure that staff receive regular work practice supervision. This will help to ensure that people are being cared for by staff that are properly supported and supervised. Improvements have been made to the premises. For example, unsafe radiators have been repaired. Action has been taken to eliminate the unpleasant odour in the main reception area. The wall covering in the laundry has been replaced making it easier to clean. The sluice has been repaired and staff have been provided with training in its use. Meadow View Care Centre DS0000063769.V376244.R01.S.doc Version 5.2 Page 7 Complete employment histories have now been obtained for all staff. This helps to ensure that staff are suitable to work with vulnerable adults. Arrangements have been made for staff to update their safeguarding training which will help make sure they promote and protect people’s well-being. What they could do better: Ensure that staff are aware of their responsibilities and duties in relation to keeping people safe and whistle-blowing on poor practice. Ensure that all safeguarding concerns are reported to the Care Quality Commission (CQC) within 24 hours. This will help to ensure that people using the service are properly protected from harm or abuse. Ensure that the provider’s system for assessing the quality of care provided at the home is implemented. A written report setting out the findings should be completed. This will help to ensure that the home is being run in the best interests of the people living at Meadow View. Ensure that the home’s service user guide includes information about service users’ views of Meadow View and details of individual bedroom sizes. This will help to make sure that people have access to the information they need to make an informed choice about whether they wish to move into the home. Ensure that staff’s competency to administer medication is assessed and a written record kept. Staff should update their accredited medication training on a regular basis. This will help to promote people’s health and well-being. Ensure that appropriate arrangements are in place to meet people’s ‘end of life’ needs, wishes and preferences. This will help to ensure that people receive appropriate ‘end of life’ care. Ensure that the premise related concerns identified in this report are addressed. This will help to ensure that people are able to benefit from living in a home which is well-maintained and meets their needs. Carry out an assessment of any potential risks involved in the use of the current central heating boilers. This will help to promote people’s safety and well-being. Ensure that staff receive fire instruction every six months and participate in at least two fire drills a year. This will help to ensure that people are able to benefit from living in a home where staff are clear about how to keep them safe in the event of a fire. Meadow View Care Centre DS0000063769.V376244.R01.S.doc Version 5.2 Page 8 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Meadow View Care Centre DS0000063769.V376244.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 DS0000063769.V376244.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Standard 6 is not applicable. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for making sure that people’s needs are assessed before they are admitted into the home are satisfactory. This means that people can be confident that staff will know how to meet their needs following admission into Meadow View. EVIDENCE: The home’s service user guide provides people with information about what they can expect once they move into Meadow View. Following a recommendation made in the last inspection report, the manager has updated the guide to ensure that it is factually correct. However, the guide does not Meadow View Care Centre DS0000063769.V376244.R01.S.doc Version 5.2 Page 11 contain service users’ views of the home or details about the sizes of individual bedrooms. Following a recommendation made in the last inspection report, the manager ensures that copies of people’s social services assessments are obtained before a decision is made to offer a place at the home. The care records of two people recently admitted into the home contain the required documentation. This will help to ensure that staff have access to the information they need to provide people with safe care that meets their needs. People’s records also include a copy of the assessment carried out by Meadow View staff. Meadow View Care Centre DS0000063769.V376244.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for meeting people’s health and personal care needs are not fully satisfactory. This means that people using the service cannot be confident that their assessed needs will be well met. EVIDENCE: Following inspections carried out in January and May 2009, the provider and manager have implemented a range of improvements. For example: • Arrangements have been put in place to support staff to improve the quality of people’s care records. Mrs Hodgeson has introduced an ‘Aide Memoire’ to help staff cover important information about people’s needs during shift handovers; DS0000063769.V376244.R01.S.doc Version 5.2 Page 13 Meadow View Care Centre • • • Improvements have been made to the way in which information about people’s nutritional needs is recorded. People’s nutritional risk assessment information is up to date; Work is underway to assess people’s capacity to make decisions and choices. The provider is currently piloting a care plan which will provide staff with guidance about when and how to carry out mental capacity assessments. Also, some staff have completed training in this area; Care plans setting out people’s need for support with the management of their finances and medication have been devised. People’s needs are also assessed following their admission into the home. Staff use the information from this initial assessment to judge people’s progress. A range of care plans have been devised for each person. Those looked at address people’s needs in a range of areas such as mobility, nutrition and personal care and are usually reviewed each month. A new assessment and care planning system is due to be introduced shortly in order to provide staff with clearer guidance about how to meet people’s needs. Of the eight staff that returned surveys, the majority said that they are given up to date information about the needs of people they support. A member of staff said ‘…in my opinion, I think that the home provides a caring, relaxing, clean and safe environment for all residents. Most of the time our residents are contented and have a happy disposition. We all try to create a happy and cheery atmosphere to boost morale and keep everyone’s mood up beat.’ Arrangements are in place to meet people’s healthcare needs. For example, people’s care records show that staff arrange for them to be visited by their GP, and the community nursing service, as and when needed. Records show that each person has received dental care in the last 12 months. Arrangements have been put in place for people to receive regular optical care. During the inspection, staff identified that one service user appeared to be having difficulty seeing the food on their dinner plate. As a result, a visit by an optician has been arranged. However, although people’s weight is checked monthly, and service users receive regular chiropody care, staff are not always updating care records to show that healthcare has been provided in these areas. Preventative health care risk assessments are carried out. For example, in the sample of care records checked, nutritional, skin care and falls prevention risk assessments have been carried out for each person. However, some assessments have not been fully completed. Failure to complete nutritional risk assessments in full could lead to gaps in staff’s knowledge about how to keep people healthy. The manager intends to complete the recommended MUST nutritional risk assessment for each person living at the home. ‘Swine flu’ and ‘Heat Wave’ risk assessments have already been completed. Arrangements have been made for the home to be inspected by a CQC pharmacist. A separate report will be issued. However, senior staff Meadow View Care Centre DS0000063769.V376244.R01.S.doc Version 5.2 Page 14 administered medication in a safe and professional manner. There has been one mis-administration of medication since the last inspection. Staff at the home were not responsible for this error. However, as a result of this, arrangements have been made to assess staff’s competency to administer medication. Also, all staff are to update their accredited training. The arrangements for ‘end of life’ planning are not satisfactory. People’s care records do not contain appropriate ‘end of life’ care plans. For example, in one person’s records their ‘death and dying’ care plan stated that they should not be resuscitated in the event of their death. However, there is no evidence that this plan had been agreed with person’s GP or other relevant healthcare professionals. Failure to devise an appropriate ‘end of life’ care plan drawn up in conjunction with the community healthcare team, could lead to uncertainty about how people’s ‘end of life’ needs are to be met. The provider is currently drawing up a good practice ‘end of life’ care plan for use within their homes. Also, Mrs Hodgeson, and some of her staff, have completed ‘end of life’ training since the last inspection, and arrangements have been made for all staff to complete training in this area. Meadow View Care Centre DS0000063769.V376244.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for providing service users with a lifestyle that meets their needs are not fully satisfactory. This means that people are not able to benefit from living in a home where the staff know how to meet their daily life and social care needs. EVIDENCE: The home obtains information about people’s social interests and hobbies before, and after, their admission into Meadow View. People’s care records contain social histories which helps staff to understand people’s life experiences before they moved into the home. A social needs care plan has been devised for each person and these are reviewed each month. This helps staff to be clear about how people’s social needs are to be met. However, person centred activity plans have not been devised for people with dementia care needs. Meadow View Care Centre DS0000063769.V376244.R01.S.doc Version 5.2 Page 16 The home has recently appointed an activities co-ordinator whose role it will be to set up a programme of social activities both within and outside of the home. People’s care records show that some social activities are provided. During the inspection, staff were observed encouraging people to engage in social conversation and participate in a small games session. Of the eight staff who returned surveys, all said that people have access to a limited range of activities. They also said that they have very little time to deliver a programme of social activities in addition to their caring responsibilities. Staff said: ‘…we could maybe have more days out with our residents, trips to the beach or Beamish. We could have more in-house activities as sometimes residents can get a little bored’; ‘…residents should have more daily activities and go for days out.’ The Short Observational Framework Inspection (SOFI) carried out as part of the inspection showed that: • • • Staff sometimes miss opportunities to engage positively with service users as they interact with their environment; Staff spend less time engaging with service users who present as withdrawn and passive; Service users whose behaviours are more challenging receive a greater amount of staff attention. The manager responded to the feedback given in a positive manner and said that she would share the SOFI comments during the next staff meeting. Arrangements have been made for a local minister to give Holy Communion each month and a hairdresser visits weekly. However, care plans setting out how staff should meet people’s religious and spiritual needs have not been devised. Visitors are made welcome and there are no restrictions on visiting times. People are able to meet with their visitors either in the home’s communal areas or in the privacy of their own bedrooms. The home has a rotating four-week menu that includes photographs of the food to be served at each mealtime. Breakfast is served from 8am onwards and tea from 4pm. Hot and cold food choices are available at all main meal times. Alternatives are always available and people can change their minds if they wish. The cook said that kitchen staff have been given with written information about people’s likes and dislikes and nutritional needs. However, they were unable to produce this information and confirmed that it had gone missing. The inspector joined people for their lunchtime meal. There was a friendly and unhurried atmosphere in the dining areas. The meal served looked tasty and nutritious. It was nicely presented with good portion sizes. A member of staff said ‘…the home serves good meals and residents are well looked after.’ Meadow View Care Centre DS0000063769.V376244.R01.S.doc Version 5.2 Page 17 Although the dining areas are pleasant, the dining tables in the lounge for people who have more advanced dementia are not attractively set and condiments are not provided. A number of people experience difficulties eating their food as a result of their dementia. The manager was uncertain as to whether people’s eating needs have been assessed by an occupational therapist. The SOFI carried out as part of the inspection found that: • • Both lounge televisions are left on during meal times even though neither were being watched; One service user received support from two members of staff to eat their lunch time meal. The first member of staff appeared to feed the person too fast for them to eat comfortably and then left mid-way without providing an explanation. The person was then helped to eat by a second member of staff who provided a good level of support. Meadow View Care Centre DS0000063769.V376244.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for managing complaints and protection are not fully satisfactory. This means that people cannot be confident that they are being cared for by staff who know how to keep them safe. EVIDENCE: The provider’s complaints procedure is displayed throughout the home so that people using the service, and their families, know who to complain to and how to make a complaint. The procedure is included in the service user guide. Mrs Hodgeson said that the home had received no complaints since the last inspection. CQC has received one anonymous complaint which led to a random inspection and the safeguarding investigation referred to below. Of the eight staff that returned surveys all said that they would know what to do if someone raised a concern. No surveys were returned by people using the service or their families. The home has an up to date safeguarding policy which takes into account the Mental Capacity Act 2005. Staff said that they have read both the home’s Whistle-Blowing and Safeguarding policies and procedures. However, staff said Meadow View Care Centre DS0000063769.V376244.R01.S.doc Version 5.2 Page 19 that they had not signed these policies to confirm that they had read and understood them. There has been one serious safeguarding incident since the last key inspection of the service. The incident that occurred has been handled under the local authority’s safeguarding procedures. Although all staff have attended safeguarding training, the incident showed that they were not clear about their duties and responsibilities under the provider’s whistle-blowing and safeguarding policies and procedures. The incident also showed that some senior staff failed to carry out their management and reporting duties in a professional manner. However, the new manager and provider took immediate action to keep the people in their care safe and are in the process of taking action to address shortfalls in staff’s practice. Staff interviewed as part of this inspection were able to clearly state what action they would take to keep people safe. Staff also spoke of lessons learned and how the home was now moving forward. Mrs Hodgson has arranged for each member of staff to update their safeguarding training and keeping people safe is now discussed at every staff supervision session. Following two requirements made in the last key inspection report that more robust safeguarding arrangements be put in place, CQC issued a Serious Concerns letter. The letter requires the provider to take prompt action to make sure that all outstanding safeguarding requirements are met. Failure to comply with requirements set by the CQC could result in further enforcement action being taken. Meadow View Care Centre DS0000063769.V376244.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of accommodation is not fully satisfactory. This means that people are not able to benefit from living in a home which is well-maintained. EVIDENCE: The home provides a physical environment that generally meets the needs of the people who live there. The home is comfortable, warm, well lit and clean. However, the rear of the building is in a poor state. The covered area directly outside of the manager’s office was flooded during a heavy thunderstorm ceiling. There is a large uncovered fish pond in this area which could present a potential hazard to a vulnerable person. However, the rear of the building is Meadow View Care Centre DS0000063769.V376244.R01.S.doc Version 5.2 Page 21 not used by service users. A major refurbishment of the building is due to commence in September 2009. A member of staff said ‘…we are due to have a refurbishment and new rooms built on. This can only improve the home and means a better place for our residents to call their home.’ The provider and staff team have made efforts to make the home more suitable for people with dementia care needs. For example, photographic door labels have been used to help people identify their bedroom. There are ‘Wayfinding’ signs to identify the purpose of each room. Bedroom doors are colour coded to help people distinguish between bedroom doors and walls. Information about the date and menu for the day has been placed on a whiteboard in one of the lounges. Each person has access to their own bedroom but only some have private ensuite facilities. People can personalise their bedrooms if they wish. Toilets are appropriately located within the home, they are easily accessible and available in sufficient numbers. People have access to a range of aids and adaptations such as a variable height bath and hoisting equipment. Mrs Hodgeson confirmed that appropriate aids and adaptations have been provided in all toilets. Following a check of the premises, a number of concerns were identified: • • • • The walls in the ground floor bathroom are in need of re-decoration. The wooden base on which the toilet sits is stained and looks unhygienic; The walls in the ground floor toilet are in need of re-decoration; The nurse call alarm pull cord is not connected in Bedroom 22. Mrs Hodgeson was unable to find the pull cord; The armchair in Bedroom 26 is stained. The toilet cistern is cracked in the en-suite facility. Meadow View Care Centre DS0000063769.V376244.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for ensuring that people are in safe hands at all times are not fully satisfactory. This means that people cannot be confident that they will be cared for by staff who are suitable to work at the home and who are competent to do their jobs. EVIDENCE: There is a rota that shows which staff are on duty and at what times. Following a recommendation made after the last inspection, the home’s rota now includes all of the information needed by the CQC to ensure that satisfactory staffing levels are in place. The rotas show that there are always a minimum of three staff on duty between 8am and 10pm for up to 21 people. Two staff cover the night time period. Domestic and catering staffing levels are satisfactory. No concerns about the appropriateness of staffing levels were identified during the inspection. Of the eight staff that returned surveys, all said that there are ‘always’ or ‘usually’ sufficient staff on duty to meet people’s needs. Meadow View Care Centre DS0000063769.V376244.R01.S.doc Version 5.2 Page 23 Seven staff have obtained a National Vocational Qualification in Care at Level 2 or above and five are in the process of doing so. Staff are provided with opportunities to complete mandatory training. Following a requirement made after the last inspection, all staff have completed first aid training. Two staff have also completed more advanced training. Since her appointment at the beginning of the year, the new manager has arranged for all staff to update their mandatory training in fire safety, health and safety, food hygiene and infection control. Mrs Hodgeson has produced a training matrix identifying which staff have completed what training and when an update will be required. Of the eight staff that returned surveys, all said that they have received training relevant to their role which helps them to understand the individual needs of the people they support. The majority of staff also said that their training keeps them up to date with new ways of working. However, the adult protection incident referred to earlier in this report demonstrates that although staff have received training in whistle-blowing and safeguarding, some staff have not used what they have learnt to inform their day to day practice. Following the last inspection the manager was asked to ensure that new staff complete a ‘Skills for Care’ induction. Compliance with this recommendation has not been checked during this inspection as no new staff have been employed. Of the eight staff that returned surveys, the majority said that their induction covered everything they needed to know to do their job when they started. New staff are subject to a range of pre-employment checks. Following a recommendation made after the last inspection, full employment histories have been obtained from all staff. Criminal Records Bureau disclosure checks and two written references are obtained before staff can start work at the home. Of the eight staff that returned surveys, all said that their employer had carried out pre-employment checks. Meadow View Care Centre DS0000063769.V376244.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for ensuring that the home is properly managed and administered are not fully satisfactory. This means that people are not able to benefit from living in a home that is always run in their best interests. EVIDENCE: Mrs Hodgeson has successfully registered with the CQC since the last inspection of the service. She is an experienced professional who has worked in a variety of residential settings for over 25 years. Mrs Hodgeson has Meadow View Care Centre DS0000063769.V376244.R01.S.doc Version 5.2 Page 25 obtained the Registered Manager’s Award, and is currently updating her statutory training. Mrs Hodgeson demonstrated good leadership skills, has a clear vision of how she would like the home to improve and is prepared to tackle poor practice and take disciplinary action to address concerns. Mrs Hodgeson feels well supported by her line manager and employer. A member of staff said ‘…we have a new manager who is trying extremely hard to bring the good back into the home since the last manager left. The manager has said that her door is always open to anyone who would like to chat.’ Another member of staff said that ‘…we have a new manager who is doing a good job.’ Following a requirement made in the last inspection report, staff are now receiving regular formal supervision. Mrs Hodgeson has introduced a new work practice supervision agreement which she has completed with each member of staff. This sets out how staff supervision will be handled within the home. Staff have received at least two sessions of supervision since the last inspection. A record of staff supervision sessions is now in place. Staff that returned surveys said that they met with their manager regularly to discuss their work and felt well supported. Arrangements are in place to monitor the quality of services provided at Meadow View. For example, the provider has a self-assessment quality audit tool which its managers are expected to complete. Mrs Hodgeson plans to complete the checklist shortly which will then be submitted to the provider and an action plan drawn up. There is no evidence that this process had been carried out during 2008 under the previous manager. The provider carries out regular monthly monitoring checks to ensure that the home is operating in accordance with the company’s policies and procedures. Satisfaction surveys are due to be issued shortly. Resident and relatives’ meetings have recently been re-instated and senior operational managers are due to attend the next planned meeting to discuss how the forthcoming refurbishment of the home will be handled. Mrs Hodgeson has not yet completed an annual development plan for 2009. Measures are in place to protect people’s health and safety. A selection of health and safety records was checked as part of the inspection. These showed that: • • Safety information has been obtained for all hazardous materials used within the home. A relevant risk assessment has been completed; Work place risk assessments are up to date. However, some of the information contained in the risk assessment file is confusing and could be mis-interpreted. Mrs Hodgeson agreed to address this matter following the inspection; The home’s lift and hoisting equipment has recently been serviced; The home has a current electrical installation certificate and an up to date fire risk assessment. • • Meadow View Care Centre DS0000063769.V376244.R01.S.doc Version 5.2 Page 26 However, the company responsible for servicing the home’s boilers issued a warning notice following a maintenance visit at the end of last year. As a result, the workman disconnected the boilers leaving the home without central heating. Following discussions with other heating engineers the supply was reconnected and considered safe for use. Mrs Hodgeson said that the boilers are due to be replaced as part of the forthcoming refurbishment in September 2009. It is of concern that the CQC was not notified of this event. The provider has not carried out a recorded risk assessment of the potential risks associated with continuing to the use the current boilers. Meadow View Care Centre DS0000063769.V376244.R01.S.doc Version 5.2 Page 27 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 3 X 2 Meadow View Care Centre DS0000063769.V376244.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last Yes 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 OP9 Regulation 13(2) Timescale for action Ensure that an accurate record 01/08/09 of medicines received into the home is kept. This will help to ensure that people’s health and welfare is promoted and protected. (This requirement will be checked as part of a pharmacy inspection which is due to take place shortly. The timescale for complying with this requirement had not expired at the time of the inspection) 2. OP18 13(6) Ensure that staff are aware of 01/09/09 their responsibilities and duties in relation to: • Keeping people safe; (A Serious Concern Letter has been issued to achieve compliance with this outstanding requirement) • Meadow View Care Centre Requirement Whistle-blowing practice. on poor Version 5.2 Page 29 DS0000063769.V376244.R01.S.doc This will help to ensure that people using the service are properly protected from harm or abuse. 3. OP18 13(6) 37 Ensure that all safeguarding 01/09/09 concerns are reported to CQC within 24 hours. This will help to ensure that people using the service are properly protected. (A Serious Concern Letter has been issued to achieve compliance with this outstanding requirement) 4. OP19 16(2) Ensure that: • The walls in the ground floor bathroom are redecorated and the wooden base for the toilet is replaced; The walls in the ground floor toilet are redecorated; The toilet cistern in the ensuite facility in Bedroom 26 is replaced and clean or replace the armchair. 01/10/09 • • This will help to ensure that people are able to benefit from living in a home which satisfactorily meets their needs. 5. OP33 24 Ensure that the provider’s in- 01/09/09 house quality assurance system is used within the home. A written report setting out the findings must be sent to the CQC. Any reviews carried out should take account of service users’ views and those of their representatives. DS0000063769.V376244.R01.S.doc Version 5.2 Page 30 Meadow View Care Centre This will help to ensure that the home is being run in the best interests of the people living at Meadow View. (The timescale for complying with this requirement had not expired at the time of the inspection) 6. OP38 23 Ensure that staff receive fire 01/01/10 instruction every six months and participate in at least two fire drills a year. This will help to ensure that people are able to benefit from living in a home where staff are clear about how to keep them safe in the event of a fire. (The timescale for complying with this requirement had not expired at the time of the inspection) 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 OP1 Good Practice Recommendations Ensure that the home’s service user guide is revised to include: • • 2. OP7 Service users’ views of the home; Details of bedroom sizes. Devise care plans that show how the home will meet people’s religious and spiritual needs. DS0000063769.V376244.R01.S.doc Version 5.2 Page 31 Meadow View Care Centre 3. OP7 Ensure that: • • All staff complete Mental Capacity Act and Deprivation of Liberty training; An assessment of each person’s capacity to make decisions is carried out. A written record of the outcome should be placed with their care records. 4. OP8 Ensure that: • • • A MUST nutritional risk assessment is completed for each person. All areas of the assessment should be fully completed; Staff update people’s healthcare records to show that they have received chiropody care and regular weight checks; Each person is given the opportunity to have an eye test every two years. Any refusal should be recorded in the person’s care record. 5. OP9 Ensure that: • • Staff’s competency to administer medication is assessed and a written record kept; Relevant staff update their accredited medication training. 6. OP11 Ensure that: • • Each person has an ‘end of life’ care plan that has been agreed with their family, GP and any other relevant healthcare professional; ‘End of Life’ care plans are subject to review by the multidisciplinary team, the service user and their carers/family, as and when people’s condition, or wishes, change; Where a person wishes to make an Advanced Decision about their ‘end of life’ wishes and preferences, the home seeks advice from the person’s care manager, GP and family; ‘End of life’ care plans are available to all people who have a legitimate reason to access it; All staff receive training in ‘end of life’ care; The provider’s ‘end of life’ policy covers Advance Decision-making. • • • • 7. OP12 Ensure that: DS0000063769.V376244.R01.S.doc Version 5.2 Page 32 Meadow View Care Centre • • • A person centred activity plan is devised for each individual with dementia care needs; Staff receive training in how to provide specialist activity sessions for people with dementia; Staff have access to specialist activity materials and equipment that will help them to deliver suitable activities for people with dementia. 8. OP12 Ensure that: • • Arrangements are made for service users to engage in local, social and community activities; Service users are consulted about the programme of activities arranged by or on behalf of the care home. 9. OP15 Ensure that kitchen staff have access to written information about people’s food preferences and nutritional needs. Ensure that: • • • People who experience difficulties eating their food receive an assessment by an occupational therapist or other relevant professional; Where a service user requires support to eat their meal, wherever possible this is provided by a single member of staff at each meal time; Attractive table top settings and condiments are provided at each meal time. 10. OP15 Consider switching off both lounge televisions during meal times. 11. OP16 Ensure that staff sign the home’s Whistle-Blowing and Safeguarding policies and procedures to confirm that they have read and understood them. Ensure that: • • • All bedrooms are provided with a lockable facility; All nurse alarms have pull cords attached and that these are easy to access; A risk assessment is carried out in relation to the potential hazards posed by the uncovered fish pond at the rear area of the building. CQC with details about how the planned Page 33 12. OP19 13. OP19 Provide Meadow View Care Centre DS0000063769.V376244.R01.S.doc Version 5.2 refurbishment of the home will be carried out. 14. OP30 Ensure that newly employed staff complete the ‘Skills for Care’ induction. A certificate of completion verified by the manager should be available within the home. Ensure that people using the service and their families, staff and professionals who have contact with Meadow View, are invited to complete satisfaction surveys. Devise an annual development plan which takes account of the following: requirements and recommendations arising out of CQC reports; any actions arising out of the home’s annual quality assurance audit; comments made in satisfaction surveys. Carry out an assessment of the potential risks continuing to use the current central heating boilers. of 15. OP33 16. OP33 17. OP38 Meadow View Care Centre DS0000063769.V376244.R01.S.doc Version 5.2 Page 34 Care Quality Commission North Eastern Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.northeastern@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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