CARE HOMES FOR OLDER PEOPLE
Meadow View Care Home Rear Of 1072 Manchester Road Castleton Rochdale Lancashire OL11 2XJ Lead Inspector
Diane Gaunt Unannounced Inspection 26th September 2005 11:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Meadow View Care Home DS0000063310.V251652.R01.S.doc Version 5.0 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 Home DS0000063310.V251652.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Meadow View Care Home Address Rear Of 1072 Manchester Road Castleton Rochdale Lancashire OL11 2XJ 01706 711620 01706 711157 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) East and West Health Care Limited Mrs Pushpa Sundramoorthy Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places Meadow View Care Home DS0000063310.V251652.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The Home is registered for a maximum of 39 service-users to include: up to 39 service-users in the category of OP (Older People). The service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. 18 January 2005 Date of last inspection Brief Description of the Service: Meadowview Care Home is a purpose built residential home providing accommodation and personal care to 39 elderly service users on both a permanent and respite stay basis. A small number of day care places are also available. Twenty four hour care is provided. All rooms are single although four bedrooms have inter-connecting doors which may be locked if not occupied by couples. A passenger lift is provided to the 1st floor. The home is situated approximately half a mile from Castleton which has a variety of shops and other community facilities. A large garden is provided to the rear. There is level access to the front door and good car parking facilities. Meadow View Care Home DS0000063310.V251652.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken over a period of 7 hours. The inspector spoke with six residents, one relative, a District Nurse, two care assistants, one senior carer, the assistant manager and the registered manager. Care practice was observed and records looked at. Comment cards asking residents and visitors what they thought about the care at Meadowview had been given out a few weeks before the inspection. Nine residents and nine relatives filled the cards in and returned them to CSCI. Their opinions are also included in the report. Requirements listed at the end of the report include 2 that had not been met since the last inspection. What the service does well: What has improved since the last inspection? What they could do better:
Meadow View Care Home DS0000063310.V251652.R01.S.doc Version 5.0 Page 6 The manager must make sure that care managers and CSCI are told of incidents between residents which put them at risk of harm. The manager and staff must also have training in how to keep residents safe and free from harm. Criminal Records Bureau checks to make sure staff are suitable to work with residents must be made before they begin work at the home. Staff should be given written terms and conditions of employment within 8 weeks of starting work. The manager must make sure that care plans include all the action staff need to take to meet residents’ needs and that changes are written into care plans as soon as they happen. Residents and relatives should be invited to talk to staff about the care plan every 6 months to make sure it records the care they want and need. A record must be kept of all tablets and medicines brought into the home for residents. The CSCI must be told about anything that happens at the home which affects the residents’ well-being. More training must be provided for staff in health and safety areas and each staff member must have a fire drill each year. The mobile hoist must be inspected every 6 months to make sure it is safe to use. Those residents who haven’t got keys for their bedroom doors must be given them unless there is a safety reason why not. A maintenance and renewal plan should be written for the home and a copy given to the manager and CSCI. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Meadow View Care Home DS0000063310.V251652.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Meadow View Care Home DS0000063310.V251652.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. As intermediate care is not provided standard 6 is not applicable. With the exception of emergencies, prospective resdients have their needs assessed prior to admission and are assured these will be met. EVIDENCE: The majority of residents were funded by the Social Services Department and therefore had Level 4 assessments completed by care managers prior to admission. In addition, senior staff from Meadowview visited all prospective residents in their homes or in hospital prior to admission to ensure the home could meet their needs. Assessments were held on file. With regard to emergency admissions, information from placing agencies was requested but not always received prior to admission. However, assessment was undertaken on admission and the manager reserved the right to request an alternative placement if Meadowview could not meet the person’s needs. The manager commented that care managers were not always able to find alternative placements quickly however. It was agreed that action to take in this event would be written into the policy/procedure regarding emergency admissions.
Meadow View Care Home DS0000063310.V251652.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 10. Residents’ health, personal and social care needs were set out in an individual plan of care but were not always sufficiently detailed or updated. Health and personal care needs were met and residents’ treated with respect. Their right to privacy was largely upheld. EVIDENCE: Three individual plans of care were inspected. They encompassed health and social care needs and recorded action to be taken to meet the needs. The plans had been reviewed by staff on a monthly basis. There was evidence on file that residents or their representatives had agreed and signed their care plans initially but there was no evidence of their involvement in reviews. An outstanding recommendation is in place. Five residents returning comment cards considered they would like to be more involved in decision making at the home, although relatives interviewed and returning comment cards considered they were appropriately consulted and kept informed with regard to the residents’ care and well-being. Care plans recorded involvement of GP, District Nurse and other healthcare professionals, although insufficient detail was provided in respect of the eyecare of one resident and occasional epileptic fits of another. Another plan had
Meadow View Care Home DS0000063310.V251652.R01.S.doc Version 5.0 Page 10 not been updated to record specific instruction to staff regarding the promotion and monitoring of fluid intake. Risk assessments were held with care plans and were regularly reviewed, but were not always signed by the resident and/or their relative. Risk assessments with regard to nutrition and skin care were routinely completed but food/fluid intake charts were not always introduced when necessary. Residents were weighed monthly and their weights monitored. None of the residents had pressure sores. Communication with District Nurses had improved and appropriate referrals were made to the service. Observation showed that personal care and hygiene needs were met at the home. This was supported by discussion with residents and relatives. Those interviewed said staff generally responded quickly to call bells. Residents and relatives considered both health and care needs were met. Residents said the home called their GP when they needed them and the services of opticians, dentists, chiropodist and audiologist were accessed as and when necessary. Although the standard relating to medication was not assessed on this inspection it was noted that when a resident had received medication directly from the hospital it was not clearly recorded on medication administration sheets and the care plan. Residents interviewed considered their privacy and dignity was respected at the home and some gave examples of staff’s day to day practice in this area. One resident commented that they would prefer a male carer to bath them but none were employed at the home. The manager had interviewed a number of male applicants for the last advertised post but none were considered suitable. Staff interviewed were able to describe their good practice. Safety locks were provided to bedroom doors and progress had been made in giving keys to residents, but not all had received them or been risk assessed. An outstanding requirement is in place. Residents confirmed lockable space was provided along with keys. Meadow View Care Home DS0000063310.V251652.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed. EVIDENCE: Meadow View Care Home DS0000063310.V251652.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Residents and their relatives were confident that their complaints would be listened to, taken seriously and acted upon. Appropriate systems were in place to protect residents from abuse, although staff had not received training to ensure their full understanding of the procedures. EVIDENCE: The home had a complaints procedure which was included in the Service User Guide, a copy of which was provided in each bedroom. In addition, the complaints procedure was displayed in the entrance area to the home and on the back of bedrooms doors. Staff interviewed were conversant with the procedure and residents and relatives spoken with said they knew to see the manager if they wished to raise a matter of concern. A complaints book was available but did not record any complaints since the last inspection. Just prior to this inspection the CSCI had received an anonymous complaint relating to care provision and staffing levels. This was investigated during the inspection. As a result of the investigation three requirements were made relating to care planning, use of food/fluid intake charts and recording of medication given by the hospital. The element regarding staffing levels was not upheld and issues around personal care were unresolved. A procedure for responding to allegations of abuse was available as was the Rochdale Inter-agency Protection of Vulnerable Adults (POVA) procedure. Staff spoken with understood the importance of reporting malpractice and were aware of the different types of abuse. They had read the procedure but had not been trained in this area. With the exception of the manager, senior staff been trained. It was noted from reading the accident book, care plans and
Meadow View Care Home DS0000063310.V251652.R01.S.doc Version 5.0 Page 13 daily report sheets that incidents between residents which put their safety at risk were not always reported to care managers for investigation and protection of residents. However, those residents interviewed and returning comment cards said they felt safe living at Meadowview. Meadow View Care Home DS0000063310.V251652.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed. EVIDENCE: Meadow View Care Home DS0000063310.V251652.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 29 Sufficient staff were provided to meet the needs of service users. Recruitment and selection procedures did not sufficiently safeguard residents living at the home. EVIDENCE: Inspection of three weeks rotas showed that sufficient staff were provided to meet the needs of residents. Feedback from staff, residents and relatives supported the view that there were enough staff on duty each shift to meet residents’ needs. Observation on the day of inspection provided further evidence. Residents spoke well of staff describing them as ‘very caring’, ‘efficient’ and ‘civil’. One resident said staff would go out of their way to help. This view was reinforced by feedback from two relatives’ comment cards who considered staff’s prime concern was the residents’ welfare and described the care as 1st class and the home ‘extremely well run’. Inspection of three staff files showed that Criminal Records Bureau (CRB) or Protection of Vulnerable Adults (POVA) checks were not always taken up prior to appointment, despite requirement having been made in the past. Two references were obtained prior to appointment, required documentation sought and copies held on file. Staff shadowed experienced staff on appointment until deemed competent. Meadow View Care Home DS0000063310.V251652.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 The health, safety and welfare of service users and staff was not always promoted and protected. EVIDENCE: Records and discussion with care staff showed that required health and safety training was provided for staff but some was in need of renewal and staff appointed since the last inspection had not undertaken all necessary training. All had completed moving and handling training however. First aid and fire safety training had been arranged for October 2005 but arrangements had yet to be made for food hygiene, health and safety, and control of infection training. No health and safety hazards were noted during the inspection. Residents and staff considered it a safe place to live and work. With the exception of a 6 monthly inspection of the mobile hoist, regular maintenance checks were undertaken in line with legislation. COSHH risk assessments were written as
Meadow View Care Home DS0000063310.V251652.R01.S.doc Version 5.0 Page 17 required and made available to staff in the office. Fire precaution checks were undertaken on a regular basis in keeping with GM Fire Officer’s recommendations. Induction included fire training but not all staff had had a fire drill within the last 12 months. The home had not informed CSCI of a number of notifiable occurrences since the last inspection. Meadow View Care Home DS0000063310.V251652.R01.S.doc Version 5.0 Page 18 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 X X X X X X X X STAFFING Standard No Score 27 3 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 1 Meadow View Care Home DS0000063310.V251652.R01.S.doc Version 5.0 Page 19 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP24 Regulation 12 Requirement Keys for bedrooms and lockable space must be given to every service users unless risk assessment indicates otherwise. (original timescale28/02/05) Staff must not be employed without satisfactory POVA 1st or CRB checks. Care plans must detail all required care including recent changes. When staff have concerns about a resident’s food/fluid intake, monitoring charts must be completed. All medication received at the home must be clearly recorded with date received, dosage and amount provided. Care managers must be informed of any incident which places a service user at risk of harm in the home. All staff, including the manager, must receive training in the Protection of Vulnerable Adults. All staff must receive training in food hygiene, infection control, health and safety and fire safety.
DS0000063310.V251652.R01.S.doc Timescale for action 31/10/05 2. 3. 4. OP29 OP7 OP8 19 15 12 31/10/05 31/10/05 14/10/05 5. OP9 12 14/10/05 6. OP18 13 31/10/05 7. 8. OP18 OP38 13 18 31/01/06 31/12/05 Meadow View Care Home Version 5.0 Page 20 9. 10. 11. OP38 OP38 OP38OP18 23 13 37 All staff must have at least one fire drill per year. The mobile hoist must be inspected by a competent person every 6 months. CSCI must be informed of all notifiable incidents within 24 hours of their occurrence. 31/12/05 31/10/05 31/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Reviews should be held with service users and/or their representatives on a 6 monthly basis and the record signed by service users/representatives to show their agreement. A maintenance and renewal plan should be written and copies forwarded to the manager and CSCI. Terms and conditions of employment should be issued to staff following 8 weeks of employment in keeping with employment law. 2. 3. OP19 OP29 Meadow View Care Home DS0000063310.V251652.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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