Inspection on 05/09/06 for Meadow View Care Home

This inspection was carried out on 5th September 2006.

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

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

Other inspections for this house

Meadow View Care Home 16/08/07

Meadow View Care Home 15/03/06

Meadow View Care Home 26/09/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

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 5th September 2006 09:30 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.V298168.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 Home DS0000063310.V298168.R01.S.doc Version 5.2 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 Past or present alcohol dependence (2), Old registration, with number age, not falling within any other category (37) of places Meadow View Care Home DS0000063310.V298168.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 39 service users to include: up to 37 service users in the category of OP (Older People) and 2 named service user in the category of A (Alcohol Dependent). Registration will revert to 39 service users in the category of OP once the 2 named service users are no longer accommodated at the home. The service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. Staff must be provided with relevant information regarding alcohol dependency and treatment related to the service user’s specific needs. 15th March 2006 2. 3. 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 residents 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. The home’s Service User Guide advises residents and their relatives that the most recent Commission for Social Care Inspection (CSCI) report is available in the reception hall. At the time of this inspection weekly fees were £331.42p per week, approximately £1436 per month. Additional charges were for hairdressing, aromatherapy, outings, newspapers/magazines, and toiletries, although the home contributed half the cost of aromatherapy. Meadow View Care Home DS0000063310.V298168.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been written using information held on CSCI records and information provided by people who live at Meadowview Care Home, their relatives, professionals who visit the home, the manager and staff at the home. A site visit to Meadowview on 05 September 2006 took place over 9½ hours. The home had not been told beforehand when the inspector would visit. The inspector looked around the building and looked at paperwork that had to be kept to show that the home is being run properly. To find out more about the home the inspector spoke with six residents, two senior carers, one carer, the cook, the manager, the hairdresser and the maintenance worker. Questionnaires/comment cards asking residents, relatives/visitors and professional visitors what they thought about the care at Meadowview had been given out a few weeks before the inspection. Seven residents, eleven relatives, and two GPs filled them in and returned them to the CSCI. A District Nurse gave verbal feedback over the telephone. Their views are included in the report. What the service does well: What has improved since the last inspection? Since the last inspection the manager had kept a closer watch on areas of responsibility that she had handed over to senior staff. As a result improvement had been made with regard to writing of care plans and administration and management of tablets and medicines. Care plans were more detailed and were discussed with residents and relatives at least 6 Meadow View Care Home DS0000063310.V298168.R01.S.doc Version 5.2 Page 6 monthly. Safer systems were in place to guide staff when giving out tablets and medicines but there were still areas where more improvement was needed. The manager had booked further training for staff. Thirteen staff had attended training in how to keep residents safe and free from harm. They had also attended a variety of health and safety courses. Some bedrooms had been decorated and carpet replaced. What they could do better: 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.V298168.R01.S.doc Version 5.2 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.V298168.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. With the exception of emergencies, prospective residents have their needs assessed prior to admission and are assured these will be met. EVIDENCE: An admission procedure, including the procedure to follow in an emergency was held at the home and was followed. The home’s practice was to visit prospective residents in their own homes or in hospital for assessment prior to admission. Residents were also invited to visit the home prior to moving in. One resident spoken with said it was helpful to look around before moving in and had been able to ask for a ground floor room at this point. Residents returning questionnaires had not visited and relied on relatives for a description of the home. Three residents’ files were inspected and each contained evidence of assessment by Rochdale Social Services Department care mangers as well as senior staff from the home. This information had been used when writing care plans. Meadow View Care Home DS0000063310.V298168.R01.S.doc Version 5.2 Page 9 With regard to emergency admissions, 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. Meadow View Care Home DS0000063310.V298168.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst resident’s health and personal care needs were met, a minority were not recorded and updated which could impact on consistency of care. Residents were treated with respect and their right to privacy upheld. There were shortcomings in the handling and recording of some medication that could result in unsafe practice. EVIDENCE: Three resident files were inspected. Detailed, reviewed care plans were in place for two of these residents but the third, who was receiving respite care, did not have a current care plan. However, the care plan file contained assessments of previous periods of respite care which had been reviewed in June 2006; and risk assessments relating to moving and handling and skin viability. On the day of the inspection, action was taken to review the risk assessments, complete further risk assessments and begin to write the care plan. Completed care plans encompassed health and personal care needs and recorded action to be taken to meet the needs. Although only one resident Meadow View Care Home DS0000063310.V298168.R01.S.doc Version 5.2 Page 11 spoken with recalled that they had a care plan, there was evidence on file that staff were reviewing care plans with residents or relatives. The written records of these meetings recorded good detail of changing care needs. Monthly care plan reviews completed by staff alone often recorded no detail however. Care plan files recorded involvement of GP, District Nurse and other healthcare professionals. Risk assessments with regard to nutrition and skin care were routinely completed and food/fluid intake charts were appropriately introduced and kept. Some staff had attended a teaching session on the MUST nutritional assessment tool given by a PCT dietician. A further session was planned for those who had not attended. Residents were weighed monthly and their weights monitored. Feedback from the District Nurse indicated that staff were providing appropriate care for residents with pressure sores. The District Nurse and 2 GPs completing comment cards considered the home communicated clearly with them; followed their advice; showed a clear understanding of residents’ needs; and provided satisfactory overall care at the home. On the day of the inspection site visit, observation showed that personal care and hygiene needs were met. The majority of feedback from residents and relatives supported this observation. Whilst five residents said they always received the care and support they needed, two said they usually did. Residents spoken with considered they received ‘good care’ which was described by one resident as ‘the care I need’. One relative completing a comment card was ‘delighted with the standard of care’ and considered the resident she visited was ‘safe and happy’, another described the care as ‘top class’. All residents returning questionnaires considered they received the medical care they needed and those spoken with said the home called their GP when they needed them. The services of opticians, dentists, chiropodist and audiologist were accessed as and when necessary. A visiting occupational therapist visited weekly and Active Minds staff visited fortnightly, each included exercise sessions during their visits. Residents who were mobile also walked around the home and the garden in the better weather. Since the last inspection the CSCI pharmacy inspector had undertaken two random inspections at the home. Improvement was noted on each visit but on the last visit on 07 July 2006 there were a number of requirements and recommendations outstanding. These were followed up at this inspection. Medication policies and procedures were in place and had been reviewed and expanded since the last key inspection. However they were still in need of further review to ensure they reflected current practice and to include the procedure for recording verbal dose changes. The procedure included self Meadow View Care Home DS0000063310.V298168.R01.S.doc Version 5.2 Page 12 administration of medication but none of the residents were self administering at the time of the inspection visit. The management of medication brought in by respite care residents had been reviewed in accordance with current guidance and records were seen to be adequately maintained. Medication for one respite care resident was no longer administered from an unlabelled ‘dosette’. None of the residents were self administering at the time of the inspection visit, and all medication was administered by trained staff. Further training had been arranged to help make sure their knowledge is up-to-date. . All medication was administered by trained staff, further training had been arranged to help make sure their knowledge is up-to-date. Senior staff had been regularly auditing the system for a number of months and errors noted with regard to recording and administration had been raised with staff. Whilst this had brought about some improvement this inspection and the audit record showed that some concerns still remain. Most medication was supplied in a Monitored Dosage System (MDS) with preprinted Medication Administration Records (MAR). Medication within the MDS appeared to be given correctly but medicines in traditional boxes and bottles were not well managed. Records showed the tablets had been given but the in three instances the numbers remaining did not match the records. This indicated some staff may have administered the tablets from one resident’s supply rather than from that provided for the named resident. Errors and gaps in the medication administration records meant that it was not always possible to tell whether residents’ medicines had been given correctly. The meaning of the letter codes used to record non-administration was not always clear. Some discontinued medicines were still printed on the MAR sheets. Records of medication received at the home and of medication leaving the home were kept, although handwritten entries were not always signed, checked and countersigned as recommended at the last three inspection visits. The medication storage was orderly and secure. There were no controlled drugs in use at the time of this inspection visit. The drugs refrigerator temperature was satisfactory but staff had not maintained the temperature records during the week prior to the inspection visit. 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. Staff interviewed were able to describe their good practice. Since the last inspection a male carer had been recruited as requested by a male resident. He did not provide personal care for female residents without their agreement – residents spoke positively of his appointment. Lockable space was provided Meadow View Care Home DS0000063310.V298168.R01.S.doc Version 5.2 Page 13 in bedrooms and safety locks were fitted to bedroom doors. Keys were provided for each. Meadow View Care Home DS0000063310.V298168.R01.S.doc Version 5.2 Page 14 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): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Social activities which residents enjoyed were provided on both an individual and group basis. Visiting arrangements at the home were informal and family and friends were encouraged to maintain contact promoting personal relationships. Residents were able to exercise choice and control over their lives. Residents would enjoy a more varied diet that should be planned to ensure it is also wholesome and nutritious. EVIDENCE: Activities were arranged for each weekday and were recorded on a weekly programme. Residents spoken with and returning questionnaires said there were always activities they could take part in. One person said they preferred to stay in their room and did so. Some enjoyed other activities, reading the daily paper, watching TV and video’s, going out. On occasion musical entertainment was also provided. Staff provided some activities e.g. bingo, dominoes, and cards. Residents also enjoyed the opportunity to chat with staff. Care plans inspected recorded residents’ past interests. The home had an open visiting policy and relatives said they were made to feel welcome and ‘at home’. They were usually offered a hot drink during their visit. Residents could see their visitors wherever they wished, either in the Meadow View Care Home DS0000063310.V298168.R01.S.doc Version 5.2 Page 15 lounges, dining rooms (outside of mealtimes) or their bedrooms. Since the last inspection residents had been out to see a musical show and visited a local garden centre. One resident went out to a club weekly and others went to the shops with or without staff, dependent upon their needs and wishes. Residents went out with relatives as and when they wished. Residents’ wishes with regard to their faith were established on admission and recorded on the care plan. A Church of England service was held at the home every week and representatives of two other Christian faiths visited residents regularly to serve communion. Those spoken with were satisfied with these arrangements. The choices residents made each day varied, dependent upon their mental frailty but residents who were able generally chose what time to get up, go to bed, what clothes to wear, what to eat, where to spend their day and whether or not to participate in activities. There was evidence of each of these choices being made on the day of inspection. Information regarding local advocacy services was displayed on the notice board in the reception area. There was evidence on care plans that care managers were contacted to support/advocate for residents as necessary. Residents had chosen not to manage their own monies, all those spoken with were happy with the arrangements in place. Menus inspected were seen to provide a nutritious and varied diet over a 3 week period. However the cooks were not following the menu and one resident said that too much minced meat was served. Observation on the day of the inspection visit supported this statement as the choice was minced meat or beefburgers. As no record was kept of lunchtime choices it was not possible to assess if the food provided was nutritionally balanced and varied. The cook and residents said two hot choices of meal were usually served each lunchtime and two or more choices were provided at teatime. However, records of teatime meals showed that soup and sandwiches were served each day. Desserts had been reviewed since the last inspection and more milk puddings provided in place of stodgy puddings. Residents said drinks were provided regularly through the day and during the hot weather staff `had encouraged’ them to have cool drinks. Residents said fresh fruit was not often served although it was occasionally cut up and offered as a snack during the day. The cooks should do this more often. Residents’ opinions of the food varied, of those returning comment cards three said the food served was always to their liking, three said it usually was and one said it sometimes was. Comments made by residents during the inspection were that the food was ‘mediocre’, ‘OK’, and ‘well prepared’. One person said they didn’t like fish cakes/fingers which were served regularly and another commented that the eggs were hard at breakfast time. Toast was not prepared freshly for residents and teatime sandwiches were seen to be prepared early and not refrigerated up until they were served. The cooks Meadow View Care Home DS0000063310.V298168.R01.S.doc Version 5.2 Page 16 should review how soon they prepare food before a meal and where they store it to ensure it is fresh and appetising when served. Suitable provision was made for those needing special diets i.e. diabetic and soft diets. Staff gave appropriate assistance to those needing it. Supplementary drinks were provided for those in need of them. Monitoring of food intake was detailed for those who were unwell or had poor appetites. Meadow View Care Home DS0000063310.V298168.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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 and residents were safe living at Meadowview. EVIDENCE: The home had a complaints procedure that 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 and recorded six complaints that had been investigated internally in the last 12 months. All were seen to have been addressed quickly, action taken and outcomes recorded. The CSCI had not received any complaints about the home since the last inspection. 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. A carer appointed since the last inspection said that this had been discussed with her as part of her induction when she began work. Thirteen staff had attended POVA training since the last inspection and the manager was planning to send those who hadn’t yet Meadow View Care Home DS0000063310.V298168.R01.S.doc Version 5.2 Page 18 attended. Almost all the staff had completed or were in the process of completing NVQ level 2 that included learning in this area. Appropriate reporting had been followed by senior staff following an incident involving two residents at the home. Residents spoken with all said they felt safe living at Meadowview. One relative expressed some concerns about a service user who at times raised their voice and who they considered may become aggressive. Prior to the inspection the manager had addressed the issue with the resident’s care manager and doctor and considered the matter to be resolved. Meadow View Care Home DS0000063310.V298168.R01.S.doc Version 5.2 Page 19 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): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A safe, clean, pleasant, hygienic and well-maintained building was provided for residents. For residents’ comfort, attention needed to be paid to renewal of a minority of furniture and fittings. EVIDENCE: The home was safe, adequately maintained, and clean. Inspection of the maintenance book showed that small repairs were done quickly, discussion with the maintenance worker supported this view. Bedrooms were decorated cyclically and/or as they became empty. Evidence of this policy was seen during the inspection. Since the last inspection a carpet had been replaced following damage by a wheelchair, and plans were in place to replace the back retaining wall. Despite recommendation at the last inspection, there was no planned maintenance and renewal programme at the home and no planned replacement of furnishing and fittings. One relative who completed a comment card said that bedroom furniture and curtains were in need of replacement. Some easy chairs and commodes in bedrooms were seen to be due for Meadow View Care Home DS0000063310.V298168.R01.S.doc Version 5.2 Page 20 replacement at the time of the last inspection (March 2006) and observation showed that in a minority of bedrooms this; a rusty toilet scandia frame was in need of replacement; and corridor walls needed attention. The manager and responsible individual should audit the home and include each identified area of need in the maintenance and renewal plan, along with a timescale for their replacement. The maintenance worker was responsible for the upkeep of the grounds which were seen to be safe, tidy and accessible. Residents said they had enjoyed sitting outside in the good weather and one resident helped in the garden at times. Level access was provided to the home, along with a passenger lift and handrails in corridors. Grab rails were provided beside all toilets and baths were fitted with hoists. Two level access showers were provided which residents appreciated. Neither the Environmental Health Department nor Greater Manchester Fire Officers had visited the home since the last inspection. Residents spoken with were pleased with their individual rooms and there was evidence they had brought in a number of personal possessions to make them more homely. All bedrooms were fitted with door locks and lockable storage space to ensure resident’s valuables were kept safe. Staff had a master key, which could be used to gain access in an emergency. Door keys were seen to be hung in the bedrooms and a minority of residents said they used them. Everyone spoken with thought the home was a safe place to live and work in. Residents and relatives spoke positively about the cleanliness, and all the residents returning questionnaires said the home was always fresh and clean. A GP considered a ‘very nice environment’ was provided. An infection control policy was in place and staff spoken with described safe infection control practice. Although one relative completing a comment card considered there was some malodour at the home, none was observed. Disposable gloves and aprons were provided for staff use when assisting with personal care. Different coloured disposable aprons were used when staff were serving food. Liquid soap and paper towels were provided in communal areas. Antiseptic hand gel was provided for staff working with a resident who had an infection at the time of the inspection. Satisfactory practice was in place with regard to disposal of clinical waste. The laundry was sited away from the food preparation area and was seen to be clean and orderly. Sufficient and suitable equipment was provided and laundry was attended to efficiently. Meadow View Care Home DS0000063310.V298168.R01.S.doc Version 5.2 Page 21 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, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sufficient numbers of staff were provided to meet the needs of residents. Recruitment and selection policies supported and protected residents. The majority of staff were trained and competent to do their jobs. EVIDENCE: Inspection of three weeks rotas showed that sufficient staff were provided to meet the needs of residents. Observation and feedback from residents and relatives supported the view that there were enough staff on duty each shift to meet residents’ needs. Residents said that staffing levels only dropped if ‘someone rang in sick’ and that they ‘quickly got a replacement’. Residents spoke well of staff describing them as ‘excellent’ and ‘brilliant’. They said that they ‘liked a bit of fun’ and were ‘there if needed’. Relatives described staff as ‘very caring and efficient’ and a GP found them to be ‘very pleasant’. Over 50 of the care staff had an NVQ qualification. Of seven senior carers and twelve care assistants, four seniors had an NVQ level 3, and two seniors and seven carers had an NVQ level 2. A carer was nearing completion of NVQ level 3 and three carers were on the course at the time of the inspection. A newly recruited carer planned to enrol for NVQ level 2. In addition to the above, the deputy manager had completed NVQ level 4 in care and the assistant manager had achieved NVQ level 4 and the Registered Manager’s Award. Meadow View Care Home DS0000063310.V298168.R01.S.doc Version 5.2 Page 22 Inspection of three staff files showed that Criminal Records Bureau (CRB) checks which the home had applied for were in place for all staff. They had all begun their employment on receipt of Protection of Vulnerable Adults (POVA)1st checks but prior to receipt of CRBs which the home had applied for. The inspector was informed they had been closely supervised during their initial employment. The manager agreed to ensure that in future staff would no longer began work prior to receipt of a CRB which the home had applied for. Inspection of files showed that other recruitment procedures were satisfactorily followed. References and work permits were in place as necessary. Inspection of files showed that induction was provided on appointment and staff said they shadowed other workers until they felt confident enough to work alone. The newest staff member interviewed said that the induction met their needs and they felt ready to do the job when it had finished. Skills for Care Common Induction Standards had not been introduced at the home. These should be implemented for new employees and for those who have not completed TOPSS foundation training or NVQ level 2. The manager kept a staff training record but this was in need of updating in order to ensure refresher training was provided as necessary. Further comment, regarding health and safety training, is made in the management and administration section below. Meadow View Care Home DS0000063310.V298168.R01.S.doc Version 5.2 Page 23 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): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvement was noted in management of the home but further work was needed to ensure that, for the safety and welfare of residents, requirements were met on time and residents were sufficiently consulted about the service provided at the home. EVIDENCE: The registered manager is a registered nurse who has had experience and training in 1st and middle line management within the NHS. She holds a degree in health studies, a diploma in counselling and a clinical teaching certificate. She does not hold the Registered Manager’s Award (RMA) but had completed a Coaching and Mentoring Course since the last inspection. Management tasks were delegated to the deputy manager, assistant manager and senior carers. The deputy manager had completed NVQ level 4 in care and the assistant manager had completed both this and the RMA. Since the Meadow View Care Home DS0000063310.V298168.R01.S.doc Version 5.2 Page 24 last inspection the manager had more closely monitored areas of delegated responsibility, and improvement had been made with regard to delegated tasks of care planning and medication management. As detailed above, they were in need of further improvement however. The home had the Investors in People Award which had been renewed in August 2005. They also had a Quality Audit policy that included satisfaction questionnaires for service users and visitors, although this had not been used since the last inspection. Other systems for seeking feedback on the service included annual residents meetings and 6 monthly staff meetings, although a meeting planned for July 2006 had not been held. Resident/relative involvement in writing and reviewing care plans had improved and there was evidence of this on file. The responsible individual conducted regular visits to the home as required by Regulation 26 of the Care Homes Regulations 2001 and copies of these were sent to the manager and the CSCI. Residents, relatives and staff said the manager was accessible on a daily basis and would listen and address matters raised. There was no current annual development plan at the home. Improvement was noted in the meeting of requirements identified in CSCI reports but a number remained outstanding. East & West Healthcare acted as corporate appointee for three residents, upon their request. Relatives and solicitors acted on behalf of others, although the home remained responsible for monies left at the home by relatives for residents’ use. Records and monies held in respect of two residents were inspected and seen to be in order. There was evidence of regular audit. Records showed that health and safety training was provided on an ongoing basis. Although the staff training record was in need of updating the manager appeared to know who was in need of training or refreshers and allocated places accordingly. A number of staff were in need of food hygiene refresher training and the manager had plans to hold an in-house course. No health and safety hazards were noted during the inspection. Residents and staff considered it a safe place to live and work. Regular maintenance checks had been undertaken in line with legislation. Feedback from a relative indicated that annual testing of small electrical equipment had not been carried out satisfactorily. Print outs of the results of these tests were held in the office and showed that each item had been tested. COSHH risk assessments were written as 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 and a fire lecture had been held since the last inspection. Not all staff attended, the manager planned to arrange a further lecture and to ensure all staff had a fire drill. Meadow View Care Home DS0000063310.V298168.R01.S.doc Version 5.2 Page 25 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 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Meadow View Care Home DS0000063310.V298168.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15 Requirement Care plans must be written and reviewed for residents receiving respite care. The registered person must continue to audit the management of medication to make sure medicines are given correctly and that accurate records of medication administration are maintained. (Previous timescale of 07/07/06 not met) The registered person must ensure that all medicines, including those for respite care residents, are administered from the pharmacy labelled container. (Previous timescale of 17/07/06 not met) The registered person must review and implement the medication policies and procedures. (Previous timescale of 24/04/06 not met) DS0000063310.V298168.R01.S.doc Timescale for action 05/10/06 2. OP9 17(3)(a) 05/10/06 3. OP9 13(2) 05/10/06 4. OP9 13(2) 05/10/06 Meadow View Care Home Version 5.2 Page 27 5. OP15 17 Menus providing a choice of nutritious, balanced and varied food to residents’ liking must be provided and maintained. The manager should ensure that staff not undertaking NVQ training achieve competence with regard to Skills for Care common induction standards. (Previous timescale of 30/06/06 not met) The provider must ensure there is an effective quality assurance and quality monitoring system based on seeking the views of service users. (Previous timescale of 31/08/06 not met) 31/10/06 6. OP30 18 12/11/06 7. OP33 24 31/10/06 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 2 3 4 Refer to Standard OP9 OP9 OP9 OP19 Good Practice Recommendations Handwritten MAR entries should be signed, checked and countersigned. A procedure for recording verbal dose changes should be implemented. The drugs refrigerator temperature should be regularly recorded and monitored. A maintenance and renewal plan should be written and copies forwarded to the manager and CSCI. Meadow View Care Home DS0000063310.V298168.R01.S.doc Version 5.2 Page 28 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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