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Inspection on 12/08/08 for Meadow View Nursing Home

Also see our care home review for Meadow View Nursing Home for more information

This inspection was carried out on 12th August 2008.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People`s needs were assessed before they were admitted to the home and people were offered visits to the home before a place is offered and accepted. Some staff were seen responding to people living at the home in a positive way, smiling and giving reassurances, showing patience and understanding. GPs and other health professionals were contacted when required and records were kept of this. The home was generally clean and adequately maintained. The home, including bedrooms were generally well decorated with suitable furniture in place. There were sensory rooms to provide individuals with stimulation. There were pleasant areas for people to spend time outside. Staff spoken with were aware of how to respond to an allegation of abuse as well as the homes `whistle blowing` policy.

What has improved since the last inspection?

Three new `rise and fall` baths had been purchased and were due to be installed in September 2008. These facilities would make a bathing more accessible for everyone living at the home. Some work had been done to the outside areas including a patio area.

What the care home could do better:

Although some work had been done to ensure that people living at the home had person centred plans, more work and training of staff was needed to ensure that this is put into practice. People`s individual records were of mixed quality, some being detailed, whilst others had blank documents or records that were not regularly reviewed. There were not records made of when others made decisions and why. People`s privacy and dignity were not always respected as personal care was seen given in a bathroom with the door open and in communal areas. We received several surveys from staff working at the home. One person wrote in a survey, "we need to employ more staff so that service users are able to go out more. There are some that don`t go out for weeks even though we would like to take them". Activities records showed that some people living at the home received inadequate leisure activities and stimulation. Some staff said that more was done with people, but this was not always recorded. People needing a wheelchair or two staff to take them out went out less often than people more mobile. This did not provide equality of opportunity and was of particular concern as people were paying their mobility allowance to the provider organisation for the provision of transport. There were times during the inspection visit where staff were observed chatting with each other and watching TV, rather than providing stimulation/activities. There was not a safe system for the receipt, administration, storage and disposal of medication. Staff numbers and deployment of staff did not always meet people`s needs for example there were several records written by staff stating that people had missed appointments due to shortages of staff. A prescription for treatment of one person`s pressure area had not been picked up from the GP surgery for six days, and there was no record of monitoring of this health issue. Staff were also undertaking transporting, cooking, laundry, and cleaning, which took time away from direct care. Several people at the home had challenging behaviour and there were a high number of recorded incidents. However not all staff had received training to support them in dealing with this behaviour. There were times when lack of supervision of people living at the home meant an increase in challenging behaviour.Although staff receive induction and mandatory training on starting employment, peoples refresher training was not up to date. One worker spoken with said, "I have had to cancel every course I`ve had booked for the last 3 months because of staffing problems". In the absence of the registered manager, the provider had not organised adequate management cover to ensure that management duties were being met.

CARE HOME ADULTS 18-65 Meadow View Nursing Home Church Lane Calow Chesterfield Derbyshire S44 5AG Lead Inspector Jill Wells Unannounced Inspection 12th August 2008 12/08/0 Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 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 Nursing Home DS0000002064.V369979.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 Adults 18-65. 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 Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadow View Nursing Home Address Church Lane Calow Chesterfield Derbyshire S44 5AG 01246 270235 F/P 01246 270235 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) Enable Care & Home Support Limited Neil Blake Care Home 24 Category(ies) of Learning disability (24) registration, with number of places Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th October 2007 Brief Description of the Service: Meadow View is situated in the village of Calow, approximately three miles to the north east of Chesterfield within a residential area close to local amenities and public transport. The home provides nursing and personal care for up to twenty-four adults with moderate to severe learning disabilities, some also having significant physical disabilities. The home comprises of four bungalows, each accommodating six residents. The bungalows are linked, although each has its own separate kitchen, lounge, dining, bathing and toilet facilities, together with their own garden areas, which have seating provided. Single bedroom accommodation is provided throughout, with six bedrooms per bungalow, each having a washbasin provided. There is level wheelchair access throughout with landscaped grounds and separate car parking areas. There is a choice of transport vehicles for people accommodated, including wheelchair accessible vehicles. Twenty-four hour care and support is provided from a team of nursing and care staff and one housekeeper who are all led by a registered manager. External management support is also provided from the registered provider. The range of fees charged by the home at the time of the inspection visit was confirmed by the provider as £466.04-£504.04 per week. Fees are dependent on individually assessed needs and any funding via local authority and primary care trust, including for the purposes of the free nursing care element of the fee. There are additional charges for personal toiletries and hairdressing. The cost of transport is charged separately and the majority of people receive a paid mobility allowance via their funding authority. Meadow View Nursing Home DS0000002064.V369979.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 the service is 0 star. This means the people who use the service experience poor quality outcomes. The inspection visit was unannounced and took place over 10 hours. There were 23 people living at the home on the day of the inspection. 4 residents, 7 staff, and the service manager responsible for the home were spoken with during the visit. Residents were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. We also looked at all the information that we have received, or asked for, since the last key inspection on the 17th October 07. This included: • The annual quality assurance assessment (AQAA) that was given to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. • What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. • The previous key inspection report Completed surveys from staff. Records were examined, including care records, staff records, maintenance, and health and safety records. A tour of the building was carried out. What the service does well: Peoples needs were assessed before they were admitted to the home and people were offered visits to the home before a place is offered and accepted. Some staff were seen responding to people living at the home in a positive way, smiling and giving reassurances, showing patience and understanding. GPs and other health professionals were contacted when required and records were kept of this. The home was generally clean and adequately maintained. The home, including bedrooms were generally well decorated with suitable furniture in place. There were sensory rooms to provide individuals with stimulation. There were pleasant areas for people to spend time outside. Staff spoken with were aware of how to respond to an allegation of abuse as well as the homes ‘whistle blowing’ policy. Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Although some work had been done to ensure that people living at the home had person centred plans, more work and training of staff was needed to ensure that this is put into practice. Peoples individual records were of mixed quality, some being detailed, whilst others had blank documents or records that were not regularly reviewed. There were not records made of when others made decisions and why. People’s privacy and dignity were not always respected as personal care was seen given in a bathroom with the door open and in communal areas. We received several surveys from staff working at the home. One person wrote in a survey, we need to employ more staff so that service users are able to go out more. There are some that dont go out for weeks even though we would like to take them. Activities records showed that some people living at the home received inadequate leisure activities and stimulation. Some staff said that more was done with people, but this was not always recorded. People needing a wheelchair or two staff to take them out went out less often than people more mobile. This did not provide equality of opportunity and was of particular concern as people were paying their mobility allowance to the provider organisation for the provision of transport. There were times during the inspection visit where staff were observed chatting with each other and watching TV, rather than providing stimulation/activities. There was not a safe system for the receipt, administration, storage and disposal of medication. Staff numbers and deployment of staff did not always meet peoples needs for example there were several records written by staff stating that people had missed appointments due to shortages of staff. A prescription for treatment of one person’s pressure area had not been picked up from the GP surgery for six days, and there was no record of monitoring of this health issue. Staff were also undertaking transporting, cooking, laundry, and cleaning, which took time away from direct care. Several people at the home had challenging behaviour and there were a high number of recorded incidents. However not all staff had received training to support them in dealing with this behaviour. There were times when lack of supervision of people living at the home meant an increase in challenging behaviour. Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 7 Although staff receive induction and mandatory training on starting employment, peoples refresher training was not up to date. One worker spoken with said, “I have had to cancel every course I’ve had booked for the last 3 months because of staffing problems”. In the absence of the registered manager, the provider had not organised adequate management cover to ensure that management duties were being met. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People were not provided with accurate information about the home, in alternative formats suitable to meet their needs. People’s needs were assessed before being admitted to the home. EVIDENCE: In the annual quality assurance questionnaire completed by the home they say that prospective service users are fully assessed by the multi disciplinary team, offered home visits, and given information about the home prior to a place being offered and accepted. They also told us that there had been no new admissions to the home in the last 12 months. During this inspection visit we looked at the service user guide. There was a separate service user guide written for each of the four bungalows. Two of these were seen. These had not been reviewed for some time as they still gave the old name, address and telephone number of the Commission for Social Care Inspection. The information concerning fees was out of date. The service user guide also said that, “no other monies are paid to the organisation”. However in the terms and conditions contract provided for each Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 10 person it stated that each person paid their mobility allowance to the service to cover transport costs, and staff confirmed this. At the last inspection visit a recommendation was made that “The home should continue to develop the service information for people and ensure it is availability in alternative formats for people”. Staff spoken with during this inspection visit were not aware of any service user guide in alternative formats for example audio format. Staff could not find the statement of purpose for the home. Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Although the service understands the rights of individuals to make their own decisions and choices wherever possible and receive appropriate stimulation, this does not always happen in practice as staff have a limited understanding of how to do this effectively. EVIDENCE: In the annual quality assurance questionnaire completed by the home they say that service users choices are respected and person centred plans are completed for all service users. They also said that they could do better by providing all staff with training and knowledge of the formats of person centred planning. At this inspection we looked at the written care plans and associated records for 3 people. They were of a varying degree of quality. One persons that was seen had a detailed personal profile and pen picture that was person centred. Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 12 For example, enjoys bath so time to be spent to have long relaxing bath. Another person had a pen picture and personal assessment document in their file, but both were blank. Some care plans were regularly reviewed. However one care plan that was seen was written in 1996, and had an ongoing review since then but had not been rewritten. The last review was December 2007. One persons care plan reflected a reactive response to the persons behaviour not a plan on how to minimise their challenging behaviour as advised by the psychologist. A staff member was spoken with about training on person centred care. They explained that this training was optional for staff and not many staff wanted to attend. Training records showed that very few staff had received this training. Peoples records showed some examples about peoples ability to make decisions for example one care plan encouraged staff to help a person choose what they wanted to wear by showing them several items. Although there were assessments concerning capacity to consent to health care, the issue of capacity was not generally reflected in people’s records. Although most people living at the home had profound learning disabilities, some individuals had capacity to consent to certain daily tasks and decisions about their own lives. Records did not reflect instances when others made decisions and why. Risk assessments were in place concerning moving and handling, bathing, and using the homes transport. There were also assessments completed concerning nutrition and pressure areas. Daily records were written for each individual. These were generally brief negative comments and mainly related to behaviour. For example, noisy before dinner, agitated, constantly tormenting staff and residents, throwing wet floor signs, reluctant to go to bed, finally went at 12 midnight. Another example was, behaviour not too bad today and, well behaved this morning. Another persons daily records only ever referred to whether they had removed their clothing or urinated inappropriately. Some staff spoken with said that they were tired and frustrated, trying to manage difficult behaviour, and the daily records reflected this. One person said, it is so frustrating, there are so many barriers to doing what we could. Most people that lived at the home had very little or no verbal communication and very limited non-verbal communication. Staff were spoken with about how they understood each individuals communication and they explained that staff that knew people well would share their knowledge with other staff. These essential individual ways of communicating were not always recorded in each person’s plan of care to ensure that staff were supported to understand each persons individual communication method. One staff member spoken with knew residents very well and gave examples of how they enjoyed listening to mobile ring tones and listening to the staff member play a mouth organ, but this was not recorded in their plan. Some staff were seen providing support to individuals without any explanation, verbal or non-verbal interaction. For example a resident was banging a chair into the table. The staff member took the chair out of their hands and moved the person away from the table, leaving the person to quickly return and the Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 13 staff member looking frustrated. There were no distraction techniques used or attempts to communicate with this person. Some staff were observed chatting and watching TV whilst people living at the home were left with no stimulation. There were however also examples of positive communication between staff and individuals for example smiling and reassurances given. One person regularly removed their clothes. There were obvious signs from staff of frustration when this occurred. Staff were observed several times taking this person naked to the bathroom to assist in replacing their clothes. Alternative ways had not been considered for example placing privacy screening around the person in the communal area whilst clothes were replaced. Staff said that the person only removed their clothes when staff were not supervising them. The psychologist report confirmed that they were less likely to do this when they received stimulation from staff, although staff said that they did not have time to provide this as often as was needed. Staff explained that the meeting was planned with a representative from Social Services concerning this person. Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 13,14,16 and 17. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. There were limited opportunities provided for leisure activities, social inclusion and stimulation. Staff did not always put the needs of people living at the home first. EVIDENCE: In the annual quality assurance questionnaire completed by the home they say that all staff at Meadow View strive to provide and facilitate service users to enable and empower them to participate in a variety of activities. They also say that in some cases the amount of staff on duty is under levels due to sickness and holidays. They tell us that the maintenance of the vehicles limit where service users can access as some service users can only access one or two vehicles due to their personal wheelchairs. We received several surveys from staff working at the home. One person wrote in a survey, we need to employ more staff so that service users are Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 15 able to go out more. There are some that dont go out for weeks even though we would like to take them. Another person wrote that, we cant do activities with them because we dont have enough time. At this inspection we spoke with staff about peoples daily living arrangements, leisure, community links and social inclusion. Staff said that most but not all people living at the home accessed day-care, although some people only attended once a week. They said that some people rarely went out and due to staff shortages there was often little time to provide activities in the home. As previously described there were times when staff were observed chatting rather than providing stimulation/activities. Some staff had little understanding or ideas as to ways that individuals could be stimulated. Some staff did not talk or interact with individual residents other than to sit them down or stop them making a noise. In one bungalow the TV was on for the whole of the day but there were no residents that could understand a programme. Activities records were seen. One persons records showed activities on the 1st, 4th, 5th, and 7th August and previous to that there were no activities recorded between 15 May and 1st August. The activities recorded for this person included walking to the chemist, shopping, and ball activities in the home. Staff spoken with said that activities did take place in the home but staff often forgot to record these. A music session was seen taking place in one bungalow, but no activities were seen throughout the day in 2 bungalows. One person’s personal planning book said “enjoys all outings, not interested in other activities. Not enough staff to take out”. The service manager was spoken with during the inspection visit about lack of activities. They said that the home could have an excess of staff and still staff do not use their initiative and take people out. Some staff do not like to walk out with residents and see going out as only using the transport. Several staff mentioned difficulties with the home’s transport. There were two minibuses and three cars, one car that could take a wheelchair. Several staff said that they had stopped driving these vehicles because they were very old and the main mini bus was very big, so manoeuvring it was difficult. Staff in one bungalow said that, as residents in this bungalow were more able to access the cars they were able to go out fairly frequently. Staff said that some people rarely went out on the transport, as they needed 2 staff to take them. This did not provide equality of opportunity. This was of particular concern as people were paying their mobility allowance to the provider organisation for the provision of transport. The service manager spoken with during the inspection visit explained that there should be 20 hours per bungalow for mobility staff to take people out. These were not dedicated staff, but provided by staff that also undertook support worker/nursing assistant duties. Staff preferred to accept over-time on care duties rather than mobility work, as this was better pay. Therefore very few mobility hours were used. Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 16 Several people had been supported to go on holiday this year. The menu was different in each bungalow. The menu displayed in the kitchen for the day in 1 bungalow was not being followed. Staff explained that they had not had time to go shopping due to staffing shortages and therefore the pork steak that was planned had not been purchased. One bungalow had also run out of fresh vegetables and only had one apple and one banana left. Staff explained that they usually had a good supply of fruit and vegetables delivered to the home. The Staff explained that when people needed their food liquefied, this was done separately, which is good practice. Mealtimes were observed. Residents were supported with their meals in stages, therefore several residents had to wait for their meal until another resident had finished. There was very little interaction between some staff and residents during mealtimes. Staff were observed treating meal times as another task that staff had to complete, rather than an enjoyable event for people. For example staff were heard chatting to each other rather than concentrating on the individual that they were supporting. Staff confirmed that there were no records of food provided for each individual, changes to the planned menu or reasons for this. If someone had a different meal to other people for example due to dislikes or dietary needs, the alternative provided was not recorded. Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. There was not a safe medication system to protect people living at the home. Peoples health care needs were met most of the time although there were times when the staffing levels, deployment and poor communication had adversely affected peoples rights to good health care provision. EVIDENCE: In the annual quality assurance questionnaire completed by the home they say that support is provided in relation to service users care plans. Qualified nursing staff facilitates medication systems and appointments are attended to maintain continuity of health care. They say that they could improve by maintaining appropriate staffing levels to ensure appointments are attended and to ensure appropriate time is allowed for staff and service users to carry out personal and healthcare support. Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 18 At this inspection visit we looked at three persons health care records. These showed that GPs were contacted when required and records were kept of this. Dentists, opticians and other healthcare professionals were involved when required. Specialist health care professionals were also involved including nutritionalist and speech therapists. A complaint had been received at the home from a psychologist working with someone living at the home concerning the person’s care. This highlighted that one person required a blood test, but 2 appointments had been cancelled due to inadequate staffing levels. This was discussed with the service manager during the inspection visit. They explained that one appointment had been cancelled as it was a ‘ fasting’ blood test and staff had given the person food. The second appointment was cancelled by staff due to staff shortages. However on investigation of the complaint by the organisation, it was found that a staff member was taking another person at that time for a similar appointment, therefore both could have gone, and there were sufficient staff throughout the building if deployment of staff had been considered. However this person had missed two appointments. Records that were seen also showed that a person had missed a dental appointment due to short staffing. Daily records of one person showed that the GP had advised that a prescription be picked up for treatment of a broken area to a person’s buttock. This was recorded 7/8, however at the time of the inspection visit 12/8 the nurse confirmed that the prescription not yet been picked up. There were no records of any monitoring of this red area. A nurse spoken with said that there had been no deterioration. One person was seen being assisted in the toilet having their incontinence pad changed. The staff member had left the door wide open and anyone passing could see. This does not respect peoples privacy and dignity. One staff member was heard using the term, feeders referring to people that needed assistance at mealtimes. This does not respect each person as an individual. Medication in one bungalow was inspected during this visit. There was an agreed list of home remedies confirmed by their GP. There was a list of staff signatures that could administer medication but not all staff that were administering were on the list. There was a recording system for receiving and returning medication. The home’s procedure says that two staff must sign the record when medication has been received and destroyed, but only one nurse was signing the record and there were occasions where they had not been signed at all. The recording of destroyed medication had only one signature. The medication administration records were handwritten. There was an initial of the person that had written them. The instructions from the pharmacist Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 19 label were not on these records. The recording sheet did not have a place for this to be recorded. Most peoples record included a photograph although one person’s did not. Staff said that this had probably gone missing. Correction fluid had been used on one record, which was not good practice. There were several gaps on the medication administration records where there was no initial or code to indicate whether the medication had been given or not. The nurse in charge was asked to do an audit trail to work out whether medication had been given or not. The systems at the home did not allow the nurse to work this out. This does not ensure a safe medication system. There was a locked fridge for the storage of medication requiring refrigeration. There was a fridge temperature record book, although the temperature should have been taken daily but was last taken over a month ago. Where the medication administration records showed an optional does could be given, staff had not always recorded which dose had been given. The medication trolley had a facility to be secured to the medication room wall, but this was not being used. The medication room was observed to be left unlocked and the key in the keyhole for over three hours. This is unsafe practice. Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Complaints and allegations of abuse were taken seriously and investigated. Lack of training for some staff in dealing with challenging behaviour and aggression may mean that some staff do not have the knowledge and expertise to deal with difficult incidents. EVIDENCE: In the annual quality assurance questionnaire completed by the home they say that policies and procedures are in place in relation to protection of vulnerable adults. The complaints procedure remains in place and there had been one complaint since the last inspection, which is currently being investigated. They say that they aim for 100 of staff to have accessed training in adult protection and strategies for crisis intervention and prevention (SCIP) training to support people in dealing with challenging behaviour. At this inspection visit the complaints procedure was seen. This was in a simple format. The complaint that had been received was from a psychologist who had been working with someone living at the home. It was regarding staffing levels and the impact that this was having on one person and possibly others living at the home. A senior manager from the organisation was in the process of investigating this complaint. CSCI have requested the outcome of this investigation. Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 21 There have been two safeguarding adults allegations made since the last inspection visit. These were both against members of staff. The correct procedures were followed on each occasion with the police and Social Services involved, as well as informing CSCI of the allegations and outcomes. Most but not all staff had received refresher training in safeguarding adults. Training records showed that not all staff had received training dealing with aggression and challenging behaviour. Staff explained that there was one particular bungalow where some people had very challenging behaviour and all staff required this training before working at the bungalow. However the nurse on duty said that two staff had recently transferred to this bungalow had not received this training. At the last inspection visit to the home it was assessed that “the arrangements and planned timescale for the completion of recognised staff training in dealing with challenging behaviours and aggression may not be in peoples’ best interests”. Records of accidents and incidents as well as daily records showed a high number of incidents involving aggression. On the day of the inspection visit one person threw a television. One person regularly up- turned tables. There were several records of hair pulling and scratching between people living at the home. Staff said that some people needed close supervision to ensure that people were safe. One staff member spoken with said that additional staff numbers could decrease the number and severity of accidents and incidents. Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People live in a clean, comfortable environment with aids and adaptations available to meet individuals needs. EVIDENCE: In the annual quality assurance questionnaire completed by the home they say that they provide a homely, comfortable and personalised environment and access to appropriate aids and adaptations to meet peoples needs. They said that all outstanding maintenance issues have been addressed and completed. Three new baths have been purchased and are due to be installed in September. At this inspection visit a tour of two of the bungalows took place. The home was generally clean and well maintained apart from a missing door handle on one person’s bedroom. This had left a hole in the door. Staff checked records, which said that this was reported two months previously. Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 23 The service manager confirmed that three new rise and fall baths were due to be installed in September 08.These would better meet the needs of people living at the home. At the last inspection visit it was highlighted that peoples incontinence pads were on display in bathrooms with individual names in place. Although the names have now been removed, the pads were still not discreetly stored for dignity and hygiene reasons. Flooring in one bedrrom was badly raised. Staff said that there were also problems in other bedrooms with the flooring in the corners where the beds had been moved around. A number of double glazed windows had broken seals causing condensation. This was highlighted at the previous inspection visit. The home, including bedrooms were generally well decorated with suitable furniture in place. There were sensory rooms to provide individuals with stimulation and staff said that these were regularly used. There were pleasant areas for people to spend time outside. Staff said that work had been done on one patio area but one was still uneven. Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 36. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Staff numbers and deployment do not meet the needs of people living at the home and this may at times place people at risk. EVIDENCE: In the annual quality assurance questionnaire completed by the home they say that staff rotas have planned around the needs of the service users in respect of staffing levels. Staff receive regular supervision and 6 monthly development and training reviews. All staff are subject to protection of vulnerable adults (POVA) and criminal record bureau (CRB) checks prior to commencing employment. They say that they could improve by ensuring that all staff vacancies are advertised in the first instance to avoid staffing voids within the home. Comments from surveys received from staff working at the home include, sometimes there are enough staff just to cover day-to-day but hardly any for extras like going out or spending time with residents and we have hardly got Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 25 any staff at the moment, and when there are only two staff on and you are busy with jobs, the service users dont get the attention that they need”. During this inspection visit the rotas were checked. On the day of the visit there were two nurses on duty between four bungalows and two support workers/nursing assistants on duty on each bungalow. There was also two staff taking one service user out, as this person needed two staff to support them. Additional staff that work at the day centre that some people attend were available in the morning to assist with getting people ready for day care, but then left to work at the day centre. The rotas showed that at night there was one nurse on duty between the four bungalows and four nursing assistants/support workers, one working in each bungalow. A staff member said that at times there had been only one nurse and three nursing assistants/support workers at night. The rotas also showed that several staff worked a double shift, which was 14 hours. Although staff spoken with said that this was their choice as they picked up overtime, working this many hours was likely to have an affect on their patience and responses to people living at the home. Staff and the service manager explained that there should be 20 hours per week per bungalow for outings. These were called mobility hours by the home and were done by the support staff. However as these hours were at a reduced hourly rate, support staff preferred to pick up additional overtime rather than the mobility hours. Therefore very few hours were used. Records showed that they were used approximately once per month rather than daily. All staff were also undertaking cooking, laundry, and cleaning, which took time away from direct care. There is one housekeeper at the home. This person works five days per week. Each bungalow received one day’s cleaning per week. All the daily cleaning duties are done by care staff. Staff in each bungalow also did food shopping once a week. As stated previously low staffing meant that sometimes staff could not be spared to do the food shopping and fresh food became depleted. Staff also transported the residents that are attending the day centre at Tibshelf to and from the centre. All of these tasks take staff away from direct care and sometimes away from the home. The last inspection visit also highlighted shortfalls in staffing numbers and deployment. As stated previously staff numbers/deployment had sometimes meant that people living at the home have been unable to attend health appointments. One staff member spoken with believed that increased staffing levels could reduce some of the incidents. Tasks that took people away from direct care meant that there was sometimes inadequate supervision of residents. Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 26 A record of one persons behaviour was being recorded as part of a psychology assessment. The psychologists view was that this behaviour decreased when the person was being supervised and stimulated. Each incident also had a record of where staff were within the home when the behaviour occurred. Examples of this were, ‘one staff in kitchen, one in stores’, and ‘one making tea and one on telephone trying to get staff cover’ and, one giving medication next door and one making tea. This record shows that this person was not receiving adequate supervision to minimise their behaviour difficulties. Daily records showed that staff had recorded on several occasions when care had not been provided due to staff shortages. One example was, missed a few times toileting this a.m. as feeding and bathing other people and only two staff on duty. Staff training records were seen. The record showed that although most people had undertaken mandatory training, several people had not received refresher training for example in fire safety, first aid and food hygiene. Approximately 50 of staff had an out of date three yearly first aid certificate. Most peoples food hygiene training was out of date. There was no one available at the home to discuss training plans. One staff member spoken with had received learning disabilities qualification induction and had registered to start NVQ 2. As stated previously not all staff have undertaken training in challenging behaviour, including some staff that were working with people with very challenging behaviours. I Staff files were not available for inspection. The service manager explained that the key was with the registered manager who was presently on long-term sick. Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,41 and 42. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The home was not being managed in the best interest of people living at the home. EVIDENCE: In the annual quality assurance questionnaire completed by the home they say that the home is run with the health, safety and welfare of service users and staff being promoted at all times. They say that they could improve by filling staff vacancies within shorter timescales and could improve communication within the home. They could also maximise attendance on all mandatory courses. Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 28 The annual quality assurance questionnaire was not returned to CSCI in the timescale required, although a reminder letter was sent. This document was passed to the inspector during the inspection visit. It was explained that the delay was due to the registered manager being off work. At this inspection visit we were informed that there was no one in overall charge of the home on the day. We had been informed in writing that the registered manager was off sick and an acting manager was covering for them. The acting manager was a qualified nurse and worked 28 hours per week. This person had been given no supernumery hours in order to fulfil the responsibilities that she had been given. This was discussed with the service manager who confirmed that the person was continuing to work all of her nursing shifts whilst acting as manager. Staff felt that the senior managers within the organisation did not understand the pressures that staff were under and did not respond to concerns raised for example difficulties with covering shifts and the transport at the home. It was evident that there were some poor communication issues. For example staff members were unaware what was happening in other bungalows and when asked a question about care provided in the service generally they were only able to comment on ‘ their bungalow’. The service did not operate as one service, and although there were advantages to separate units for people living at the home to live in a homely environment, the lack of organisation and staff deployment meant that this was having an adverse effect. The service manager responsible for the home employed by the organisation was undertaking monthly reports. These were seen and did not highlight any significant concerns. Staff spoken with did not feel that they had received additional support whilst the manager had been absent. Policies and procedures were not inspected on this occasion. The visitors’ book was not being used, and this book did not have times of signing in and out. This is a requirement for fire safety. Other records were not being kept for example a record of the food probe calibration, and as stated previously record of food provided or activities undertaken. Staff spoken with were not aware where the latest inspection report or statement of purpose was within the home. Due to staff working on minimum staffing levels, when a member of staff rang in due to sickness this was seen by staff as a crisis situation. On the day of the inspection visit someone rang in sick and this took one person significant time on the telephone to try and cover during a busy time at the home. The service manager spoken with said that she felt staff did not always ring around Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 29 everyone that could be available and were too quick to say that there was no one to cover a shift. Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 1 2 3 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 2 32 2 33 1 34 x 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 X 2 x LIFESTYLES Standard No Score 11 X 12 X 13 1 14 1 15 X 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 1 x 1 2 x x 2 2 x Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes 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 YA18 Regulation 12(4)(a) Requirement Care and support must be provided with dignity and privacy at all times including providing personal care support behind closed doors and away from communal areas, and interactions between staff and residents must be positive to ensure that people are treated as individuals at all time and their privacy and dignity is respected. Staff must have the knowledge and skills to provide positive communication, interaction and stimulation with people living at the home to ensure that residents receive positive support and have the opportunities to develop socially and emotionally. Everyone living at the home must have equal opportunity to community links, social inclusion and leisure activities appropriate to their individual needs and wishes both inside and outside the home, so that people receive adequate stimulation. Timescale for action 12/10/08 2. YA11 18(1) ( c)(i) 12/11/08 3. YA14 16(2)(m) 12/10/08 Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 32 4. YA17 17(2) Schedule 4 5. YA19 6. YA19 7. YA20 8. 9. YA20 YA23 There must be a record of food provided for people and of any special diets prepared for individuals in sufficient detail to determine whether the diet is satisfactory in relation to nutrition. 13(1) (b) Prescriptions and treatments advised by a GP must be picked up and started quickly, and a record made of monitoring of particular health care issues so that peoples healthcare needs are always met. 13(1)(b) People living at the home must be supported and facilitated to attend all healthcare appointments to ensure that peoples physical health needs are met at all times. 13(2) The procedure for recording receipt, administration and return of medication must ensure that an audit trail is possible for each medication so that people are protected by a safe medication system. 13(2) Medication must be stored securely at all times to ensure a safety of medicines. 18(1)(c)(i) Staff must receive training appropriate to the work they are to perform. This includes training in dealing with peoples’ challenging behaviours and violence and aggression so that staff have the right skills and knowledge to provide safe care and support. (A Similar requirement was made at the last inspection visit. The timescale given of 31/01/08 was not met. A further final timescale has been given) 12/09/08 12/09/08 12/09/08 12/09/08 12/09/08 26/11/08 Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 33 10. YA33 18(1)(a) 11. YA35 18(1) (c)(i) At all times there must be staff working in such numbers and appropriately deployed to meet the needs of everyone living at the home. This must take into account work that take staff away from direct care of people, appointments, time transporting to day care, outings, as well as dependency levels of individuals. This is to ensure that people living at the home have their needs met at all times. (A similar requirement was made at the last inspection visit). All staff must receive mandatory training, including refresher training for fire safety, moving and handling, first aid, food hygiene and infection control so that staff have the knowledge and skills to perform their work safely. The staff files must be available for inspection at all times to ensure that CSCI can undertake their Regulation duties. There must be a record of all visitors to the home. This record should include their name, date and time of visit so that people living at the home can be protected and to meet fire safety rules. 26/11/08 12/12/08 12. YA34 17(3)(b) 12/10/08 13. YA37 17(2) Schedule 4 12/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 34 1. YA1 The homes service user guide should be reviewed and provided in alternative formats to ensure that people that need information about the home receive accurate and accessible information. Peoples plan of care and other records should be person centred and individualised and include positive interventions and detailed communication abilities. They should reflect each individuals capacity to consent to various aspects of their care and include when a decision is made by others and the reason for this. This is to ensure that staff are aware of each person’s individualised care and support. All staff should receive training in the person centred care and planning to ensure that care is provided in a way that avoids institutionalised support, language and recording. The provider should review their transport arrangements to ensure that everyone living at the home has equal opportunity to be supported to access transport and engage in leisure activities outside the home. There should be accurate individual records of activities provided both inside and outside the home to ensure that there is evidence that people receive adequate stimulation. There should be sufficient food including fresh fruit and vegetables available at all times so that the planned menu can be followed. Any changes to the planned menu should be recorded with reasons given for the change. Meal times should be relaxed, unrushed and in a congenial atmosphere with staff providing positive, focussed time for each person that needs assistance. Where medication directions show an optional dose, the person administering the medication should record the dosage given to ensure a safe medication system. The temperature of the fridge used for storing medication should be regularly checked and recorded to ensure safe storage of medication. The medication administration records should not have gaps. There should either be an initial or a code to confirm the administration or otherwise of the medication. This is to ensure safe medication system. Medication administration records should include a photograph of every person that receives medication so that staff, including day care staff can use these for recognition and therefore ensure safe medication administration. Correction fluid should not be used on medication DS0000002064.V369979.R01.S.doc Version 5.2 Page 35 2. YA7 3. YA7 4. YA14 5. YA14 6. YA17 7. 8. 9. 10. YA17 YA20 YA20 YA20 11. YA20 12. YA20 Meadow View Nursing Home administration records as stated by the Royal Pharmaceutical Society guidelines to ensure safe medication recording. 13. YA20 The hand written medication administration record should include instructions, taken from the pharmacy label as per the Royal Pharmaceutical Society guidelines to ensure a safe medication system. There should be a list of all staff that can administer medication at the home with a specimen signature and initial to ensure a safe medication administration system. The recording system of receiving and disposing of medication should follow the organisations written guidance which states that two people must sign the records when medication is received and disposed of. This is to ensure a safe medication system. All staff should have up to date Safeguarding Adults training to ensure staff are aware of the up to date policies and procedures concerning protection of vulnerable adults. Repairs and maintenance should be dealt with promptly including a missing door handle on a bedroom door, broken seals of double-glazing window units causing condensation, uneven patio and raised flooring in some bedrooms. This will ensure that people live in a well maintained home. Consideration should be given to the impact on staff and the care provided when staff regularly work 14 hour double shifts. Incontinence pads should be stored more discreetly for dignity and hygiene reasons. The acting manager in the absence of the registered manager should be given adequate support and time to undertake the management duties expected of them to ensure that the home is well managed. There should be a record of attempts to cover a shift that has become available due to last minute sickness to evidence that every attempt has been made to provide adequate staffing. Communication should be improved between the organisation and staff working at the home as well as between staff working in each bungalow so that people living at the home receive effective, consistent, flexible care and support. The last CSCI inspection report should be readily available so that staff and visitors can read the report to inform them of the findings. The food probe should be regularly calibrated as per the home’s written guidelines and a record made of this to DS0000002064.V369979.R01.S.doc Version 5.2 Page 36 14. 15. YA20 YA20 16. 17. YA23 YA24 18. 19. 20. YA36 YA18 YA37 21. YA37 22. YA37 23. 24. YA41 YA41 Meadow View Nursing Home ensure that people’s health and safety are met around hot food preparation. Meadow View Nursing Home DS0000002064.V369979.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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