Inspection on 17/10/07 for Meadow View Nursing Home

This inspection was carried out on 17th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Meadow View Nursing Home 01/04/10

Meadow View Nursing Home 27/01/09

Meadow View Nursing Home 10/10/08

Meadow View Nursing Home 12/08/08

Meadow View Nursing Home 11/12/06

Meadow View Nursing Home 19/12/05

Meadow View Nursing Home 24/08/05

Meadow View Nursing Home 31/01/05

Meadow View Nursing Home 08/09/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Meadow View Nursing Home Church Lane Calow Chesterfield Derbyshire S44 5AG Lead Inspector Sue Richards Unannounced Inspection 17th October 2007 09:30 Meadow View Nursing Home DS0000002064.V354336.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.V354336.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.V354336.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.V354336.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th December 2006 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 led by a registered manager. External management support is also provided from the registered provider Enable, which is a registered charity. Clear and transparent information for people about the fees charged and what they cover was not available at the home at our visit. Copies of some previous inspection reports are openly provided in the entrance area to two of the bungalows, although the most recent report was not amongst these. The range of fees charged by the home is confirmed by the provider via their finance department as follows: £453.70-£491.70 per week following a recent increase on 01/10/07. 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, hair dressing. The cost of transport is charged separately and the majority of people receive a paid mobility allowance via their funding authority. (It should be noted that the fee charged is not a true reflection of the cost of Meadow View Nursing Home DS0000002064.V354336.R01.S.doc Version 5.2 Page 5 the placement as Enable have a significant number of staff who are employed by the local Primary Care Trust seconded into their homes, including Meadow View, therefore those staffing costs are borne by the trust). Meadow View Nursing Home DS0000002064.V354336.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. For the purposes of this inspection we have taken into account all the information we hold about this service. This includes our previous key inspection report of 12 December 2006 and information provided in our annual quality assurance questionnaire completed by the home. We were unable to survey people, as the home did not return the AQAA until after this inspection. At this inspection there were twenty-four accommodated at the home who all receive nursing care and who have severe learning disabilities, with some also having physical disabilities. We used case tracking as part of our methodology. This involved the random sampling of three people, whose care and service provision was more closely examined. We spoke with people, looked at the written care plans and associated health/care records of people case tracked and also inspected their private and communal accommodation. We also spoke with staff and management about the arrangements for their recruitment, induction, training, deployment and supervision. Examined related records and observed some of staffs’ interactions and approaches with others. We also had the formal assistance of an expert by experience, Mr Paul Scarrot, who visited the home on the day of our inspection visit from 11.30 am to approximately 3.30 pm. Mr Scarrot, attended with a personal supporter. His particular focus was to use his personal experience and knowledge to look at how people are supported within their daily lives, with particular focus as to how their rights and quality of life are promoted. He did this by looking around the home, talking with people and by making general observations. Following his visit he provided us with a summary of his views and findings, which are identified and incorporated under the relevant sections of this report What the service does well: People live in a clean and comfortable environment, which is well decorated, furnished and personalised. Peoples’ needs are effectively assessed and accounted for that their care plans continue to effectively underpin the care they receive. Peoples’ rights and responsibilities are mostly respected and recognised by staff that work hard to meet peoples’ needs. Meadow View Nursing Home DS0000002064.V354336.R01.S.doc Version 5.2 Page 7 People are provided with nutritious food and their healthcare needs are effectively managed and met, including their medicines. Satisfactory management systems underpin peoples’ protection from abuse and they are safely and reasonably well supported from a staff team, who are effectively recruited, inducted and trained. The home is reasonably well managed and run and peoples’ health, safety and welfare is promoted and protected. What has improved since the last inspection? What they could do better: Ensure that openness and transparency is promoted with regard to fees information for people by providing clear information about these and what they cover within the home’s service guide, to better assist people in choosing a home. Continue to develop service information for people in alternative formats. Review and develop methods and arrangements aimed at best practise in promoting peoples’ inclusion in respect of their daily living choices. Explore the need to provide independent advocacy for people, and consider the implications for the care home and the people who live there, which may arise from the Mental Capacity Act. Ensure that the arrangements for people to engage in their preferred social, occupational and leisure activities are further improved, to consistently accord with their rights, needs and known lifestyle preferences. Ensure that the training, which is commenced for staff in respect of dealing with challenging behaviour and violence and aggression, is fully completed within our stated extended timescale. Meadow View Nursing Home DS0000002064.V354336.R01.S.doc Version 5.2 Page 8 Give prompt attention to repairs, which are required at the home and ensure that suitable bathing adaptations and facilities are provided for people, which are maintained and are in good working order. Promote peoples’ dignity and privacy by providing suitable privacy screening in bathrooms and appropriate storage of peoples’ incontinence aids. Use the residential forum as a guide to assist in the planning adequate staffing levels at the home and ensure these are always provided. Undertake suitably recorded risk assessment(s) relating to the extensive use of laminate hard flooring throughout the home, identifying any potential associated risks to people, which may result from falls. Review the infection control policy guidance for staff to ensure that it meets with the most recent/current Department of Health guidance for care homes. Ensure that an up to date annual development plan is in place and available at the home. 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.V354336.R01.S.doc Version 5.2 Page 9 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.V354336.R01.S.doc Version 5.2 Page 10 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): NMS 1, 2, 4 & 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Peoples’ needs are effectively assessed and accounted for, although openness and transparency is not best promoted with regard to fees information for people and which does not best assist them in choosing a home. EVIDENCE: At our last key inspection of this service we judged that people can be confident that full assessment information is obtained in order to provide a basis for individuals’ care planning. In our annual quality assurance questionnaire completed by the home they say that they always ensure that people are always fully assessed and have opportunity to visit the home before any arrangements for their admission are made. They say they use a person centred approach, with consideration to peoples’ race, gender, disability, sexual orientation and religion. They say they their records and peoples wellbeing are indicators that this is a successful process and do not feel that they could improve the admission process and the way they assist people to choose the home. Meadow View Nursing Home DS0000002064.V354336.R01.S.doc Version 5.2 Page 11 At this inspection we looked at how information is provided for people about the home and the services it aims to provide. We also looked at people’s written needs assessment information and spoke with staff about these. There were no people accommodated known diverse religious or cultural needs. Although some service information is provided in each bungalow, copies of the most recent inspection report were not available, although reports previous to that were displayed in bungalows one and four. There was no service guide available or clear information as to the range of fees the home seeks to provide, or details as to how fees are determined for people to access before they make a decision to move into the home. Some of the service information is provided in picture/simple format, such as the complaints procedure. The registered manager said that given people’s mental capacities, that their representatives are provided with information about fees direct from Enable before they are admitted to the home and also individual information about fees by way of written contracts/terms and conditions, which are agreed with them on or after their admission to the home. Copies of these, including information in simple and picture format were seen in the individual care files of those people case tracked. These individual terms and conditions provided clear details as to the fees charged by the home for that indvidiual, what is included and what is not and the arrangements for their funding and payment of their fee, including local authority and any free nursing care contribution as determined by those. People’s needs are well recorded and accounted for in a holistic manner, including their individual capacities, known likes, dislikes and lifestyle preferences and recorded the involvment of their representatives in obtaining that information. Copies of assessment information from relevant outside funding authorities are also in place for the determination of people’s placement. Staff confirmed that people are able to visit the home before their admission there. Meadow View Nursing Home DS0000002064.V354336.R01.S.doc Version 5.2 Page 12 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): NMS 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Peoples written care plans continue to effectively underpin the care that is given, although methods and arrangements for promoting peoples’ choices and independent advocacy, could be improved. EVIDENCE: At our last key inspection of this service we judged that peoples’ care plans are generally good and underpin the care that is given and that people are supported to participate as much as they are able to in making choices about their lives. In our annual quality assurance questionnaire completed by the home, they said that they say that they ensure that peoples’ choices are respected and they are included within peoples’ written care plans, which are person centred. They also say that people are supported as much as they are able and in accordance with their given capacities and risk assessed needs, to make Meadow View Nursing Home DS0000002064.V354336.R01.S.doc Version 5.2 Page 13 decisions about their lives. That their evidence of this is largely within the written records and care plans, which they maintain for each person. They feel they have improved over the last twelve months by commencing a programme of training, which all staff are to complete in respect of person centred care planning and that they can continue to improve in this area and ensure that all staff receive this. At this inspection we looked at the written care plans for people case tracked and our expert by experience looked at how people are involved in making decisions about their lives by talking with people and by observation. (Due to their given capacities it is not possible to engage in depth discussions with people who live at the home). Peoples’ written care plans are for the most part detailed and in accordance with their risk assessed needs and are generated from placing/funding authorities single assessment and care plans. They detail peoples specialist care interventions, including that related to those prescribed by outside specialist health care practitioners and for people who are likely to be aggressive where appropriate. Areas where limitations or potential restrictions on individuals’ freedoms have been identified are recorded. Records are made to some extent within peoples’ care plans as to how staff promote people’s daily living choices in accordance with their given mental capacities, although not extensively. At our visit there was one person accommodated, whose challenging behaviour impacts significantly on other people both in the bungalow they live and the immediately connecting bungalow. We spoke with the manager about the home’s understanding and consideration of the Mental Capacity Act and its implications for the home. The manager had recently obtained a copy of this and was due to undertake training in respect of this. A programme of briefings are also planned for all staff to attend. Our expert by experience who visited the home with us, gave the following feedback: That due to people’s given capacities staff often make choices for people. That it is positive that people are supported to have their own bank accounts and are assisted in the safe keeping of any personal monies at the hom That people, are not always best assisted to maximise their capacity to make choices due to lack of aids, such as as pictures or photographs which may assist them in choosing meals, décor of their rooms, holidays etc. Meadow View Nursing Home DS0000002064.V354336.R01.S.doc Version 5.2 Page 14 That advocacy may not be best promoted for people accommodated or for staff in terms of their understanding of its use in respect of decision making, particularly where people lack capacity. Meadow View Nursing Home DS0000002064.V354336.R01.S.doc Version 5.2 Page 15 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): NMS 11, 12, 13, 14, 15, 16 & 17. Quality in this outcome area adequate. This judgement has been made using available evidence including a visit to this service. In many ways peoples’ rights and responsibilities are mostly respected and recognised and they are provided with nutritious food. However, their active inclusion could be better promoted, and the organisation and availability of activities could be improved, to better ensure that peoples’ rights, needs and preferences are more consistently met. EVIDENCE: At our last key inspection of this service we judged that staff, do strive to provide suitable activities and recreational pastimes, however shortages in staffing levels do not always ensure fulfilling lifestyles for residents. In our annual quality assurance questionnaire completed by the home they say that people regularly access day services and that staff always strive to provide social and leisure activities, both within and outside the home and that Meadow View Nursing Home DS0000002064.V354336.R01.S.doc Version 5.2 Page 16 written records at the home evidence this. They say there have been improvements in staffing deployment arrangements resulting in more consistent access for people to day services and other activities. And that once mini-bus driver training currently being undertaken by further staff, will provide a greater improvements for people in terms of accessing the local community. Over the next twelve months they intend to review funding arrangements with the local authority via the care review process in order to seek further service improvements in this area. At this inspection, together with our expert by experience, we spoke with staff about peoples’ daily living arrangements and routines, including as to how they are supported to maintain their links with families, friends and the local community, and also their meals provided. We also examined associated written records for those people case tracked and our expert by experience observed the provision of lunch for people. Feedback from staff was variable regarding the provision of and access to activities for people, including the local community. All said that activities are organised and that people also continue to access day care, although these are still sometimes compromised due to staff shortages caused mainly by staff sickness. One staff member did not feel happy driving the home’s transport vehicle, which they felt was old and worn out. We discussed these issues with the registered manager, who confirmed there had been some staffing difficulties, which had at times compromised access to day care for people. Written records also confirmed this. However, he provided satisfactory details of recently recruited relief and permanent staff who are due to commence their employment at the home and also some staff returning from absence. Details of staff driver training were also provided. Family links and friendships both inside and outside the home are supported and encouraged and the home’s written records, including daily logs demonstrate this. People are supported to go on annual holidays and trips and staff choose these for them. Staff said that people are provided with choice at mealtimes and that they plan and shop to accord with people’s known preferences, likes and dislikes. However, as stated previously there are no suitable aids to assist people in making menu choices, such as picture/photographs menus. Our expert by experience observed that some people who live at the home were completely overlooked and not introduced by staff. Meadow View Nursing Home DS0000002064.V354336.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 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples’ healthcare needs are well met and their medicines are safely managed in their best interests. EVIDENCE: At our last key inspection of this service we judged that peoples health care needs are met as determined by their care plans and that that peoples’ medicines are handled and administered safely. In our annual quality assurance questionnaire completed by the home they say peoples’ health care needs are well provided for via their care plans. That people are supported in the way that they prefer via a named nurse/key worker system and that their medicines are safely managed. They feel that although they have made some improvements by increasing their staffing levels. However, that they could improve further by ensuring better planning for additional staffing provision necessary to escort and support people in their attendance at appointments outside the home and in Meadow View Nursing Home DS0000002064.V354336.R01.S.doc Version 5.2 Page 18 providing more quality time for people from staff who are caring for them. (See staffing section of this report). They say that they aim to address this by continuing to assess and monitor peoples’ needs and by acting according to those needs. At this inspection we looked at how people receive their personal support and healthcare. We did so mainly by discussion with staff and examination of peoples’ personal records as due to peoples’ given capacities we are unable to hold in depth discussion with them about their care. Our expert by experience also talked with staff about the arrangements for peoples’ health checks. We also examined the arrangements for the management and handling of peoples’ medicines for those people case tracked. People personal support and healthcare records are comprehensive and well maintained and include an individual personal plan for each person, which includes details of peoples’ known preferred daily routines, key things that are important to them in terms of their care and support and staff approaches with them. Staff spoken with is conversant with these and also peoples’ wider health care needs and long term goals. Healthcare plans are reflective of recognised practise and peoples’ risk assessed needs and the arrangements for their access to outside healthcare practitioners for the purposes of specialist and routine healthcare screening are also well accounted for. At the time of our inspection visit the speech and language therapist visited a person at the home. The arrangements for the management and administration of peoples’ medicines are satisfactory. Meadow View Nursing Home DS0000002064.V354336.R01.S.doc Version 5.2 Page 19 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): NMS 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Satisfactory management systems underpin peoples’ protection from abuse, although 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. EVIDENCE: At our last key inspection of this service we judged that staff training, policies and procedures with regard to complaints and protection for people were in place to promote their rights. We made a related requirement that staff who require must undertake relevant and recognised training in respect of non-physical and physical interventions for dealing with challenging behaviours (see also Staffing section of this report). We made one recommendation that there should be regular updates to consolidate initial training staff receive regarding safeguarding vulnerable adults. In our most recent annual quality assurance questionnaire completed by the home, they say that they ensure suitable arrangements for the management and handling of complaints and to promote peoples’ protection from harm or abuse. Meadow View Nursing Home DS0000002064.V354336.R01.S.doc Version 5.2 Page 20 They feel they have improved over the last twelve months by introducing training for all staff for crisis intervention and prevention and they aim to improve over the next twelve months by continuing and completing the staff training programme and ensure that they receive regular updates and refresher training via a rolling programme. At this inspection we looked at the arrangements for complaints and for ensuring people are protected from harm and/or abuse, including staff training arrangements. We did this by talking with staff and examining records and we reviewed information we hold about the home with regard to complaints and protection. There is a suitable written complaints procedure for the home and available in a simple picture format for people. There is also adequate policy and procedural guidance for staff in respect of safeguarding people and reporting the witnessing or suspicion of abuse of any person. Staff spoken with is conversant with the above procedures and had received training in respect of recognised safeguarding adults procedures. The manager also provided details for the ongoing updating of staff in respect of these, which are satisfactory and via an ongoing rolling programme. However, some staff confirmed that they have not yet received their formal training with regard to dealing with challenging behaviours and violence and aggression. One of the people case tracked was particularly challenging in their behaviour and frequently aggressive. Staff confirmed there are care plans in place to assist them in dealing with this person and that they worked to an agreed consistent approach, which accords with recognised practise, and which are regularly discussed and reviewed. They also said there is always staff on duty who care for this person who have received the training. The registered manager provided details of training for staff in respect of dealing with challenging behaviours and violence and aggression, confirming that all staff working in the bungalow where the particular resident is accommodated, has received this. He also provided details of a planned rolling programme for all other staff to undertake this outside the home, which is organised by external management. Concerns are raised by a number of staff and including the manager, who felt this training, should be provided sooner for all staff who require this, at the home, to be completed within a short focused timescale in order to consolidate and effect consistency in their skills, knowledge and confidence. Meadow View Nursing Home DS0000002064.V354336.R01.S.doc Version 5.2 Page 21 Meadow View Nursing Home DS0000002064.V354336.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): NMS 24, 27 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service Overall, people live in a clean and comfortable environment, which is well decorated, furnished and personalised. However, the organisation of and attention to required maintenance and repairs at the home, does not always meet with peoples’ best interests. Toilets and bathrooms do not all provide sufficient privacy or meet with peoples’ needs. EVIDENCE: At our last key inspection of this service we judged that a homely, comfortable and personalised environment is provided with aids and adaptations that meet the needs and lifestyles of those residents accommodated. We made three requirements in our report of that inspection regarding repairs in specified areas of the home Meadow View Nursing Home DS0000002064.V354336.R01.S.doc Version 5.2 Page 23 In our annual quality assurance questionnaire completed by the home they say that they provide a clean, homely, comfortable, well maintained and personalised environment, which has the necessary aids and adaptations that people require. They say they have improved over the last twelve months by ensuring that outstanding repairs and maintenance issues detailed in our last key inspection report are addressed. And, that they have also undertaken areas of redecoration and renewal to some furnishings and fabric of the building. However, they feel that the timeliness of response to repairs and maintenance issues could be improved. They aim to complete works a patio area, which are now approved and to install new baths in three of the bungalows in order to better meet the peoples’ changing needs. At this inspection we looked at the environment and spoke with the manager and staff about the arrangements for ongoing upgrading, repairs and renewal of the home. Our expert by experience took a general tour of the home and we looked at some of the private and communal facilities accessed by people that we case tracked. Two of the requirements made at out last key inspection are achieved, works to the patio areas are now organised and due to commence. We therefore agree to an extended timescale for completion of this. Overall the home is clean, tidy, comfortable and personalised. Our expert by experience said that overall he felt it to be a good home. He also said, “It is nice that each bungalow has its’ own garden with a bird table and that each bungalow has a sensory room with suitable decorations and equipment, which are all different.” “Some of the bedrooms are nicely decorated, with different lighting. The staff told us they have bubble bath and music to make bath time more relaxing.” “One of the bungalows has a summer house and chair for one resident who likes to go there for some quiet time.” “All of the lounges had fans and doors opening into the garden with the air flowing through, so it wasn’t stuffy and there are no bad smells.” “Residents clothes are washed separately and put into their own clean laundry boxes so they don’t get mixed up.” However, he did note that that there is no carpet throughout, with all communal areas accessed by people having laminate flooring and some bedrooms. One of the people case tracked did have a carpet in their room. The manager advised us of the reason for its use, which relates to infection Meadow View Nursing Home DS0000002064.V354336.R01.S.doc Version 5.2 Page 24 control advice, however, there was no indication in peoples’ records as to whether this would have been their known preference or choice, although risk assessments are in place with regard to slips and falls. (See also management section of this report re accidents). Not all baths meet peoples’ needs, requiring repair and/or renewal with more suitable adaptations. The spar bath in Bungalows two and four do not function and staff say that given the high level of peoples’ physical needs there that a rise and fall bath is required in bungalow 2. There is a rise and fall bath in one bathroom, for which the seat was broken, although a replacement was ordered via a suitable supplier. Bathrooms also did not best promote peoples’ dignity and privacy in their layout. Being a large open space having a toilet, bath and open walk in shower with no privacy curtains. And although there are separate toilets for people to use, not all of these are accessible due to repairs being required to the door of one and to the lighting in another, which staff said had been for some time. We are advised that it is usual practise to for staff to ensure that only one person uses the bathroom at any one time. Peoples’ incontinence pads are also left out in communal bathrooms with their names labelled onto them and formal general hazard notices detailing person transfer safety requirements are also displayed in bathrooms. A number of windows require repair or replacement of seals to glazing, although this is identified within recent environmental audits undertaken by external management. Since our last inspection a small separate quiet room available within the complex. Meadow View Nursing Home DS0000002064.V354336.R01.S.doc Version 5.2 Page 25 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): NMS 32, 33, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are safely and reasonably well supported from a staff team who are effectively recruited, inducted and trained, although are not always effectively deployed. However, completion of existing recruitment arrangements may better ensure this. EVIDENCE: At our last key inspection of this service we judged that the home is not always appropriately staffed in accordance with peoples’ needs and that staff are not always adequately trained to care and support the resident, which have potential risks for residents and staff. We made three related requirements in the management section of that report with regard to ensuring adequate staffing arrangements, including two further areas of training for staff (aside from that referred to under the Complaints section of this report). In our annual quality assurance questionnaire completed by the home, they say that staff rotas are planned around peoples’ needs. That there are suitably Meadow View Nursing Home DS0000002064.V354336.R01.S.doc Version 5.2 Page 26 trained staff on at all times and that records kept, including those of staff personal development reviews evidence these. They say they have improved over the last twelve months by increasing the provision of staff hours at the home, which has included the recruitment of additional nurses and care staff. They feel they could improve by more effective recruitment planning, to better ensure that posts are not vacant for prolonged periods of time and in ensuring more timely arrangements for staff training. However, at the time of completing this questionnaire they confirmed that they were in the process of recruiting for additional permanent staff and also relief staff to cover for sickness and absence. At this inspection we spoke with staff about the arrangements for their recruitment, induction, training and deployment and examined related records. We also looked at staffing arrangements on the day of our inspection visit. All staff spoken with confirmed that at times, there are some staffing difficulties, but that staff usually worked additional hours to assist in providing adequate cover. All felt that peoples’ care needs are usually well met and that their health, safety and welfare is always maintained, but that these difficulties sometimes impact on peoples’ known preferred lifestyles and as referred to in our findings detailed in the Lifestyle section of this report. Some of the more senior staff felt that staff overhead hours might not be effectively calculated for in respect of ensuring effective planned cover for staff training and holidays. Clear examples of where this had occurred were provided. In our annual quality assurance questionnaire the manager provided details of care, nursing and other staff hours provided in the week before this was completed. For that week, a total of 1,223.5 care staff hours provided, together with 456 hours registered nurse cover in that week. Staff duty rotas provided at this inspection visit, detailed on a par with this. The residential forum guidance for up to 24 people with a high level of need indicates that 1,594.42 care staff hours should be provided, which includes 341.08 staffing overheads. The manager provided details of some permanent and relief staff recently recruited pending receipt of satisfactory criminal record disclosures, which should go some way in meeting those additional hours required. Meadow View Nursing Home DS0000002064.V354336.R01.S.doc Version 5.2 Page 27 The requirement we made at our last key inspection for this service to ensure that adequate staffing levels are provided at all times is to be achieved by 31 December 2007 and therefore is carried forward into this report. We also examined the personal records of four of the most recent staff starters, which for the most part were satisfactory. Confirmation of the relevant recruitment checks, are also provided in respect of each person. However, there was no record of induction kept at the home for them. The manager advised that induction records, is kept at head office and staff spoken with confirmed their satisfactory induction. (See management section of this report in respect of staff training regarding safe working practises, which is achieved in accordance with the two requirements that we made in our last key inspection report). Meadow View Nursing Home DS0000002064.V354336.R01.S.doc Version 5.2 Page 28 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): NMS 37, 29 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is reasonably well run and peoples’ health, safety and welfare is promoted and protected. EVIDENCE: At our last key inspection of this service we judged that peoples’ health, safety and welfare is generally being promoted, although the deficits in staffing and gaps in training that may compromise this. We made three requirements regarding area of core health and safety training for staff. One of these regarding dealing with challenging behaviour is referred to under the Complaints and Protection section of this report and is partially Meadow View Nursing Home DS0000002064.V354336.R01.S.doc Version 5.2 Page 29 complied with. The other two are with regard to safe moving and handling practises and infection control training and are complied with at this inspection. In our annual quality assurance questionnaire completed by the home, they say that they say that the home is always run to promote peoples’ health, safety and welfare. And that there is a formal system of quality assurance and monitoring based on seeking peoples’ views about the home and its services. They say that this can be evidence by they home’s record keeping. They say that they have improved over the last twelve months in their recruitment drive to increase staffing levels and in terms of providing outstanding key training to promote staff safe working practises. They feel they could do better by ensuring that all staffing vacancies are appointed to, by better manpower planning and by continuing to provide key training for staff as detailed above, which is their aim over the coming months. They also intend to implement a recognised quality assurance benchmarking system ‘Essence of Care’ At this inspection we discussed the format of the home’s quality assurance and monitoring system with the manager, including arrangements for monthly visits to the home via external management arrangements. Reports of the monthly visits are provided at the home. Formal feedback following this years’ service audit conducted via external management is not yet provided and there is no formal written development plan available at the home. We are advised of the home’s most recent satisfaction survey sent out to peoples’ relatives and representatives. The results of which are to be collated. The arrangements to ensure staff safe working practises were discussed with staff and also examined via staff training records. These are also satisfactory. We looked at the home’s arrangements for the reporting and recording of accidents at the home, mainly via case tracking. Accidents are properly recorded. These include a number of falls, two of which resulted in residents suffering fractures. Although, the cause of these is directly related to their medical needs and not to individual slips or trips. Meadow View Nursing Home DS0000002064.V354336.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 2 2 3 3 X 4 3 5 3 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 X 26 X 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X Meadow View Nursing Home DS0000002064.V354336.R01.S.doc Version 5.2 Page 31 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 YA1 Regulation 5(1)(ba)(bd) Requirement Timescale for action 17/01/08 2. YA23 18(1)(c)(i) 3. YA24 23(2)(b) (c) & (n) 4. YA27 12(4)(a) Clear and transparent information must be provided about fees for people within the service guide, which must be available to assist them in choosing a home. Staff must receive training 31/01/08 appropriate to the work they are to perform. The training programme now commenced for staff in respect of dealing with peoples’ challenging behaviours and violence and aggression must be fully completed within our stated extended timescale. (NMS YA 27 also applies here). 28/02/08 Prompt attention must be given to repairs, which are required at the home and ensure suitable bathing adaptations and facilities provided for people, which are maintained and are in good working order. The home must be conducted in 31/01/08 such a manner, which respects peoples’ dignity and privacy. In this instance the provision of suitable privacy screening in bathrooms and appropriate storage of peoples’ incontinence DS0000002064.V354336.R01.S.doc Version 5.2 Meadow View Nursing Home Page 32 aids/pads. 5. YA33 18(1)(a) At all times there must be suitably qualified, competent and experiences persons working at the home in such numbers as are appropriate for peoples’ health and welfare. (Carried forward from previous key inspection report of 12/12/06, as timescale to achieve this is not yet expired). 31/12/07 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. 5. Refer to Standard YA1 YA7 YA7 YA16 YA14 Good Practice Recommendations The home should continue to develop it service information for people and ensure its availability in alternative formats for people. Methods for promoting peoples choices should be developed, including picture communication aids to assist in their daily living choices. The possible need to promote appropriate advocacy for people should be explored, together with the implications for the home arising from the Mental Capacity Act. People’s rights and responsibilities should always be respected and promoted with regard to their inclusion within the context of their daily lives. The existing organisation and arrangements for people to engage in social, occupational and leisure activities should be improved to more consistently accord with their rights, needs and known lifestyle preferences. The home should review its infection control policy guidance for staff to ensure that it meets with the most recent/current Department of Health guidance for care homes. There should be an annual development plan in place and available at the home. 6. YA30 7. YA39 Meadow View Nursing Home DS0000002064.V354336.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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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