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

This inspection was carried out on 12th August 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Meadow View Nursing &... 16/10/07

Meadow View Nursing &... 06/06/06

Meadow View Nursing &... 11/10/05

Meadow View Nursing &... 10/05/05

Meadow View Nursing &... 13/10/04

Meadow View Nursing &... 23/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Meadow View Nursing & Residential Home Finlay Avenue Penketh Warrington Cheshire WA5 2PN Lead Inspector June Shimmin Unannounced Inspection 12 and 14 August 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadow View Nursing & Residential Home Address Finlay Avenue Penketh Warrington Cheshire WA5 2PN 01925 791180 01925 728730 bsamuel@ashberry.net 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) Ashberry Healthcare Limited Mrs Pauline Leah Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing: Code N, to people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category: Code OP The maximum number of people who can be accommodated is: 41. Date of last inspection 16 October 2007 Brief Description of the Service: Meadowview Nursing and Residential Home provides both personal and nursing care for 41 older people. It is located in Penketh, a suburb of Warrington in Cheshire. The home is on a main bus route and fairly near to shops, churches and a library. The home is a single storey building with 41 single rooms, lounge, two dining areas, conservatory, laundry and hairdressing salon. There is a small, sheltered garden at the front of the building and several smaller sitting out areas around the building. The weekly fee payable at the home ranges from £333 to £440. Further details regarding fees are available from the manager. Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. An unannounced visit to the home was carried out on 12 and 14 August 2008 by two inspectors and lasted nine hours. One inspector carried out a short observation in one part of the main lounge. Because people living in care homes are not always able to tell us about their experiences, we used a formal way to observe people in this key inspection to help us understand. We call this the Short Observational Framework for Inspection (SOFI). This involved us observing 5 people who live in the home for up to 2 hours and recording their experiences at regular intervals. This included their state of well being, and how they interacted with staff members, other people who live in the home and the environment. This visit was just one part of the inspection. Other information received about the home was also looked at. Before the visit the home manager was asked to complete a questionnaire to provide up to date information about Meadow View. CSCI questionnaires were also sent out to people who live in the home, their families and staff in order to find out their views. Other information since the last key inspection was also reviewed. During the visit, various records and the premises were looked at. A number of people who live at the home, several relatives and staff were spoken with and they gave their views about Meadow View. What the service does well: Staff working at Meadow View are highly regarded. Typical comments were, “staff are very kind and caring” and “the nurses, carers, cooks are good. Cook will do what you want. If I don’t fancy something she will do something else. You can’t fault the place”. Most staff enjoy working at Meadow View. They told us, “we have a very friendly, cooperative team who all work together to give the best to our residents”. One relative commented about the standard of catering, “good variety of well cooked food.” There are a number of activities taking place in the home so people living there have the opportunity to enjoy taking part in social events. Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Meadow View needs to improve the content and layout of the information given to people about the home so that it is easy to read and understand. A written assessment of the care needs of people moving into the home must be provided to show that the home can meet the needs of people wishing to live there. Records about the prevention and management of pressure ulcers need to improve to show that staff are managing these issues well. Care plans and risk assessments should be written as soon as possible after a person moves into the home to ensure that their care needs are identified and appropriate actions taken promptly to meet those needs. Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 7 Records must be kept of all complaints together with the outcome of any investigation and the actions taken as a result to show that the home’s manager is listening to what people say and acting on their concerns. All staff must undergo further refresher training in safeguarding adults so they know how to identify potential abuse and what to do if they suspect someone is being abused. Policies and procedures relating to safeguarding adults need to be updated to make sure that they give staff clear advice about the actions to take if abuse is suspected. Upgrading of bathrooms and showers needs to take place to ensure that these are suitable for people living in the home. Sufficient storage space should be provided so that bathrooms and shower rooms are not being used to store items. Unwanted or broken equipment should be disposed of. Recruitment procedures need to be improved so that suitable references are provided by previous employers and people know that staff are suitable to work in 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 & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. Information about the home is difficult to read and understand so people may not be aware of all the services offered by the home. A full assessment of people’s needs is not always carried out before they move into the home so their needs may not be fully identified or met. EVIDENCE: Meadow View provides information in a folder (Service User Guide) for people considering moving into the home to help them decide if their needs will be met there. However, it is written in small print, which would make it difficult for some people to read. The style of writing is very formal and uses a lot of jargon that people might not understand. The leaflet refers to “enclosures” which are not included in the folder. The address of the CSCI referred to the Northwich office, which closed in February, 2008 so people might not know how to contact us if they wished to do so. Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 10 Two people had been admitted to Meadow View as an emergency the previous evening. The deputy manager said that essential details about their care needs had been communicated by telephone. The social worker had not yet forwarded a written copy of their care needs. The deputy manager said that a nurse was compiling care plans to make sure that their needs would be documented and so that staff would know what those needs were. We asked to see the assessments of three people who recently moved into Meadow View. In two cases the deputy manager said that the original assessment could not be found. A senior carer had completed the third assessment with support from the deputy manager but the assessment lacked detail so that various care needs had not been fully identified. For instance there was no weight recorded, an inaccurate description of a pressure ulcer and little information about the social care needs and mental health state of the person being admitted. This means that the person’s care needs might not be fully identified before admission. However, staff at the home had completed a “life profile” for two of the people shortly after they had moved in. This is good practice as it enables staff to understand the individual’s family background, social and cultural needs, which means that care can be more person-centred. In all instances a social worker had completed a separate assessment of the person’s needs although in one case the social worker stated that there had been no changes in a period of four months. Since moving in this person had been admitted to hospital on two occasions indicating perhaps that the person’s care needs had increased. Although Meadow View offers respite care it does not provide intermediate care so Standard 6 does not apply. Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The health and personal care needs of people living in the home are generally well met but documentation regarding the prevention and management of pressure ulcers needs to be improved to demonstrate that people are fully protected. EVIDENCE: The care plans of three people living in the home were seen. One was for a person coming into the home for respite care, one for a person receiving nursing care and the third for someone receiving personal care only. Overall the care plans were somewhat confusing as risk assessments had been written for issues that should have been written as a care plan. For instance, the home had a risk assessment tool for the identification of people at risk of developing pressure ulcers, a further risk assessment for this and a care plan. The second risk assessment appeared to serve no purpose and could confuse staff about how they should be dealing with these areas of care. Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 12 The care plan for a person who had moved to the home for respite care was not written until three weeks after they moved in. The only document completed on the day of admission was a moving and handling risk assessment so that other risks such as the risk of developing pressure ulcers were not documented on moving in even though the person was later identified as being at high risk. Two days after moving into Meadow View this person was admitted to hospital and discharged eleven days later. A care plan was still not provided at this time so staff would not know what actions should be taken to meet that person’s care needs. The content of the care plans was satisfactory but did not state what the person could do and there was nothing recorded regarding the person’s social needs. The care plan for a person receiving nursing care was generally of a good standard and had been kept under monthly review. The content of the reviews was good and showed that staff had evaluated whether care was effective. The nutrition care plan identified that the person was losing weight and action had been taken to introduce supplementary drinks so the person was now regaining weight. However, the documentation of a pressure ulcer was not of a good standard, as it had not been kept under regular review so that the deterioration in the pressure ulcer was not recorded over a period of three months. Also the care plan did not sufficiently detail the size, grade or description of the pressure ulcer, indicating that nurses needed further training in this subject. A care plan for catheter care did not include the actions to be taken to manage the catheter safely. The care plan does encourage the person to remain independent where possible and this is good practice. There was a care plan for the risk of social isolation but this was not specific enough. For instance it stated that the person enjoyed music but not modern music but did not state what the person actually enjoyed listening to. The manager said that the home is trying to move towards more person centred care but this is not yet reflected in care plans. The third care plan and risk assessments were written when the person moved to the home. The care plans were confusing as several care needs had been written on one care plan. The content of the care plans needed to be more detailed to indicate the actions that should be taken by staff to meet the care needs of the person. The records about a pressure ulcer had again not been fully documented so that there were insufficient actions described to meet the care needs of the person. During a tour of the building one it was noted that appropriate pressure relieving equipment was provided in several bedrooms. Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 13 A liaison nurse at Warrington hospital communicates between the home and the hospital about any residents who are admitted to hospital. She keeps the home up to date with their progress. She lets the home know of any special equipment or care that they will need when they return to the home. She is also able to identify and facilitate any training the home’s staff need to look after a person returning from hospital. This has helped people to return more quickly and the nurses at the home find it very helpful. Records indicated that contact was made with various care professionals whenever necessary to ensure that people in the home received appropriate advice and support. The management of medication is quite good. Several minor issues were raised with the manager, who undertook to put them right. The home has just changed to a new local pharmacy a month ago and has been provided with two new medicine trolleys, making it easier for staff to administer the medicines. Overall, the records show that people living in the home receive their medication as it has been prescribed. During the SOFI the inspector noted a number of very positive interactions between staff and people living in the home. Whenever staff spoke to people who were sitting down they crouched down and made eye contact. They spoke quietly and privately to people and were aware of dignity considerations for example when asking people would they like to go to the toilet before lunch. Staff appeared comfortable with touching people. One person was a little agitated and a member of staff sat by her and held her hand and stroked her hair till she was calmer. Another person needed to be hoisted from armchair to wheelchair. This was done extremely well with two members of staff chatting to her through the procedure. They were asking her about what she would like for lunch. The transfer was completed with no distress to the person. Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People in the home enjoy a good standard of catering and have access to a range of social activities so their quality of life is enhanced. EVIDENCE: People living in the home are offered a choice of meals at both the main meal of the day served at lunch and also in the evening. The quality of food provided was good and the cook said that the home uses a variety of fresh and frozen produce. Although the menu is displayed in small print in the entrance to the home it is also written on a board in the dining room so people can see more easily what the choices are. Staff were also observed asking people what they wanted to eat. The cook was aware of people who needed specialist diets so that people received the food in a manner they could manage. The manager said before the inspection that “as a result of listening to people who use our services we have reviewed the menus to ensure the quality of food meets the wishes and nutritional requirements of people living in the home.” Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 15 During the morning a staff member was playing floor snakes and ladders with a few people who seemed to be enjoying themselves. The carer said that staff can provide activities for people when they have time from their caring role. However, sometimes residents are not interested in doing anything. It was also noted that two televisions were on during most of the day but no one was watching. The lack of quiet areas in the home makes it difficult for people who do not want to watch television to sit in an area other than their bedroom to read a book or newspaper. People did say that they could stay in their own room if they wished. Relatives commented that they were made to feel welcome when they visited and found the staff friendly. An activity organiser is employed at Meadow View and she plans a weekly activity programme. She had provided a summer newsletter, which was displayed in the entrance of the home in large print so that people could read it easily. A summer fair had been held the week before our visit; the manager told us it had been a great success. A coach had been hired to take a group of people living in the home and helpers to Chester Zoo. Information about other activities on offer was displayed in large print and included monthly quizzes, making hanging baskets and painting plant pots, the compilation of scrapbooks and memory boards and making cards for sale at the home. Evidence of the handiwork of several people was seen in the garden at the front of the building. The manager said that the activity coordinator also takes people into Warrington on shopping trips. Photographs of people taking part in activities were displayed in the dining room and showed people enjoying visiting entertainers, painting, cooking and playing bowls. One relative commented, “Mum enjoys going to the pub and making cards.” A representative of a local church visits Meadow View every month and people can join in if they wish. Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. Insufficient record keeping regarding about complaints means that the home may not be fully listening to people who make complaints. A lack of clarity about the actions to take if an allegation of abuse is made puts people in the home at risk of not being adequately protected. EVIDENCE: Meadow View has a complaints procedure, which is displayed in the entrance to the home. During the inspection this was amended to include the up to date telephone contact details for CSCI so people could contact us by telephone if they wished. It should also include the fax and email address of the CSCI so that people can use other methods of communication if they wish. The home should also ensure that this information is added to the Service User Guide, which is given to people when they come to live in the home so they have up to date information. The manager did not tell us about the number of complaints received by the home before the inspection and there was no record in the home of complaints prior to April 2008 so it was difficult to check if complaints had been made during the period since the last key inspection until April 2008. Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 17 The manager showed us the follow up to a complaint made in June 2008. However, although three complaints had been made about the conservatory there was no written response to these complaints so the manager could not demonstrate that the concerns of the people making the complaints had been taken seriously or acted upon. The manager considered that as the complaints had been made verbally that it was only necessary to respond verbally. Records show that all staff have undertaken training in safeguarding adults in the last year either externally or via a training session organised in-house by the home. However, the outcome of a recent allegation relating to safeguarding adults indicates that senior staff are not fully aware of their role and responsibilities in this regard, potentially putting people at risk. This is not helped by a safeguarding adults policy for the home, which is ambiguous, so does not give staff clear guidance about what to do if they suspect someone has been abused. Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22 and 26 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. Although some improvements have been made to the environment further redecoration and upgrading of the home is needed to make it a pleasant and comfortable living environment. EVIDENCE: During a tour of the building no odours were noticed and effective measures were in place to control the possible spread of infection in the home. Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 19 Since the last key inspection various improvements have been made to the internal environment of the home. These include new flooring in all the main corridors and the building of a small conservatory. However, there have been major problems during the building of the conservatory and the manager could not provide a date when this work would be completed so that it is currently unoccupied. This means that there is still limited space for people seeking somewhere quiet to sit. At a staff meeting there was a reference in the minutes to the lounge being “institutionalised.” Part of the area next to the lounge has been converted to a nurses’ office, which enables staff to keep a closer watch over people in the lounge and to be more accessible to residents and relatives. During a tour of the premises it was noted that paintwork in the corridors and especially on the doors was badly knocked and looked shabby. Lighting in some parts of the home was not very good. Some bathrooms were used for equipment storage. The manager should conduct an audit to check if all of this equipment is needed or is useable so that any unnecessary equipment can be disposed of. None of the bathrooms were at all pleasant and none were suitable for the more dependent residents. One senior staff member said that she thought the bathrooms were very poor. In the last inspection report there was reference to a new shower room being built but 10 months later it is still at the planning stage. This is really needed particularly for people who can’t access the bath. A part time gardener is now employed at the home. There have been some improvements to the exterior of the home with some gardens looking better cared for, mainly at the entrance to the home. To the rear one courtyard looked drab with evidence of weeds and few flowers. The garden seating was worn and shabby and needed painting or varnishing to make it comfortable and safe to sit on. Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. Recruitment procedures are not sufficiently robust to make sure that staff are suitable to work with the people who live at the home. Despite an extensive training programme few staff have achieved an NVQ qualification so might not be fully equipped to meet the needs of people in the home. EVIDENCE: Staffing levels during the morning of our visit appeared sufficient to meet the needs of people living in the home. During the afternoon it was noted that staffing levels decreased slightly and that people had to wait for someone to come to help them. For a short period of time there was no one available in the main lounge to either observe or offer assistance to residents. This was discussed with the deputy manager and it was suggested that a different deployment of staff might help in this regard. People living in the home and relatives were complimentary about staff and typical comments included, “receiving good care.” Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 21 The recruitment records of three new staff were seen. In all cases there were issues with the references obtained. For instance there was no reference from the previous employer of one nurse recently recruited so that the home could not verify if the person’s performance was satisfactory during their last employment. Some recruitment information was missing but later provided by the manager during feedback about the findings of the inspection. Training records indicate that the home has carried out training in various mandatory and other subjects. The Director of Operations for Ashberry Healthcare wrote that five staff have achieved NVQ2 and one person NVQ3. Other staff are working towards these awards. The home has started the process of training staff about caring for people with dementia and this process should continue so that all staff are aware of how to care for people who find it difficult to communicate. Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. The management of the home is not yet fully developed to ensure that the home is run in the best interests of people living there. EVIDENCE: The manager has been through the process to become registered with the CSCI as required by law. The manager is a registered nurse and has nineteen years experience in care of older people. She has worked at the home for two years and has been manager for fifteen months. The manager is supported by a deputy manager who is also a nurse. Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 23 Staff say that the manager is approachable. She is very committed to her role but has shown that she is still learning about the full extent of her responsibilities. The manager has started the registered manager’s award and hopes to complete this next year so that she will have a management qualification. Various methods are used to check the quality of care and services at the home. The manager has carried out audits of various processes such as medication, which has helped to raise standards in this regard. A senior manager of Ashberry Healthcare visits the home monthly to report on progress in the home. A report was not available for February 2008 and the report for July 2008 was only a brief report following a telephone call from the Commission. Reports for other months were available. The manager has held staff meetings so that staff can voice their opinions about how the home is managed. The manager is hoping to hold meetings for residents and relatives in the near future. The manager keeps us informed of notifications for some matters arising at the home but not all that are required by the regulations. The manager completed a CSCI questionnaire about the home before our inspection took place. Parts of this were not completed so that we were not given all the necessary information about the home. For instance the section on maintenance of the home was not fully completed so it was difficult to check when or if various equipment and installations had been serviced in the last year. Several people living in the home commented that they had to keep their doors closed at all times because of the fire risk. The doors were not fitted with self-closing devices, which have to be fitted to any fire door that is kept open so they close automatically if there is fire. Records were seen relating to monies kept on behalf of residents by the home. These were accurate and up to date. Records about training in fire safety, fire drills and moving and handling indicated that most staff had undertaken this training in the last year so that they had completed this mandatory training and would be competent in those areas. Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 2 2 2 X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No 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 OP3 Regulation 14(1) Timescale for action A full assessment of a person’s 12/11/08 needs must be carried out before they move into the home, (except in emergencies), so that people know that their needs can be met there. A record of complaints made 12/11/08 about the home must be kept together with information about the investigation and any actions taken as a result, to show that people are being listened to and their concerns taken seriously. All staff must undertake 12/11/08 refresher training in adult protection so that they can recognise abuse and know what to do about it. Bathing facilities must be 12/02/09 provided that are suitable for the needs of all people living in the home. Requirement 2 OP16 22(3), (4) and (8) 3 OP18 13(6) 4 OP21 23(2) (j & n) Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 26 5 OP29 19(4)(b) (i)(c) Schedule 2 (3) As part of the recruitment 12/11/08 process, two written references must be obtained for all staff who are employed at the home. This should include a reference from the person’s previous employer and records should be kept of any difficulty obtaining references and actions taken as a result. This means that people are protected by a robust recruitment policy. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The Service User Guide should be amended to make it easier to read and free of jargon so people can understand it. It should include the contact details of the CSCI so people can choose how to contact the commission if they wish. Assessments should include information about a person’s previous hobbies or leisure interests so that carers can provide activities that are suitable for the individual and so that care is person centred. Documentation relating to the prevention and management of pressure ulcers should improve to show that staff are knowledgeable about what they are doing and so that people receiving care are protected. Care plans and risk assessments should be written when people move into the home so their care needs can be fully met and they are not put at risk. The home’s policy and procedure relating to safeguarding adults should be amended to make it easier to understand and to give staff clear guidance about what to do is they suspect someone is being abused. 2 OP3 3 OP7 4 5 OP7 OP18 Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 27 6 7 8 OP19 OP20 OP22 9 10 11 12 13 OP28 OP30 OP31 OP38 OP38 The rear, external areas of the home and garden seating should be improved so that people can enjoy the gardens. There should be a review of the way shared living spaces are used so that people can enjoy social interaction of their choice without the interference of excessive noise. Items should not be stored in bathrooms and the provision of storage space should be reviewed so that people living in the home have easy access to toilets and bathrooms at all times. A minimum of 50 of care staff should achieve NVQ 2 so that they have the knowledge and skills to perform their role. More staff should be given training in dementia and the management of challenging behaviour so that they can manage the care of all people living in the home. The manager should complete NVQ 4 in management to demonstrate that she has the knowledge and skills to perform her role. The manager should ensure that the CSCI is notified of all events as stipulated under regulation 37 and as required by law. Consideration should be given to fitting self-closing devices on all bedroom doors so that people can keep their doors open if they wish. Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection North West Region Unit 1, Level 3 Tustin Court Port Way Preston PR2 2YQ 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. Extracts may not be used or reproduced without the express permission of CSCI Meadow View Nursing & Residential Home DS0000059120.V369525.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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