Inspection on 11/06/09 for Meadowbank Nursing Home

This inspection was carried out on 11th June 2009.

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

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

Meadowbank Nursing Home 20/06/07

Meadowbank Nursing Home 17/05/06

Meadowbank Nursing Home 26/10/05

Meadowbank Nursing Home 25/05/05

Meadowbank Nursing Home 13/10/04

Meadowbank Nursing Home 28/04/04

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 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Meadowbank Nursing Home Meadow Lane Clayton Green Bamber Bridge Lancashire PR5 8LN Lead Inspector Vivienne Morris Key Unannounced Inspection 11th June 2009 09:30 DS0000025569.V375784.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadowbank Nursing Home Address Meadow Lane Clayton Green Bamber Bridge Lancashire PR5 8LN 01772 626363 01772 698044 askinsh@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Ltd 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) Mrs Helen Elizabeth Askins Care Home 120 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Meadowbank Nursing Home DS0000025569.V375784.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. To service users 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 Dementia - Code DE The maximum number of service users who can be accommodated is: 120 Date of last inspection 20th June 2007 Brief Description of the Service: Meadow Bank Nursing Home is situated in Bamber Bridge close to the motorway network, easily accessible by road and public transport. The home provides care for up to 120 persons within four 30-bedded single storey homes, set amongst well-established, landscaped gardens. Enclosed sensory gardens are also available. Care is provided for the frail elderly and persons requiring care associated with a diagnosis of dementia. All private accommodation is in single, fully furnished bedrooms. Although there are no en-suite facilities provided, toilets and bathing facilities are conveniently located throughout the home. Each house has pleasantly decorated spacious lounges and dining areas, although service users are able to dine within their private accommodation, if they so wish. The laundry services and kitchen facilities are centrally located within the administration block and main reception area. The scale of charges as at 11th June 2008 ranged from £335.50 to £ 726.00 per week. Additional charges were incurred for hairdressing, chiropody, magazines and newspapers. The service users’ guide contained detailed information about life at Meadow Bank and it was provided to prospective residents to assist them in Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 5 making an informed choice about where to live. This document was also available in each bedroom so that people living at the home could refer to it as they wished. The quality rating for this service is three star. This means that people who us this service experience excellent quality outcomes. Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The last key inspection to this service took place on 20th June 2007. A review of the service was conducted on 20th June 2008. The quality rating for this service is three star. This means that people who use this service experience excellent quality outcomes. Every year the provider completes a selfassessment, known as an AQAA, which gives information to the Commission about how the service is meeting outcomes for the people living at the home and how the quality of service provided is monitored. The site visit to Meadow Bank formed part of the inspection process and was conducted by two inspectors from the Care Quality Commission over one day in June 2009. It was unannounced, which means that the managers, staff and people living at the home did not know it was going to take place. During the course of the site visit, discussions took place with those living at the home, as well as relatives, staff and managers. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation was viewed and all communal areas were seen. We also observed the general activity within the home. Comment cards were received from three people who were living at the home, 14 staff members and three relatives. Their feedback is reflected throughout this report. Every year the provider completes a self-assessment, known as an AQAA, which gives information to the Commission about how the service is meeting outcomes for the people living at the home and how the quality of service provided is monitored. We observed the activity within the home and tracked the care of four people during the site visit, not to the exclusion of other people living at Meadow Bank. The total key inspection process focused on the outcomes for people living at the home and involved gathering information about the service over a period of time. The Care Quality Commission had received three complaints about this service during the past twelve months. Two were referred back to the provider to investigate using the home’s complaints procedure and the third resulted in a random visit being conducted. What the service does well: People’s needs were assessed before they moved in to the home so that the staff team could decide if they were able to provide the care and support required by each individual. Most of these assessments were very detailed, providing staff with clear guidance about how individual needs were to be best Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 7 met. The privacy and dignity of people living at the home was respected and this was confirmed by those spoken to and through the policies and procedures of the home. The plans of care provided staff with very clear guidance about how the assessed needs of people living at the home were to be accurately met. They were very person centred and extremely detailed showing an individualistic approach to care. A wide range of external professionals were involved with the care of people living at Meadow Bank so that they received the health care which they required. The routines of the home were very flexible and activities were arranged within the home for those who wished to participate. Relatives spoken to were happy about how visitors were received into the home and they told us that the staff were all very friendly, kind and caring. Sufficient information was provided to people about the use of the local advocacy services to act on their behalf, should they so require and people living at the home were able to have some control over their lives by managing their own finances, should they so wish. A choice of menu was available and the atmosphere at lunch time was relaxed so that people were able to enjoy their meals. Those requiring support with eating their meals were assisted in a discreet manner, whilst others were encouraged to eat independently. The complaints procedure was freely available within the home and it was also included within the service users guide so that people were given enough information about how they could make a complaint should they so wish. The policies and procedures in relation to safeguarding vulnerable adults were easily accessible and staff spoken to knew the procedure to take should an allegation of abuse be received by the home. A pleasant environment was provided for the people living at Meadow Bank, it was clean, tidy, warm and comfortable, which created a homely atmosphere. Odour control was in general good and the risk of cross infection was minimised as a result of the practices adopted by the home. The staffing levels were calculated in accordance with the assessed needs of people living at the home and when people became more dependent on staff support then numbers of staff on duty were adjusted accordingly. Before people had started working at the home they had been taken through a detailed induction programme so that they knew what was expected of them and so that they were able to do the job for which they had been employed. Records showed that a wide range of training had been provided for staff and that a good percentage of care staff were appropriately qualified to ensure that people living at the home received the care and support needed. Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 8 The recruitment practices adopted by the home were thorough so that those living at the home were appropriately safeguarded. When asked what the service does well one member of staff wrote on the comment card, ‘it is a very caring home, which has good standards in all aspects. Very welcoming to clients, relatives and staff. There is a caring support team for staff to help meet training needs’ and another commented, ‘we are provided with up to date and ongoing training. We have a good staff support network. The unit and home managers are very approachable’. One person living at the home commented, ‘I have no complaints whatsoever. The feeling of peace and safety I feel is immense. I have suffered such horrible nightmares I am still terrified of going to live alone. Even to visit my home fills me with dread. Thank God for Meadow Bank’. One relative wrote on the comment card, ‘the staff are always very friendly and welcoming. They do an excellent job in all aspects that I have seen. They treat the residents with respect and dignity at all times and they cope with difficulties with the utmost professionalism’ and another commented, ‘they provide basic care well. The home is kept clean and warm. What has improved since the last inspection? What they could do better: The pre-admission assessments could have been more consistent in the amount of detail provided for staff, to ensure that everybody’s needs were thoroughly assessed before they moved in to the home using a person centred approach. The responses received about meals and activities varied quite significantly. Therefore, it is recommended that the home look in to these areas to Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 9 determine if some people are not entirely satisfied and the reasons why they are not. The home could now extend monitoring the quality of service provided by circulating questionnaires to stakeholders in the community to see if they felt that goals were being achieved for the people living at Meadow Bank. When asked what the home could do better one relative wrote on the comment card, ‘the time given to residents by carers is usually very rushed. Some carers (not all) rush round at great speed and don’t give any time to the residents’ needs’. Comment cards received from people working at the home, in general, were very positive, but a few negative responses were provided, although we could not find evidence on the day of our visit to support such comments. We spoke to a high percentage of residents, relatives and staff who were all happy with the quality of service provided. However, it may be useful for the management team to look in to the issues raised, which were about the care provided, meals served and the provision of activities. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 10 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 Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of people were assessed before they were admitted to the home so that the staff team could ensure that they could deliver the care and support required by each individual. EVIDENCE: During this visit to Meadow Bank Nursing Home we examined the preadmission assessments of seven people living at the home. We found that, in general, people’s needs were thoroughly assessed before they went to live at Meadow Bank to ensure that their individual needs could be fully met so that they received the care and support required. The assessments seen on three of the four houses were extremely detailed and provided staff with clear guidance as to how the needs of people could be best met. However, the two pre-admission assessments seen on Ribble House could have been more Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 12 person centred and could have provided more specific detail about the individuals’ needs and exactly how these were to be met. Comment cards were received from 14 staff in total, 13 of who were care staff. Ten of the 13 care staff told us that they were always given up to date information about the needs of the people they supported. Written comments included, ‘the unit manager and staff nurses are always updating us about any new changes’, ‘we are given a full handover of clients needs before they come to the home’ and ‘it depends upon staff, as some of the most experienced staff do not inform us of any important information, such as, the admission of a new client or a change in someone’s medication’. Comment cards were received from three people who use the service and all three said that they received enough information to help them decide if the home was the right place for them to live. One of these people wrote, ‘my son got information from the internet. We came to visit and loved it’. Two of the three relatives who sent us comment cards said that they always received enough information about the care service to help them make decisions; one person said that they sometimes did. When asked what the service does well, the manager of the home wrote on the self-assessment, ‘comprehensive written information is provided to all prospective clients, outlining the ethos of Bupa Care Homes and Meadow Bank, as well as vital information to help with the process of choosing a care home. Prospective residents who are unsure are given the option of a trial in the home, to ensure their happiness and well-being’. The manager supported these statements by giving some good examples of how they were achieved. One member of staff working on Sabrina House told us, “The unit is managed really well and effectively. Theres good communication - we know everything about a new resident before they come to the home. This helps us prepare as a team. This is the best team Ive ever worked in. You get enough information about residents to care for them. The nurses sit down and discuss things in a group - how we could care for the new resident, how they would interact with other residents. If residents needs change the main nurse and associated nurse discuss things. They speak to the family and see if there is anything in their background that may have affected them. Then the care plans are updated. We have good relationships with the residents’ families. Its a relaxed unit”. Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs were fully met, their privacy and dignity being respected at all times and the management of medications was good. EVIDENCE: Over the course of the day we spoke at some length with many people living at the home and their relatives about the care they received and we observed the general day to day activity within the home. The registered manager told us what the service did well and provided some good examples to support the information she gave to us. The care plans seen were very detailed and person centered, being based on the information collected in the assessment period before admission to the home to ensure that all assessed needs were taken in to consideration. Clear guidance was provided for staff as to how peoples needs were to be met and a wide range of assessments were in place which identified any potential risks so Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 14 that strategies could be implemented to keep people safe. One person living at the home said, “We are very well looked after. The staff are great. I am very happy living here”. We received 13 comment cards from care staff who work at the home. One of these people told us, ‘as a carer we do not receive information regarding residents who have passed away. As a part time carer I do not receive enough information’ and when asked if staff are given up to date information about the needs of people they support one person wrote on the comment card, ‘it depends upon staff, as some of the most experienced staff do not inform us of any important information, such as, the admission of a new client or a change in medication’. The three people who live at the home and who sent us comment cards told us that in general they receive the care and support they need and that the home always makes sure they get the medical support which they require. When asked what the home does well one of these people wrote, ‘it cares for all my needs’. Three relatives who sent in comment cards told us that, in general they felt the needs of the people living at the home were fully met. The plans of care had been reviewed regularly and any changes in peoples needs were reflected well. The health care needs of people were recorded very well, supported by a risk management framework and a wide range of external professionals were involved in the care provided to those living at Meadow Bank, so they received the health care required. Medications were being managed appropriately so that people were protected from any medication errors or drug misuse. The plans of care incorporated good accounts of how the privacy and dignity of people needed to be respected, particularly when providing personal care. We saw that those living at the home had a good rapport with staff and that staff spoke to them in a respectful manner and treated them courteously by knocking on their bedroom doors before entering so that their privacy and dignity was protected. Policies and procedures were in place in relation to maintaining peoples privacy and dignity and information was given to people living at the home and their relatives about the importance of respecting peoples wishes. A policy was in place in relation to equal opportunities and non-discriminatory practices to ensure that everyone living at the home were treated the same and were provided with the same opportunities. One person told us, “the staff are all very kind and they treat me well” and another said, “I have no complaints about the way I am treated”. Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The daily routines of the home were flexible and people were encouraged to maintain their leisure interests and activities whilst living there. The management of meals was good and visitors were made welcome to Meadow Bank. EVIDENCE: The social care needs of people moving in to the home had been assessed very well by the use of, a map of life, which described any significant events in peoples lives and told us about the people important to them. The map of life also told us about individual leisure interests and hobbies as well as their life history. Collectively this information provided a clear pen picture about peoples lives throughout the ages. The organization had introduced ‘personal best’, which identified individual interests and supported people to maintain these interests whilst living at the home. One person had been a keen bird watcher and so the home had supplied a CD of bird songs for him to listen to. Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 16 We visited each unit in turn and gathered a lot of information about life at Meadow Bank. The atmosphere in each of the four houses was calm, relaxed and happy. We spoke with many people during our visit who all provided us with positive feedback about Meadow Bank. Comments received from people living at the home included, ‘I am more than happy with the home. Everyone is so friendly and helpful’ and ‘I enjoy playing Bingo and the meals are very good’. Two activity co-coordinators were employed at the home who were responsible for organizing, planning and implementing activity programmes throughout the site. We spoke with one of these staff members who was extremely motivated and entertaining for the people living at the home. We were impressed with the progress made on Sabrina House since our last visit to this service. A café and sweet shop had been developed, which was a replica of an old fashioned sweet shop and which was accessible to people living on the other three units. The patio outside this area we were told is going to be converted in to an extension of the café. A games room had also been created, which housed a rowing machine, football machine, snooker table and punch-bag. We were very impressed with the unit manager on Sabrina House who was extremely motivated to provide a good service for the people living there. He was very knowledgeable about the needs of people in his care. He demonstrated good management skills and therefore the unit was well organized, providing a suitable place for people to live. Information was provided to people about visiting arrangements within the home, showing that relatives and friends were able to visit at any time and that contact with the local community was regularly encouraged, such as visits from religious ministers and outside entertainers. Information about local advocacy services was easily accessible within the home, so that people were aware of how to access someone to act on their behalf, should they wish to do so. Visitors spoken to said that they are always made to feel welcome by staff. On the day of our visit the food served looked appetising and nutritious and the menu showed plenty of choice. Those we talked to told us that the food was good and that they were happy with the choices that were on offer. Lunchtime was a very relaxed, enjoyable experience for those living at the home and people were offered the daily choice of food. Staff were very aware of the likes and dislikes of those who were unable to make their own choices and they were seen to anticipate people’s needs well. The management of meals was good. We observed lunch being served and saw that staff were very sensitive to the needs of people living at the home. Staff constantly acknowledged residents with winks and smiles and explained what they were doing. When one resident asked for something, a staff member replied in a Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 17 cheerful manner, ‘course you can’. Quiet encouragement was given, which people responded to positively. One person living at the home said, I enjoy the meals I am given and there is plenty of choice”. When asked if the home provided activities that people could join in, those who sent us comment cards and who live at Meadow Bank provided us with mixed views. One person told us that the home could provide more suitable activities. When asked if those living at the home enjoyed their meals, one person indicated on the comment card that they usually did and another two said that they sometimes did. One staff member wrote on the comment card, ‘the quality of food is extremely poor and each client will not gain nutrients from the food served’. However, we did not receive any negative feedback about the meals from those we spoke to during our visit. Two staff members, when asked what the service could do better indicated that residents could have a balanced diet and improved activities which are suitable for all the service users, including days out for suitable residents. When asked what the service does well the registered manager wrote on the home’s self-assessment, ‘we ensure that all personal plans are individual and based on the choices and preferences of the residents. Should they chose to do so, residents are encouraged to handle their own finances. We encourage the personalisation of a residents personal space, giving somewhere they can really feel at home. We have developed our menus to allow for resident choice and preferences. The Menu Master helps ensure every menu within the home is customer led and nutritionally balanced. The Nite-Bite menu allows our residents to choose what to eat when they feel like it, providing healthy choices at any time through the night. We provide picture menus to help open up choice. We encourage the involvement of residents and staff in the development of the menus. We have a structured activities programme, with dedicated Activities Co-ordinators’. One member of staff working on Sabrina House said, “The garden is set up for growing flowers and vegetables to sell to visitors and staff. We have dominoes, reminiscence (done individually, not as a group) and board games, musicals, football nights. We try to take people out as much as possible. We have quiet chats. Theres a snooker and football game. We identify those who dont join in and try and encourage them to do individual things, such as having nails done, or flower arranging. We have a sensory room as well, theres quite a lot going on! They would possibly benefit from more outings, but thats linked to staffing levels. We take them out for lunch, including the families with us. There could possibly be a bit more fruit but on the whole there is a balanced diet. A good choice as well. Usually the menu for the next day comes and the residents choose what they want. If theyve forgotten what they chose, they can change. They get enough, and its good quality. Wed make food at night if they wanted anything. We have night boxes, holding Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 18 tins of beans, spaghetti, chocolate, biscuits etc to use. If a resident stays in bed, breakfast can be served within a timescale, because we have to think about when the next meal time is, but its their choice”. A member of staff working on Ribble House told us, “the meals are good, and the only thing I would comment on is that the soft diets always seem to be made up of mashed potatoes and they would have that twice a day. I have told my line manager but nothings changed. There is always fresh fruit available. Activities are difficult because this is the nursing unit, but we will often manage dominoes and bingo, and a fairly good range of activities”. We spoke to many other people who all gave us an account of life at Meadow Bank and all were positive comments. One person living at the home said, “They’re all lovely girls - the day and the night staff. I would tell matron if I was unhappy. I love my room. I wanted a patio door so when another room became available they let me move. I love my Bingo, and Ive done arts and crafts and we have social evenings. I think everyone here is happy and likes it. Theres always a choice of meals - there may be something you dont like, but theyll give you something else”. Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints were managed well and people living at Meadow Bank were safeguarded by the robust policies and procedures adopted by the home. EVIDENCE: There was a clearly displayed and easily accessible written complaints procedure for the people living at the home and their relatives and this was included in the home’s Service Users’ Guide so that people would know how to make a complaint should they so wish. All three people who sent us comment cards and who live at the home told us that there is someone they can speak to informally if they are not happy and that they would know how to make a formal complaint, should they need to do so. Two of these people said that staff always listened to them and acted upon what they said and the third person told us that staff usually did. Those we spoke to during our visit all told us that they would know who to speak to should they want to make a complaint. All 13 care staff who sent us comment cards said that they would know what to do if a service user, their relative, advocate or friend had concerns about the home. People who we spoke to said that they had no complaints at all about the service provided and that they were quite happy with the care and support received. Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 20 There were policies and procedures in place for the Protection Of Vulnerable Adults and the training matrix showed that people working at the home had been given training on abuse awareness. All those we spoke to on the day of our visit told us that they would know what to do should they have concerns about the welfare of someone living at the home. One member of staff told us, “Im aware of the Whistle blowing Policy, and if I thought anyone was being abused in some way I would speak to my manager about it, or my senior, and would write a statement if needed” and another commented, “If someone wanted to make a complaint, Id advise them to speak to a senior member of staff, but we also have complaints forms on the unit. I know about the complaints procedure. You inform the manager or senior who writes it down and they pass it to the manager who passes it to Head Office”. Another staff member told us that they had received training about the Whistle blowing policy. Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home, in general, provided a safe and well-maintained environment for people to live in, which was homely, clean and hygienic. EVIDENCE: We toured the premises during the course of our inspection and we found it to be of a good standard. The registered manager told us what improvements had been made during the last two months, she wrote on the home’s self assessment, ‘an extensive refurbishment programme has taken place improving all houses with new furniture, bathrooms, flooring and decorations. All three people who sent us comment cards and who live at the home said that, in general the home was fresh and clean. One of these people simply wrote, ‘exceptional’ when asked about the standard of cleanliness. Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 22 Beech House. Beech house was seen to be clean and comfortable, providing a pleasant home for people to live in. Bedrooms were personalised, communal areas were tastefully decorated and the house was maintained to a good standard, creating a homely and safe environment for those living at Beech house. There was a system in place so that any maintenance problems were appropriately reported, to ensure that any work required was carried out promptly. An enclosed sensory courtyard was available outside, with a seating area, providing a safe and pleasant area for people to sit during the warmer weather. Willow house This house was very clean and comfortable throughout, with nice touches, such as a variety of flower arrangements in the communal areas and personal possessions in bedrooms, which provided a lovely and homely environment for the people living at Willow house. Sabrina house People living at Sabrina house had easy access to a secure courtyard, so that they could sit outside and enjoy the fresh air at their leisure. Pictures were displayed around the house and where possible personal possessions adorned bedrooms. There was a lot of space available for these people, which was important to them. The house was uncluttered, therefore providing a safe environment for people living there. This unit had undergone some massive structural alterations and complete refurbishment since our lat key inspection, which made it brighter and more homely for the people living on Sabrina House. However, there were a few areas needing attention. The fence in the secure garden behind Sabrina House was broken, the lounge carpet near the window was ‘sticky’ and there was a slight unpleasant smell in one area of Sabrina House in the corridor. Ribble House. The general environment on Ribble house was of a good standard. Bedrooms were personalised and the unit was clean and tidy throughout, providing a pleasant and homely place for people to live in. General The main kitchen and laundry departments are situated in a separate administration block, central to the four houses. Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 23 The kitchen was fit for purpose, being clean and well equipped with sufficient utensils to ensure effective management of meals. The laundry department was well organised, with sufficient machinery to meet the needs of the residents and of the home. The staff working in this department were fully competent to correctly operate the equipment to ensure an efficient laundry process. The AQAA showed that policies and procedures were in place in relation to the control of infection and, in general, the home was free from offensive odours throughout, providing pleasant smelling and hygienic environments for people to live in. The entire grounds of the site at Meadow Bank were very well maintained, providing pleasant areas for people to walk or to sit in. It was observed that at the time of the site visit some work was taking place within the grounds to further enhance the outdoor areas. Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A good number of care staff working at Meadow Bank were appropriately trained. The numbers of staff on duty were sufficient to meet changing needs of residents and the recruitment practices thoroughly safeguarded those living at the home. EVIDENCE: At the time of the site visit there were a total of 91 people living at Meadow Bank Nursing Home. We spoke to staff on all four houses, who provided us with some positive comments. It was pleasing to see that those working at the home looked happy and demonstrated positive attitudes. Beech House. At the time of our visit there were 25 people living at Beech house. The duty rota was examined on this unit, which showed staff that were on duty at any time of the day or night and which demonstrated that additional staff were brought into work as people became more dependent on care intervention. Ribble house. There were 22 people living on Ribble house at the time of our visit and it was noted that the level of care required by these people was very high. However the duty rota showed a high ratio of staff to residents to ensure that people’s needs were being consistently met. Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 25 General Notices were displayed within the different houses about training that was planned for the near future, showing that the home was committed to keeping staff up to date with current practices and allowing for personal development, so that the people living at the home received appropriate care. Some staff training certificates were displayed within the houses and others were retained on staff files, confirming that a wide range of training was provided for people working at Meadow Bank, including a variety of mandatory courses and training specific to the needs of people living at the home to ensure that staff had the right skills to look after the people in their care. Before people started working at the home they were given a comprehensive induction period so that they understood their role and were able to perform the duties expected of them. . Equal opportunity policies were in place at the home to ensure that everyone applying for work was treated the same and was given the same job opportunities. Those who sent us comment cards and who live at the home said that in general there are staff available when they are needed. When asked what the service does well one member of staff wrote on the comment card, ‘it always gives full training and support for staff. The unit manager and matron are very approachable for anything’. All 14 members of staff who sent us comment cards told us that they were given training which was relevant to their role and which kept them up to date with new ways of working. However, one of these people felt that they were not given training which helped them understand and meet the individual needs of people living at the home. One staff member wrote on the comment card, ‘training at Meadow Bank is very good and relevant to caring for the elderly with mental health problems’, and another commented, ‘the training I receive is very thorough and relevant to my role. We are regularly informed of future training courses provided by the company and other external agencies to enable us to increase our knowledge’ and a third told us, ‘I was impressed with how my training needs were met once I informed my manager of my interest in completing a National Vocational Qualification’. Records showed that 54 of care staff had achieved a recognised qualification in care so that an acceptable number of staff were appropriately trained to deliver the care and support required and to supervise newer employees. Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 26 Staff members who sent us comment cards felt that in general their induction covered what they needed to know to do the job when they started. One of these people wrote on the comment card ‘I was given training for a full week prior to starting work at the home’ and another commented, ‘my induction wasn’t as good as what new employees receive these days’. However, when asked what the service could do better one staff member wrote on the comment card, ‘it could provide more training based upon dementia care and challenging behaviour in conjunction with the Primary Care Trust’. We were told that during the induction period new staff are provided with a learning portfolio and working guide and are expected to complete work books in relation to a wide range of mandatory training so that they receive enough training to be able to look after the people in their care. The probationary period for new staff lasted for a period of three months during which time they were closely observed and obsessed to ensure that they were suitable for the position of which they applied. We examined the personnel files of four members of staff. All necessary checks had been conducted before people started working at he home so that those living at Meadow Bank were sufficiently protected. Comments received from those working at the home included, “we get full induction training. Ive had a recent update of the content of my induction. Ive achieved a National Vocational Qualification (NVQ) at level 3 since Ive been here. You get good support from colleagues and managers”, Ive got NVQ level 2 and Ive done Macmillan Care of the Dying, moving and handling, fire awareness, mental capacity act, and we do other specialised training two to three times a year” and “we all have to be up to date on mandatory training. Im attending restraint training soon. There are always updates and courses”. Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 AND 38. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was well managed by a competent person, having effective systems in place for monitoring the quality of service provided. The health, safety and welfare of people living at the home were sufficiently protected. EVIDENCE: When staff were asked if they felt that they had the right support, experience and knowledge to meet the different needs of people who use the service, 11 of the 14 who sent us comment cards told us that they always did and three people said that they usually did. One of these people wrote, ‘I feel the unit manager shows his experience in this field with the staff to enable us to gain more insight into the nature of the service users’. Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 28 When asked what the service does well the manager of the home wrote on the self-assessment, ‘Regular Health & Safety meetings take place, with a standardised agenda giving staff the oppourtunity to communicate on Health and Safety issues. The minutes from these meetings go to the Regional Manager and Quality and Compliance team. The home is supported by a national team of Quality and Compliance officers whose role includes supporting quality issues within the home, auditing and providing guidance on policies, procedures and practice’. The AQAA showed that systems and equipment had been appropriately serviced and a random selection of service certificates examined, supported this information, to ensure that a safe environment was provided for those living at Meadow Bank. The policies and procedures of the home had been reviewed periodically so that staff were kept up to date with current practices and any changes in legislation. The home had received an external quality award, showing that it was being assessed at intervals by a recognised external body. A variety of meetings took place regularly and notes of the meetings were available for people to read, should they wish to do so. Customer satisfaction surveys had been conducted annually so that the views of people using the service and their relatives were sought in order that the home could monitor the quality of service provided. It is recommended that the views of stakeholders in the community, such as doctors, dieticians, district nurses and chiropodists now be sought on how the service is meeting its goals. A variety of audits were being conducted at regular intervals so that the home was confident that policies and procedures were being followed in day-to-day practise and so that it could establish if the goals for the people living at Meadow Bank were being fully met. Accident records were examined on Beech and Sabrina Houses and these were appropriately maintained in line with data protection in order to protect the confidentiality of people living at the home. The policies and procedures in relation to fire safety were being followed in day-to-day practice and staff spoken to confirmed that fire training was provided for those working at the home. Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 29 The registered manager of Meadow Bank had a lot of relevant experience, having completed the Registered Managers’ Award and a variety of relevant training courses. This demonstrated that she was competent to manage the care service and was able to educate her staff team, so that the outcome for those living at the home was positive. There were clear lines of accountability within the home so that the service was successfully managed and a good quality of life was provided for those living at the home. Staff spoken to said that the manager of the home was very supportive and they felt that she was very approachable. There was a strong belief of being open and transparent in all areas of running the home so that people were kept informed of matters involving them. The management team were resident focused and the health, safety and welfare of those living at Meadow Bank was evidently their priority. Clear and accurate records were maintained of any monies kept by the home, on behalf of those living there, so that people’s finances were adequately protected and systems were in place to safeguard any valuables handed over for safe keeping. A wide range of risk assessments had been conducted, which were sufficiently detailed, showing that systems had been put in place in order to reduce the possibility of injury to people living at the home. Each house had hoists available to ensure that people were moved and handled correctly in accordance with their risk assessments. The environment was free from hazards, which could pose risks to those living at the home. Policies and procedures were in place at the home in relation to Health and Safety issues, moving and handling, food hygiene and Infection Control practices, so that staff were aware of the importance to ensure that the health, welfare and safety of people living at the home was consistently protected. One person working on Ribble House said, “The senior staff are very approachable. We have good support, theres always someone on hand. Residents can choose what they do - they can stay in bed if they want and have their breakfast later. We have a standard routine between us and all muck-in. On the whole people work well as a team” and another commented, “I enjoy the work - I would have left otherwise. They set a file up for new residents and the seniors or nurses do the care plans. This is a good team there is no conflict”. When asked if there was anything else they would like to tell us one staff member wrote on the comment card, ‘I am very happy in my job and place of work. I feel well supported by the manager of the home’. Meadowbank Nursing Home DS0000025569.V375784.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 Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 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 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 4 Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 31 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. Standard Regulation Requirement Timescale for action 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 OP3 Good Practice Recommendations All pre-admission assessments should be person centred and provide detailed guidance for staff about the needs of people moving in to the home and how these assessed needs are to be best met. It is recommended that the management team to look in to a few negative issues raised by staff, in relation to the care provided, meals served and the provision of activities. It is recommended that more variety is served for those receiving a soft diet, particularly in relation to mashed potatoes. Attention should be paid to the broken garden fence in the secure garden behind Sabrina House, the ‘sticky’ carpet near the window and the slight unpleasant smell in one area of Sabrina House. It is recommended that the views of stakeholders in the community, such as doctors, dieticians, district nurses and chiropodists now be sought on how the service is meeting DS0000025569.V375784.R01.S.doc Version 5.2 Page 32 2 3 4 OP8 OP12 OP15 OP15 OP19 5 OP33 Meadowbank Nursing Home its goals for those living at the home. Meadowbank Nursing Home DS0000025569.V375784.R01.S.doc Version 5.2 Page 33 Care Quality Commission North West Citygate Gallowgate Newcastle Upon tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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