Inspection on 17/05/06 for Meadowbank Nursing Home

This inspection was carried out on 17th May 2006.

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

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

Other inspections for this house

Meadowbank Nursing Home 11/06/09

Meadowbank Nursing Home 20/06/07

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Meadowbank Nursing Home Meadowbank Nursing Home Meadow Lane Clayton Green Bamber Bridge Lancashire PR5 8LN Lead Inspector Vivienne Morris Unannounced Inspection 17th May 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 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. Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Meadowbank Nursing Home Address Meadowbank Nursing Home Meadow Lane Clayton Green Bamber Bridge Lancashire PR5 8LN 01772 626363 01772 698044 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) www.bupa.com BUPA Care Homes (CFHCare) Limited Care Home 120 Category(ies) of Dementia (60), Old age, not falling within any registration, with number other category (60), Physical disability (1) of places Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. This home is registered for a maximum of 120 service users to include: Up to 30 service users requiring nursing care in the category OP- Old Age, not falling within any other category. Up to 60 service users requiring personal care in the category OP - Old Age, not falling within any other category. Up to 60 service users in the category DE Dementia (aged 50 years and above). One named female service user in the category PD aged 62 years and above. This condition will no longer apply should the service user no longer reside at Meadowbank Nursing Home or, due to advancing age, fall into the category OP. The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. 26th October 2005 6. 7. Date of last inspection Brief Description of the Service: Meadowbank 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. One place is available for a named resident suffering from a physical disability. 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. Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 Page 5 The scale of charges as at 17th May 2006 ranged from £424.00 to £609.50 per week. Additional charges were incurred for hairdressing, chiropody, magazines and newspapers. A brochure of the home was being provided to prospective service users and their representatives. However, the service users’ guide, which contained more detailed information about life at Meadowbank was not routinely provided and was not freely available for those considering to live at the home to assist them in making an informed choice about where to live. Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted over one day during May 2006 by three regulatory inspectors from the Commission for Social Care Inspection. The inspection process focused on the outcomes for people living at the home. A range of evidence has been gathered to formulate this report. During the course of the inspection service users, relatives and staff were spoken to, relevant records and documentation were examined and a tour of the premises took place, when a random selection of private accommodation was viewed and all communal and service areas were seen. Comment cards were returned from three residents and three relatives; some of the comments received are included within the body of this inspection report. All the key standards were assessed at this inspection and progress towards meeting the requirements and recommendations made at the previous inspection was established. The Commission for Social Care Inspection had received one complaint about this service since the previous inspection, in relation to nutrition, which was investigated by the Commission for Social Care Inspection and was found to be upheld. A notice of immediate requirement was issued at the time of the investigation and monitoring visits were conducted to ensure that the requirements and recommendations had been appropriately addressed. What the service does well: Detailed information about service users’ assessed needs had been obtained from the funding authority prior to admission so that the staff team were fully aware of individual needs. Some care records showed that the home had also conducted pre-admission assessments to ensure that the staff team were able to adequately meet individual needs. Some care plans examined had been developed from the information obtained prior to admission and were found to be well written, providing staff with clear guidance as to how individual needs should be managed. A detailed nursing assessment had been conducted for some residents on admission to ensure that the health care needs of those living at the home were adequately met. Meals were in general well managed, ensuring that residents received a wholesome, nutritious diet. Residents were provided with a well-balanced menu and were able to dine in areas of the houses, which suited them, enabling them to have some control over their lives. The dining tables were pleasantly arranged and residents had access to condiments and beverages, Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 Page 7 allowing them some independence and personal choices. Mealtimes were seen to be relaxed and unhurried, allowing people adequate time to eat their meals at their own pace and to enjoy the dining experience. Specialised meals were provided and staff spoken to were fully aware of the dietary needs of the people in their care, ensuring that their nutritional requirements were being met Information was readily available for people so that they were aware of the provision of local advocacy services, should they wish to have someone to act on their behalf. Complaints were being well managed. An appropriate procedure was in place, which was clearly displayed within each house. Any complaint received had been fully investigated with appropriate records kept. People living at the home were adequately protected from abusive situations. Staff were fully aware of their responsibility to report any allegations of abuse to ensure the continued protection of those living at the home. The home, in general was safe and well maintained so that the people living there were adequately protected. The bedrooms and communal areas were in general pleasantly decorated and furnished, allowing people to display personal possessions, which provided a comfortable and homely environment for the residents. Infection control protocols had been implemented to ensure the protection of those living at Meadowbank. All staff were issued with contracts to ensure that they were aware of their terms and conditions of employment and all new staff had been appropriately inducted to ensure that they knew about the aims and objectives, the policies and procedures and the routines of the home. Money held by the home on behalf of residents was sufficiently safe guarded and the quality of service provided was monitored in order to establish if the goals for those using the service were being adequately met. System and equipment had, in general been appropriately serviced to ensure that the health, safety and welfare of residents and staff was adequately protected. What has improved since the last inspection? The majority of requirements and recommendations made at the previous inspection in relation to the environment had been addressed to ensure that the safety of those living at the home was promoted and so that the home was in general well maintained. Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 Page 8 The range of risk assessments conducted had been extended since the previous inspection, identifying any potential hazards, which may have had an impact on residents’ health, safety or welfare. Although residents’ bedrooms at Meadowbank had fixed furniture, the rooms were pleasant and where possible were arranged in accordance with residents’ needs and preferences. What they could do better: Sufficient information about the service must be provided to people thinking of moving into the home to enable them to make an informed choice about where to live. The home’s pre-admission assessment process was not consistent and needed to be improved. Information gathered about the needs of some service users was very basic and did not provide the home with sufficient information about the assessed needs of those wishing to live at the home. Service users or their representatives should be invited to be involved with the pre-admission and care planning process to enable them to have some input in to the care delivered. Plans of care must be developed from the information gathered prior to admission and must be updated at least monthly to reflect residents’ current needs. Some of the care plans examined needed to be more detailed so that staff were provided with clear instructions as to how individual needs were to be met. A thorough risk assessment framework should be implemented to ensure that clear instructions are provided for staff as to how risks need to be minimised or eliminated and the management of medications needed to be improved to minimise the possibility of misuse, mishandling or drug errors. All members of staff did not consistently promote the privacy and dignity of those living at the home so that people were treated and respected as individuals within their own rights. Residents must be encouraged to make choices and enabled to have some control over their lives. The activities provided were found to be somewhat limited, which did not provide sufficient stimulation for those living at the home. A new activities coordinator had recently been appointed and was therefore in the process of determining individual abilities and social interests. Residents should be involved in the development of the activities programme, so that activities provided are in accordance with service users preferences. This programme should be presented in a suitable format for those living at the home, so that people could decide which activities they preferred. Odour control on Sabrina house needed to be addressed in order to enhance the environment for the residents on this unit. Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 Page 9 Pipe work and radiators should be guarded or have guaranteed low temperature surfaces to ensure the safety of those living at the home. A system should be implemented so that the ratio of care staff to residents is calculated in accordance with their assessed needs, and the home should continue to progress towards achieving a ratio of 50 of care staff with a National Vocational Qualification to ensure that sufficient numbers of staff are adequately trained. The recruitment procedures should be improved to ensure that all documents and information is obtained prior to employment in accordance with the National Minimum Standards for Care Homes for Older People and the Care Homes Regulations, so that the people living at the home are adequately protected. Care staff should be issued with the General Social Care Council code of conduct to ensure that they are aware of their responsibilities. A system should be implemented so that staff training needs are easily identified and so that training courses are updated in a timely fashion. Training must be provided for all staff employed, including bank staff to ensure that they are able to adequately undertake the work expected of them. The home should seek the views of those using the service, their relatives and stakeholders in the community on how goals for residents are being achieved and the results of residents surveys should be published to assist people in making an informed decision about moving into the home. Lockable facilities should be provided for the retention of money and valuables to ensure adequate protection of resident’s finances and possessions. The home should make arrangements for residents to be able to access their money held at the home at any time in order to promote independence. The registered person must ensure that fire fighting equipment and portable electrical appliances are serviced annually to ensure that they are safe for use and in good working order. 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. Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 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.V287259.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users and their relatives had not been provided with sufficient information about the routines of the home to enable them to make an informed choice about where to live. However, enough information had been gathered before admission to ensure that the home was confident that the staff team could adequately meet service user’s individual needs. EVIDENCE: A statement of purpose and a service users’ guide were available, which set out the aims and objectives of the home and included information about services provided, facilities available and daily routines of the home. Although a brochure of the home was available in the reception area, the statement of purpose and service users’ guide were not freely available and had not routinely been issued to prospective service users so that people were able to make an informed choice about where to live. The care records of eight people living at the home were examined. Collectively the information gathered prior to admission was detailed enough Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 Page 12 for the home to be confident that the staff team could adequately meet individual assessed needs. For those residents placed by social services, care management summaries gave a clear picture of identified needs to ensure that staff working at the home were aware of what people required. The standard of pre admission work carried out by Meadowbank varied between the four houses, so that the quality of needs assessments was inconsistent. The pre-admission process did not involve the resident or a representative to ensure that people wishing to live at Meadowbank were given the opportunity to be involved in the care planned. Beech House: - Prospective service users had been thoroughly assessed by the funding authority and detailed information had been provided to the home so that staff were aware of people’s assessed needs before they were admitted. However, the pre-admission assessments conducted by the home were found to be very basic and only partially completed, which did not demonstrate that the resident’s needs were being adequately assessed before admission to the home. Ribble House and Sabrina House: -Sufficient information had been obtained for people living on Sabrina and Ribble Houses prior to admission to ensure that assessed needs could be fully met by the home. Willow House: - Files examined demonstrated that a lot of information had been obtained prior to admission, which was transferred onto the plan of care to ensure that assessed needs were being fully met. Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care planning process was not thorough enough to ensure that the personal, health and social care needs of residents were consistently being met. The management of medications did not adequately protect those living at the home and the dignity of residents was not consistently respected. EVIDENCE: Care records seen showed that each resident had a plan of care drawn up. However, the standard of care planning varied between the units and needed to be improved in some areas as good record keeping is an important tool in promoting high quality care. The records of those people requiring care associated with a dementia related illness were used to test equality and diversity. Beech House: - One plan of care had been developed from the information obtained prior to admission and was found to be well written, providing staff with clear guidance as to how this persons individual needs should be managed. However, this care plan had not been consistently reviewed on a monthly basis to ensure that instructions provided for staff were current and up to date. The plan of care for another service user was less informative, with Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 Page 14 some documentation being incomplete, which did not provide staff with a clear picture about individual needs and therefore did not promote the welfare of the resident. Ribble House: - The plans of care seen on Ribble House were very well written, providing staff with clear guidance as to how individual needs were to be met. A detailed nursing assessment had been conducted on admission to ensure that the health care needs of those living at the home were adequately addressed. Sabrina House: - The plans of care examined were well written documents, providing staff with very detailed, clear guidance as to how individual assessed needs were to be met, including psychological needs. A detailed nursing assessment had been conducted on admission to ensure that the physical and mental health care needs of those living at the home were adequately addressed. Staff spoken to were aware of how to access the plans of care and they confirmed that these were checked regularly to ensure that they were aware of the needs of people living at the home. One relative spoken to was very satisfied with the care provided and felt that staff welcomed visitors to the unit. Another relative commented, “these girls (the staff) are excellent. This is the best place for my relative. My relative is well looked after”. Willow House: - The plans of care seen provided very limited information in relation to how some assessed needs were to be met. The information gathered prior to admission for one service user had not been consistently recorded on the plan of care and therefore the inspectors could not determine if this individual’s needs were being adequately met. One relative spoken to was generally happy with the care provided, but was disappointed about the lack of activities available for the residents. A variety of risk assessments had been conducted on all four houses. However, these did not always provide clear guidance for staff as to how potential hazards were to be eliminated or minimised to protect the safety of those living at the home. A variety of external professionals had been involved in the care of those living at Meadowbank to ensure that some health care needs were being met. However, a comment card received from one relative stated that the resident is often sitting in a chair without spectacles, which greatly limits vision. The plans of care had not consistently been drawn up with the involvement of the service user or their representative to enable them to have some input into the care provided. Comment cards received from two relatives stated that they are not consulted about the care of the resident and that they are not always kept informed of important matters affecting them. Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 Page 15 The management of medications needed to be improved in order to promote safe handling. Hand written transcriptions had not always been signed, witnessed and countersigned in order to minimise transcribing errors. The amount of medications received into the home had not always been accounted for in order to minimise the possibility of mishandling. Some gaps were evident on the Medication Administration Records, therefore it was difficult to establish if the medications had been administered or not. Eye preparations were being stored appropriately, but had not always been dated on opening to ensure that the shelf life was not exceeded. One bottle of eye drops was found to have expired, which was discarded at the time of the inspection. The controlled drugs throughout the home were found to be stored and recorded appropriately to minimise the possibility of their misuse. It was established that in general people living at the home were treated with dignity and their privacy was respected. However, one member of staff on Beech House was seen to have a poor attitude towards the residents, which did not promote their dignity. This concern was discussed with the manager of the home at the time of the inspection, who was advised to look into the matter to ensure that the service users living on this house were treated with respect and dignity. Other staff spoken to informed the inspector that they were instructed during induction about privacy and dignity and were aware of the need to respect those living at the home. Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users found that they were provided with a varied, nutritious diet and the lifestyle experienced in the home was flexible. However, their social interests were not always satisfied and although the home encouraged those living there to maintain contact with family and friends they were not always supported to exercise choice and control over their lives. EVIDENCE: The inspectors established that an activities coordinator had very recently been appointed who was responsible for the organisation and provision of social activities to ensure that those living at the home were encouraged to maintain their interests. The inspectors were informed that an additional activities coordinator was due to be appointed in the near future to ensure that sufficient activities were provided for residents. Activity programmes were displayed within each house so that those interested were able to decide which activities they would like to participate in. However, the programs were not always presented in suitable formats for all service users to easily access. Three comment cards received from residents stated that the home did not always provide suitable activities. Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 Page 17 Beech house: - The inspectors noted that people visiting Beech house were welcomed to the unit and were treated respectfully. However, a member of staff on this house was observed constantly requesting residents to sit down, which restricted their freedom of movement within the unit and therefore did not allow them choice and some control over their lives. Ribble house: - One inspector observed lunch being served on this unit and found that a choice of meals were offered and staff spoken to were aware of special diets required, ensuring that appropriate dietary intake was maintained. It was noted that residents were able to eat their meals in the dining room, lounge or in their bedroom as they wished, allowing them a choice of dining arrangements. Staff were seen to be assisting those needing help with their meals in a sensitive manner and allowing them time to eat at their own pace to ensure adequate nutritional intake. However, the food prepared for those requiring pureed diets was liquidised together, which did not look appetising. The dining tables were pleasantly arranged with tablecloths, cruet sets and flower arrangements, making mealtimes a pleasant experience for those living on Ribble house. Sabrina House: - The inspectors discussed the routines of daily living with both service users and staff. From these discussions it was evident that, in general, service users were supported in choosing what they wish to do. Where service users were unable to make informed choices, then relatives would be consulted to ensure that the residents’ wishes were respected and decisions were made in their best interests. The activities co-ordinator was seen to be providing some stimulation suitable for the client group living at Sabrina house. The inspector noted that wartime scrapbooks were available so that people were able to reminisce if they wished. A separate smoke lounge was available, so that those wishing to smoke were able to do so without disturbing other residents. A sensory room was also available so that those living at Sabrina house were able to have periods of relaxation. Food on this unit was prepared to suit the client group in order to maintain adequate nutrition. Willow House:- The inspectors observed three residents playing dominoes and others were watching TV. One resident said, “Although the routines within the home are fairly flexible, there isnt enough to do. It can be boring for people, especially if they are not mobile”. A relative stated that there haven’t been activities provided for a long time and no trips out for the residents. One resident said that staff take two residents to the local supermarket, so that they can buy fresh fruit. One relative stated that there was limited fresh fruit available at the home, so this was brought in for residents by relatives. The inspector established that there was a small amount of fresh fruit available in the main kitchen and discussed with the chef the possibility of some being supplied to the satellite kitchens on the houses so that it would be readily available. Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 Page 18 Lunchtime was seen to be relaxed and unhurried so that people were able to take their time and enjoy the dining experience. Residents confirmed that they were able to choose their meals, which they always enjoyed. The dining tables were pleasantly prepared and residents had access to pots of hot beverages on the tables so that they could help themselves. The pureed diets on Willow house were presented attractively in order to maintain appetite and nutrition. One resident informed the Inspector that some people go for walks in the grounds of the home and those who have French windows in their bedrooms are able to sit outside in the garden if they so wish. One resident confirmed that people are able to stay in their own room if they prefer to do so and although involvement in activities was not this persons choice, it was felt that there were not enough activities provided. It was established that some residents living on the Willow House were able to manage their own finances, if they chose to do so, which allowed them some control over their lives. However, lockable facilities for the retention of money were not always provided to ensure that their finances were adequately protected. One resident confirmed that the routines within Willow house were flexible and people were able to make choices about their lifestyle and activities of daily living. Residents were not always aware of their right to access their own records so that they could make some decisions about the information recorded about them. Staff informed the inspector that beverages and snacks were routinely offered to visitors of residents and some relatives stayed for meals on a regular basis. A relative also confirmed this information, who also added; “the staff make you feel very welcome when you visit”. A visiting policy was in place at the home and information relating to visiting was also included in the statement of purpose and service user guide, although these documents were not routinely issued to prospective residents to ensure they were aware of visiting arrangements. Visitors and residents confirmed that they were able to meet in private if they so wished. Another visitor spoken to felt that visitors were welcome at any time and felt that staff were approachable. The main kitchen was seen to be clean, tidy and well organised and the chef was very aware of residents’ dietary needs to ensure that they received appropriate diets and adequate nutrition. A varied, nutritious menu was available, which demonstrated a good selection of meals was provided. Comments received in relation to the standard of food served included, “the food is very good. We get a choice every day” and “ I enjoy the mealtimes as I like the food we get”. The last Environmental Health Officer’s report did not identify any problems and described the catering facilities as ‘a well run kitchen’. Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 Page 19 Information was provided and available in the home in relation to accessing advocacy services so that people were given the opportunity for an independent person to act on their behalf should they so wish. The policies of the home demonstrated that residents would be supported to manage their own financial affairs should they so wish to ensure personal autonomy and choice. Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Complaints were well managed and the policies of the home adequately protected residents from abusive situations. EVIDENCE: A written complaints procedure was available at the home, which was clearly displayed within the four houses and was referred to in the service users’ guide. This procedure specified whom complaints may be made to and that a response would be forwarded within 21 days. A record was maintained of all complaints received, including the details of investigations and any action taken, which showed that complaints were well managed. It is recommended that a system be implemented to enable the manager to identify any recurrent pattern of complaints received. Records were kept of any allegations made or incidents within the home, which showed that appropriate investigations have been conducted and relevant authorities notified. Policies and procedures were available at the home in relation to the protection of vulnerable adults so that staff were aware of the procedure to follow should any allegations of abuse be received. Staff spoken to were clear about their responsibilities to report any allegations of abuse and what action to take in order to protect the people living at the home. Staff confirmed that they had received relevant training in relation to the protection of vulnerable adults to ensure that they were aware of how to handle allegations of abuse. Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The layout of the home was suitable for it’s stated purpose and was in general safe and well-maintained, providing a clean, hygienic and comfortable environment for those living at the home, although an unpleasant odour was evident on one of the four houses. EVIDENCE: The inspectors toured the four houses at Meadowbank Nursing Home, which in general were found to be clean, tidy and well presented. Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 Page 22 Beech House: - On the day of the inspection Beech house was pleasant smelling, providing a comfortable environment for people to live in, which was an improvement since the previous two inspections. The recommendations and requirements from the previous inspection had been addressed, demonstrating that the environment was being adequately maintained. The house was pleasantly furnished and decorated, providing suitable surroundings for those living at Beech house. Ribble House: - The bedrooms in this house were well presented, and provided a modern linotype flooring with rugs for those who wanted them. People had their own possessions around them and rooms looked individual and were set out to best suit the service user. Service users who were watching TV or sitting chatting were using the large lounge/dining area. Service users confirmed that they were free to access areas of the home as they wished, demonstrating some choice and control over their lives. Bathrooms were clean and well stocked with soap, towels and toilet tissue and offered service users a choice of bathing in a shower or bath. Sabrina House: - The lounge area was pleasantly decorated and well furnished, providing a suitable environment for those living there. Bedrooms were clean and provided a comfortable, pleasant space for individuals, who had their own possessions, such as pictures around them. The kitchen and bathrooms were clean, and provided soap and towels as needed. Bathrooms were well signed with symbols to make them easy to locate. However, there was an unpleasant smell noted on entry and around the communal areas, which did not provide a pleasant atmosphere for those living at Sabrina House. Willow House: - This house provided in general a pleasant environment for people living there. Items such as bookcases and display cabinets were evident making the place look more homely. The unit was clean, tidy and pleasant smelling. However, it was noted that some areas of paintwork was scratched and areas that had been re-plastered had not been painted. Willow house was found to be looking worn and in need of some redecoration to enhance the environment for the residents. Some service users had keys to their rooms and felt this was good to help them have privacy in the home. Bedrooms were individualised with personal possessions and were arranged in accordance with the preferences of residents so that a homely atmosphere was created. Bathrooms were clean and well presented, offering the choice of baths and showers to the service users. One service user commented, “I like my bedroom, it suits me because I have my own things around me. It is comfortable”. Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 Page 23 General Outside areas of the home were well cared for, and provided a pleasant outlook from the houses. Policies and procedures demonstrated that infection control protocols were in place and it was evident that staff had implemented measures to control the risk of cross infection to protect the safety of those living at the home. The laundry department was well managed and appropriate for the needs of the home and those living there. However, it was noted that the walls needed some attention in the interests of hygiene as the paintwork was flaking. A comment cared received from one relative stated that clothes were often mislaid or damaged in the wash, although the company did make reimbursements for lost or damaged articles. Confirmation had been obtained to demonstrate that the home complied with the Water Regulations (Water Fittings) 1999 to ensure health and safety measures were in place. Not all radiators were guarded and guaranteed ‘low surface temperature’ radiators had not been installed, which could present a potential hazard for people living at the home. Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home could not demonstrate that the numbers of staff on duty met residents’ needs or that care staff were sufficiently trained to undertake the duties expected of them. The recruitment procedures were not thorough enough to protect those living at the home. EVIDENCE: At the time of the inspection there were 94 people living at Meadowbank Nursing Home. The four houses at Meadowbank were allocated designated care and ancillary staff and therefore separate duty rotas were in place, showing which staff were on duty at any time of the day or night. The ratio of care staff to service users were still being calculated in accordance with the minimum staffing requirements of the previous regulating authority. The levels of care staff on duty on each unit should be calculated in accordance with the dependency levels of service users to ensure that service users’ assessed needs are being adequately met. It was established that one staff member on Willow house had been reallocated from day duty to night duty, therefore leaving the day shift with less staff than was usual, which could have resulted in the care of residents being compromised. One relative stated that the staff on Willow house are Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 Page 25 sometimes too busy to serve afternoon drinks. It is recommended that the dependency levels of those living at the home are reviewed and a system operated to calculate the ratio of care staff to residents according to their needs. Comment cards received from two relatives stated that in their opinion there were not always sufficient numbers of staff on duty. At the time of the inspection there were 58 care staff employed at the home, of which 12 had achieved a National Vocational Qualification at level 2 or above. The home should continue to progress towards 50 of care staff achieving a National Vocational Qualification to ensure that sufficient numbers of staff are adequately trained. The recruitment procedures were assessed during the course of the inspection. The records of three staff members were examined. Two references had been obtained for each staff member. However, one reference was considered to be inappropriate and one member of staff had commenced employment prior to a POVA first check being received, which did not adequately protect those living at the home. Staff had been issued with contracts so that they were aware of the terms and conditions of employment. However, they had not been provided with the General Social Care Council code of conduct to ensure that they were aware of their responsibilities as care workers. Although the inspectors were informed that training was provided for permanent staff the system for determining training needs was not clear. It was difficult to establish what mandatory training had taken place and when updating was due as there was no systemic approach to training for staff in place and a training matrix had not been developed so that training needs could be easily identified. Records showed that new staff had competed induction programmes so that they were aware of the aims and objectives and policies and procedures of the home and the needs of residents. The inspector was informed that training was not always provided for bank staff to ensure that they were kept up to date with current policies and procedures. Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The quality of service provided was being monitored so that outcomes for residents could be established. Money retained by residents was not consistently protected, but that deposited with the home was adequately safe guarded. The health, safety and welfare of residents and staff were, in general sufficiently protected. EVIDENCE: Standard 31 could not be assessed on this occasion as the manager of the home was newly appointed and therefore had not yet been registered with the Commission for Social Care Inspection. Some systems had been implemented so that the quality of service provided could be regularly monitored. Unit managers had completed weekly reports Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 Page 27 covering a range of items so that the manager was able to identify any shortfalls, which could affect the outcome for those living at the home. The manager of the home was responsible for randomly assessing the quality of care planning process and recording her findings to ensure that the plans of care were adequate to meet the needs of residents. The organisation had reviewed and updated the policies and procedures to ensure that they were in line with current legislation and good practice guidelines. The organisation also conducted annual audits in order to determine if the home was meeting its aims and objectives in providing a good quality service for those living at Meadowbank. The home had achieved an external quality award and was therefore monitored by an outside professional recognised quality assurance system to ensure that standards were maintained in the home. Reports were completed and forwarded to the Commission for Social Care Inspection following monthly visits by the responsible individual, which involved discussions with residents and staff so that it could be establish how the service was performing for individuals. The inspectors were informed that the organisation conducted surveys at intervals, but the home did not have sight of these. Surveys specific to Meadowbank had not been conducted for some time, so that people were able to provide feedback about the service anonymously should they so wish. The views of stakeholders in the community had not been sought on how the home was achieving goals for residents. Residents were able to manage their own finances if they chose to do so, which enabled them to have some control over their lives. However, lockable facilities were not always provided for the retention of money and valuables to ensure that residents’ financial interests were consistently protected. Accumulated personal allowances were retained in a residents’ bank account. However, records were kept of amounts belonging to each individual and interest accrued was proportionally allocated. Money, which was held at the home on behalf of residents, was retained securely so that they were confident that money deposited with the home was safe guarded. Arrangements should be made so that those living at the home are able to have access to their money at any time in order to promote independence. Service certificates and relevant documentation was available for inspection, which showed that, in general systems and equipment within the home had been appropriately serviced so that the health, safety and welfare of residents Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 Page 28 and staff was adequately protected. However, the following issues needed to be addressed: 1. Portable Appliance Testing had been conducted in most areas of the home. However, the electrical equipment in the hairdressing salon, reception and manager’s office was overdue. 2. The fire fighting equipment had not been serviced since March and April 2005, and was therefore overdue. Clear safety notices were displayed throughout the home so that residents and staff were aware of any possible hazards and the procedure to follow in the event of fire. Staff spoken to confirmed that they had received a variety of training courses making them aware of health and safety procedures. Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 Page 29 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 Score No 19 2 20 X 21 X 22 X 23 X 24 X 25 X 26 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 2 X X 2 Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 Page 30 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4(2) Timescale for action The registered person shall make 31/05/06 a copy of the statement of purpose available on request for inspection by every service user and any representative of a service user. The registered person shall 31/05/06 supply a copy of the service users’ guide to each service user. The registered person shall not 31/05/06 provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so there has been appropriate consultation regarding the assessment with the service user or a representative of the service user. (Timescale of 31/07/05 and 31/12/05 not met) The written plan of care must 30/06/06 give clear instructions for staff as to how individual assessed needs are to be met. Residents or a representative of theirs must, wherever possible, be given the opportunity to be involved in the care planning process. DS0000025569.V287259.R01.S.doc Version 5.1 Page 31 Requirement 2. OP1 5(2) 3. OP3 14(1)(c) 4. OP7 15(1) Meadowbank Nursing Home 5. OP7 15(1)(2) (b)(c)(d) 4. OP8 13(4)(c) 5. OP9 13(2) 6. OP10 12(4)(a) 7. OP12 16(2)(m) 8. OP12 16(2)(n) 9. OP14 12(3) (Timescale of 5/11/04, 31/07/05 and 31/12/05 not met) A system for reviewing and updating plans of care must be established and maintained to ensure that current needs are accurately reflected. (Timescale of 31/12/05 not met) The registered person must ensure that any unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. The registered person must make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The registered person shall make suitable arrangements to ensure that the care home is conducted in a manner, which respects the privacy and dignity of service users. The registered person shall having regard to the size of the care home and the number and needs of service users consult service users about their social interests, and make arrangements to enable them to engage in local, social and community activities. The registered person shall having regard to the size of the care home and the number need to service users consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation. The registered person shall, for the purpose of providing care to service users, and making proper provision for their health and welfare, so far as practicable ascertain and take into account DS0000025569.V287259.R01.S.doc 30/06/06 30/06/06 31/05/06 31/05/06 31/07/06 31/07/06 31/05/06 Meadowbank Nursing Home Version 5.1 Page 32 10. OP14 12(5)(b) 11. OP19 23(2)(d) 12. OP26 16(2)(k) 13. OP29 19(1)(a)( b)(c) 14. OP30 18(1)(c)(i ) 15. OP38 23(2)(c) their wishes and feelings. The registered provider shall, in relation to the conduct of the care home encourage and assist staff to maintain good personal and professional relationships with service users. The registered person shall having regard to the number and needs of the service users ensure that all parts of the care home are kept clean and reasonably decorated. The registered person shall having regard to the size of the care home and the number and needs of service users keep the home free from offensive odours. The registered person shall not employ a person to work at the care home unless the person is fit to work at the care home and he has obtained in respect of that person the information and documents specified in Schedule 2 of the Care Homes Regulations, including POVA first confirmation. The registered person must, having regard to the size of the care home, the statement of purpose and the number and needs of residents ensure that persons employed to work at the care home receive training appropriate to the work they are to perform. The registered person shall having regard to the number and needs of the service users ensure that equipment provided at the care home for use by service users or persons who work at the care home is maintained in good working order, including fire fighting equipment and portable electrical appliances. DS0000025569.V287259.R01.S.doc 31/05/06 31/08/06 30/06/06 31/05/06 31/08/06 15/06/06 Meadowbank Nursing Home Version 5.1 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP3 OP7 Good Practice Recommendations The home’s pre-admission assessment process should be thorough enough to ensure that the home is confident that the staff team can meet individual assessed needs. The plans of care should be generated from the information gathered during the pre-admission process and should be reviewed and up dated at least once a month. Care records should be fully completed. The activities programme should be presented in a format, which is easily accessible, by those living at the home. Service users should be provided with information, which makes them aware of their right to access records belonging to themselves. A lockable facility should be provided for each resident for the retention of money and valuables. Fresh fruit should be easily available. It is recommended that a supply of fresh fruit be kept in each satellite kitchen within each of the four houses. Pureed diets should always be presented in an attractive manner. It is recommended that a system be implemented to enable the manager to identify any recurrent pattern of complaints received. Pipe work and radiators should be guarded or have guaranteed low temperature surfaces. The ratio of care staff to residents should be calculated in accordance with the needs of service users. The home should progress towards 50 of care staff achieving a National Vocational Qualification at level 2 or above. Care staff should be provided with the General Social Care Council code of conduct. References should be professional and should not be accepted from family or friends. A system should be implemented so that staff training needs can be easily identified, including when courses are DS0000025569.V287259.R01.S.doc Version 5.1 Page 34 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. OP7 OP12 OP14 OP35 OP15 OP15 OP16 OP19 OP27 OP28 OP29 OP29 OP30 Meadowbank Nursing Home 16. OP33 17. OP35 due for renewal and so that completed training can be established. The monitoring of the quality of service provided should be further developed by obtaining regular feedback from residents and their relatives and by seeking the views of stakeholders within the community on how the service is achieving its goals. Service users should be able to have access to their own money at any time. Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 Page 35 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Meadowbank Nursing Home DS0000025569.V287259.R01.S.doc Version 5.1 Page 36 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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