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 20th June 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 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 Ellen Roberta Pepper Care Home 120 Category(ies) of Dementia (60), Old age, not falling within any registration, with number other category (60), Physical disability (5) of places Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. This home is registered for a maximum of 120 service users to include: Up to 60 service users in the category OP (Old Age, not falling within any other category) Up to 60 service users in the category DE (Dementia) Up to 5 service users in the category of PD over 55 years of age (Physical Disability) 17th May 2006 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. 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 20th June 2007 ranged from £319.50 to £ 640.00 per week. Additional charges were incurred for hairdressing, chiropody, magazines and newspapers. The service users’ guide contained detailed information about life at Meadowbank and it was provided to prospective residents to assist them in 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. Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Two regulatory inspectors conducted the unannounced site visit to this service over one day during June 2007, which formed part of the key inspection process. Two random inspections had been conducted since the last key inspection in order to monitor progress with the requirements and recommendations issued and to follow up some concerns raised about the management of medications. It was evident that all fifteen requirements made at the last key inspection had been appropriately addressed in order to improve the service for the people living at Meadowbank, which is commendable. The pharmacy inspector also spent six hours at the home during this site visit assessing the medication standards. During the course of the site visit, discussions took place with 15 people living at the home, as well as 3 relatives and 10 staff members. 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. Comment cards were received from eight people involved with the service and their feedback is reflected throughout this report. The information provided by the home on the Annual Quality Assurance Assessment (AQAA) prior to the site visit has also been taken into consideration when writing this report. The inspectors ‘tracked’ the care of four people living at the home during the site visit, not to the exclusion of other residents residing at Meadowbank. The total key inspection process focused on the outcomes for people living at the home and involved gathering information about the service from a wide range of sources over a period of time. The Commission for Social Care Inspection had received one complaint about this service since the last inspection, which was partially upheld. What the service does well:
The information gathered before admission was detailed enough, so that the home was confident that the assessed needs of people wishing to move in could be adequately met. The plans of care were extremely well written documents, providing staff with clear guidance about how the assessed needs of people living at the home were to be met and how people were to be supported to maintain their privacy and dignity. Residents had been involved in the care planning process and a review of care provided was conducted on a monthly basis to ensure that current needs were accurately reflected in the plan of care. A comment card was received from one person living at the home, indicating that, in general, Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 6 she usually received the care and support required and that the staff listened to her and acted on what she said. The care plans were person centred so that people living at the home were individually respected and all were offered the same opportunities, showing that equality and diversity was an important aspect of life at Meadowbank. However, one relative indicated on the comment card that the care service usually supported people to live the life they choose, but added, “ More could be done, people should be treated more as individuals”. A variety of external professionals had been involved in the care of people living at Meadowbank to ensure that their health care needs were being appropriately met. Relatives spoken to were happy about how visitors were received into the home and those spoken to informed the inspectors that the staff were all very friendly and caring. Sufficient information was provided to people about the use of the local advocacy services to act on their behalf, should they so wish. One resident said, “The staff are very approachable and helpful”. Activities were provided both in the home and outside, so that people were able to continue their leisure interests whilst living at the home and so that they were able to maintain links with the local community. The routine of the home was fairly flexible and aimed to allow residents their freedom and independence by enabling them to have some control over their lives. Visiting arrangements were in place to suit the needs of individual residents and advocacy services were accessed for those wishing to have an independent person to act on their behalf. Meal times were well managed and people were provided with a choice of nutritious and well-balanced food to ensure adequate dietary intake. Meals were well presented to promote appetite and to aid in nutrition. Those requiring support with eating their meals were assisted in a discreet manner, whilst others were encouraged to eat independently. The resident who returned a comment card indicated that they sometimes liked the meals at the home and added, “I would prefer more fresh produce than frozen”. 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 did they could make a complaint should they wish to do so. The policies and procedures in relation to safeguarding adults were in accordance with the Department of Health guidance ‘no secrets’, so that people knew the procedure to take should an allegation of abuse be received by the home. Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 7 The home was pleasantly furnished and decorated to a good standard and the premises, both internally and externally were, in general, well maintained providing those living at Meadowbank with a safe, clean, comfortable and homely environment in which to live. Staff were provided with a wide range of training, including mandatory courses and courses relevant to the needs of the people in their care and the induction process was thorough enough to ensure that people working at the home were competent to do the job expected of them. The registered manager held relevant qualifications, had a lot of experience and was appropriately trained to manage the care home. Those spoken to felt supported by the management of the home. What has improved since the last inspection?
At the time of the site visit to this service we found that significant improvements had been made in many areas since the last inspection. It was evident that the manager and her staff team had worked hard to raise the standards within the home, which was very noticeable and which is commendable. Information about the home had been provided to prospective residents and it was also freely available in bedrooms, so that people living at the home were able to refer to it whenever they chose to do so. The Statement of Purpose had been updated so that current information was provided to any interested party. People living at the home or their relative had, where possible been involved in the pre-admission process so that they were able to make decisions about the care they were to receive. The assessments conducted by the home before people were admitted, combined with additional information from other sources, was thorough enough to enable the home to decide if the needs of people could be adequately met by the staff team. There had been dramatic improvements made to the planning of individualised care and the home were now taking a person centred approach with the involvement of the resident or their relative, so that they had some in put into the care received. The plans of care had been regularly reviewed, providing staff with clear up to date guidance as to how individual assessed needs could be fully met by the staff team. A wide range of risk assessments had been conducted, so that people living at Meadowbank were adequately protected from any possible hazardous situations. The inspectors observed people living at the home being treated with respect, ensuring that the privacy and dignity of residents was consistently maintained. It was evident that people living at Meadowbank were comfortable chatting to
Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 8 the staff and that the residents and staff had good relationships with each other. A lot of work had gone into obtaining information about people’s life and social interests and supporting them in maintaining these whilst living at the home. The arrangement for the planning of activities involved consideration of people’s interests, so that they could be involved in things that they enjoyed and so that their wishes and feelings were taken into account. The activities programme was clearly displayed within each house, so that people could decide which activities they preferred to join in. The service users’ guide provided readers with information about their right to access records belonging to themselves, if they so wished. The home was, in general, pleasant smelling, maintained to a good standard of cleanliness and was in a good state of repair throughout. The management of meals had improved since the last inspection, with fresh fruit being available within each satellite kitchen and pureed diets being presented in a more acceptable manner. Complaints received by the home were appropriately recorded and a system was in place so that the manager could identify any recurrent patterns. The ratio of care staff to residents was being calculated in accordance with the dependency of people living at the home and it was evident that additional staff were deployed in order to provide 1:1 care for some people, who required it. The recruitment procedures had improved since the last inspection with all relevant checks being conducted before people were employed so that those living at the home were adequately protected. A lot of training was available for staff, including a range of mandatory courses and training specific for the needs of the people living at Meadowbank, so that those working at the home were able to provide a good level of care in accordance with assessed needs. The monitoring of the quality of service provided had been improved so that the views of residents and their relatives were sought on how the home was achieving its goals for people living there. Systems and equipment to be used by residents or staff had been appropriately serviced to ensure that it was in good working so that the health and safety of both residents and staff was adequately protected. What they could do better:
The management of medications could have been improved still further so that people living at the home were adequately protected from possible medication errors.
Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 9 The complaints procedure displayed in Sabrina house needed to be amended, so that correct contract addresses were available for people wishing to make a complaint. Any exposed pipe-work and radiators should be guarded or should have guaranteed low temperature surfaces in order to protect the safety of people living at the home. More care staff could be trained to National Vocational Qualification level 2 or above, so that at least 50 of care staff achieves a recognised qualification in care. The registered manager could extend the monitoring of the quality of service provided, so that any external professionals, who are involved with the care of people living at the home, are given the opportunity to say how they feel the service is meeting its goals. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Meadowbank Nursing Home DS0000025569.V338094.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.V338094.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were given sufficient information to allow them to make a choice about where to live. The preadmission process was thorough so that the staff team were confidant that individual needs could be met and so that the independence of people could be maximised. EVIDENCE: The AQAA showed that the home had an up to date brochure, which was provided to all enquirers and that a detailed needs assessment was carried out prior to admission. One comment card was received from a resident who felt that there was enough information provided to enable her to decide if the home would be suitable to meet her needs. The AQAA also showed that admission policies were in place and that the home had improved in relation to the pre-admission assessment process, by involving residents, their families and outside agencies more, so that all needs were thoroughly assessed and taken into consideration when planning person
Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 12 centred care. However, it did indicate that improvements could be made in communicating with relatives regarding expectations of short-term care and that two weekly review meetings were planned for new residents to further improve the service. Six comment cards were received from relatives, which indicated that, in general, they were given enough information to help them to make decisions and one person added, “Definitely enough information is provided when the care manager is on duty”, and another wrote, “If my relative is poorly I am contacted immediately”. The care of four people living at the home was ‘tracked’ during the course of the site visit. Information obtained before admission to Meadowbank was, in general, detailed enough for the home to decide if the assessed needs of people wishing to move in could be adequately met. Meadowbank Nursing Home DS0000025569.V338094.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of people living at the home were being consistently met, although the management of medications could have been better. Staff always respected the privacy and dignity of people in their care. EVIDENCE: The care of four people living at the home was ‘tracked’ during the course of the site visit. This included one resident from each of the four units. The AQAA showed that individual care plans were updated each month and that they had been developed with the involvement of each resident or their relative, so that people were able to make decisions about the care they received. The AQAA also showed that improvements had been made to the drug disposal systems, but indicated that further improvements could be made in carrying out additional medication rounds, to allow more flexibility. The pharmacy inspector assessed the medication standards at this site visit. His findings are within the text of this section of the report. Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 14 Care plan forums had been set up to provide additional training so that staff were fully aware of how to plan the care required for the people living at the home. This was supported by the excellent care plans seen at the time of the site visit. However, the AQAA indicated that the formulation of care planning for trained staff could be improved. All four plans of care had been developed from the information gathered prior to admission and were found to be extremely detailed and exceptionally wellwritten documents. This enabled staff to have a clear picture of people’s assessed needs and how these needs were to be appropriately met. Residents or their relatives had been given the opportunity to be involved in the care planning process, so that they could have some in put into the care provided. The plans of care had been consistently reviewed at least every month to show that people’s current needs were accurately reflected. The registered manager and staff team are to be complimented on the significant improvements made to the planning of care, which is now person centred and of a high standard. Four of the six comment cards received from relatives showed that the home always gave the support or care expected. One stated that usually the expectations were met and another felt that more stimulation could be provided for the people living at the home suffering from a dementia related illness. The AQAA and the care records showed that a variety of external professionals were involved in the care of people living at the home to ensure that their health care needs were being appropriately met. A comment card was received from one General Practitioner (GP), showing that individual’s health care needs were being met by the care service. When asked what the care service does well, this GP wrote, “Generally very satisfactory”. Appropriate pressure relief was being delivered and specialised equipment was provided to make the lives of people living at the home as comfortable as possible. One relative stated on the comment card, “I find that all the staff are very caring” and another said, “Some of the staff are wonderful, very caring and friendly. A small number do not have the right attitude”. Comment cards received from relatives indicated that the differing needs of people living at the home were usually met, although again one person felt that more could be done for the people needing dementia care. One person living on Beech house said, “The staff are all very kind to the patients”, and it was noted that residents smiled as staff came into contact with them. One incident was observed whilst we were visiting this house, which was dealt with appropriately by staff, who were very pleasant and caring towards the resident involved. Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 15 A wide range of detailed assessments were in place so that the health and safety of people living in the home was protected within a risk management framework. The inspectors observed staff speaking to residents in a respectful manner and knocking on bedroom doors before entering to ensure that privacy and dignity was consistently maintained. A written policy was in place and available to staff, which demonstrated that those living at the home were supported to maintain their privacy and dignity at all times. Induction records showed that staff had been instructed to treat service users with respect and care records demonstrated that the wishes of people were respected in relation to maintaining privacy and dignity when giving personal care. The comment card received from a General Practitioner showed that the care service always respected individual’s privacy and dignity. People spoken to were happy with the care provided. One said, “ The staff treat me well and respect my privacy and dignity at all times”, and another said, “ I get the right attention if I feel unwell”. Others spoken to said that they felt comfortable in the presence of staff. One relative spoken to was very happy with the care his relative was receiving. He said that he is always consulted about the care provided, confirming that the consultant was involved with the unit and that he was always informed of any changes to his relatives care. Nursing staff had access to a written medicines policy that reflected current and best practice. This is important to ensure staff have the necessary information and skills to give medicines correctly. The medicines records were supplied by a community pharmacy and were suitable to the needs of the home. Important information contained in the patient information leaflets was now being identified more consistently, which helped ensure records reflected when medicines should be given to residents. Record keeping had improved since the last pharmacist inspection, although recording mistakes were still evident. Managers were carrying out regular checks to try and identify mistakes and appropriate action was taken. Staff usually signed the records after administering medicines and clear explanations were recorded when medicines were not given. This is important in preventing mistakes and ensuring the health and well being of residents is maintained. Records of medicines received were not always completed accurately and this needed improvement as it helped show whether medicines were being given to residents correctly. Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 16 Medicines being disposed of were now recorded accurately and were usually double checked and countersigned. An accurate record of medicines disposal is important because they help show if medicines have been given correctly and also helps prevent mishandling and misuse. On checking several medicines stocks against records it was found that some medicines did not “add up” correctly. The current system was not simple to audit and these discrepancies may be due to poor record keeping or staff not giving medicines correctly. A new system of audit and checking was being developed that would enable managers to identify mistakes more efficiently. This is important to ensure medicines are given correctly and staff are competent. Residents received their medicines in the dining room at mealtimes and in their own rooms at other times. The timing of giving medicines was not always correct and this was confirmed by speaking to staff and checking the records. It was recognised that some medicines timings had been considered but further work was required to ensure all medicines are given correctly. Medicines must be given to residents at the right time to ensure they work correctly and to reduce the chances of side effects occurring. Most medicines prescribed as “when required” or, as a “variable dose” now had clear written instructions for staff to follow to ensure they were given correctly. This is essential to ensure they are given correctly. Current stocks of medicines were stored securely, this ensured they were not mishandled or misused. Controlled drugs were stored and recorded correctly, this is important in preventing mishandling and misuse. The manager said care staff had received medicines handling training and the competence of care staff when administering medicines was periodically assessed. Having competent trained staff is essential to ensure medicines are given to residents as prescribed. Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social and recreational activities were provided in accordance with residents’ expectations and the rights of people were upheld. Residents received wholesome food and the special dietary needs of people were met. EVIDENCE: The inspectors spent long periods of time at each house, observing the daily activities and the routines of the home, speaking with people and looking at various records in order to determine what life was like at Meadowbank for the people living there. Beech House. The atmosphere was relaxed, even though it was a busy time of day and freedom of movement was evident, providing those living on Beech house with a friendly environment. Staff were seen to spend time with residents and chat to them, having a joke, which was pleasing to see and the people living at the home appeared to enjoy the interaction. Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 18 The house was arranged to assist people in maintaining reality with daily life, by displaying prints of old local scenes and trips out. Personalised glass cases were available outside each bedroom, so that people were able to display their own photographs and other sentimental items. The weekly activities programme was prominently displayed in large print on the wall, so that people were easily able to decide which activities they preferred to join in. Information in relation to meals available was displayed on the chalkboard in the dining area so that people were aware of the menu choices. One person living on Beech house was seen to be provided with a snack on request. Another person was seen to be receiving 1:1 support from a staff member, who were both sitting in the garden together chatting. One member of staff spent a long period of time talking kindly with one gentleman and staff were seen to initiate conversation with people living on Beech house, who seemed comfortable chatting to staff and asking them questions. The two activity co-ordinators arrived during our visit to Beech house. One resident asked what activity was arranged for the afternoon. Staff explained it was someone’s birthday and that activities would be arranged around that. A discussion took place with the activities staff, who were very motivated and keen, telling one inspector that they were trying to involve relatives in activities, so that they too had some interest with things that were taking place, both inside and outside the home. There was a reasonable stock of food in the kitchen on Beech house, so that people were able to have snacks between meals, if they so wished. Plenty of fresh fruit was also available. Staff said that people were offered a choice of meals the day before and that the people living there generally enjoyed the meals. Willow house The people living on Willow house looked comfortable sitting and chatting with staff. Drinks were being served during our visit and people were being supported with fluids, as was required. The dining tables were well presented, with individual flower arrangements on each table, providing a pleasant atmosphere for people to dine in or to just sit and chat. Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 19 There was a pleasant outdoor area, which was safe for people to access, so that those living on Willow house could go outside as they wished with minimal risk. One inspector spoke to a housekeeper, who was fully aware of individual routines of people living at Beech house and said that she arranged cleaning bedrooms around their daily activities so that they were not unduly disturbed. The environment was homely on Willow house, with personal possessions in bedrooms and pictures around the unit of residents involved in activities. Activity information was displayed on the walls; so that people could decide which activities they preferred to join in. Discussions took place with two people living on this unit, who both said that they liked the activities provided and felt they were suitable for them. These residents also said that the food was good most of the time and that a choice of menu was available, but alternatives could be requested if necessary. The two people spoken with on Willow house also said that people came in from the local church and organised services, so that people’s religious needs were being met. Senior staff spoken to said that they do not have access to residents’ monies in the evenings or during the weekend, as this was kept in the general office. However, they said that this does not cause any problem, as they usually know in advance if anyone is going out and they can access money on behalf of people living on Beech house in plenty of time. A range of beverages were offered for the residents during our visit and people were asked what biscuit they would like. However, it would have been nice to see people being offered a selection of biscuits so that they could see what was available and then choose their own. Sabrina house A range of information was clearly displayed on Sabrina house in relation to leisure activities and menus, so that people could make choices about how they wanted to spend their days and what they preferred for their meals. The house was clean and relatively homely, although there were some limitations because of the category of person living on Sabrina house. However, it was evident that personal possessions were in bedrooms in order to create a homely environment, as far as possible. Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 20 It was noted that drinks were freely available to ensure that people were receiving adequate fluid intake. Good relationships were observed between staff and the people living on Sabrina house, which created a friendly atmosphere. One person was sitting reading a newspaper and staff were seen to be sitting and talking with residents in a friendly and caring manner, either on an individual basis or in small groups. Lunch was observed being served on Sabrina house. Staff were seen asking people living there what they would like for their meal, allowing them sufficient time to select a choice from the menu or to have an alternative, if they so wished. Plenty of space was available, enabling some people to sit alone whilst dining, if they preferred. One visitor was helping a resident with her meal, showing that relatives were encouraged to participate in the care of their loved ones, if they wished to be so. Relatives visiting at lunchtime were also offered a meal, so that they could eat with their relative, if they wished to do so. One member of staff was heard speaking sensitively to a resident, whilst helping him with his meal, allowing the gentleman to hold his hand during the activity. Another staff member was seen observing a resident from a distance and offered help when it was needed. One person living on Sabrina house had, by choice, a late breakfast and could not manage lunch, so it was arranged that he could have something to eat during the afternoon, when he felt ready to eat. The atmosphere at lunchtime was quiet and relaxed, providing people living on Sabrina house a pleasant environment in which to dine. Ribble house. The atmosphere on Ribble house was relaxed and friendly, providing people living at the home with a pleasant environment in which to live. Staff were seen treating people with respect and speaking with them in a sensitive manner, ensuring that their privacy and dignity was maintained at all times. The people living on Ribble house required a high level of nursing intervention and it was evident that staff were aware of their individual needs and were very supportive when assisting them with their daily activities. Good social care assessments were in place, so that the preferences of people living on Ribble house were made known to staff and therefore people could be supported to continue their interests whilst living at the home and so that family links could be maintained. One visitor spoken to on Ribble house was very satisfied with the care provided to his relative and confirmed that he is made to feel very welcome whenever he visits the unit. This relative informed one of the inspectors that he is encouraged to be involved in the care of his relative and is invited to any activities provided by the home.
Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 21 General The AQAA showed that an appealing, nutritious and wholesome diet was provided with alternatives to the menu available, if people did not want the meal choices. Dietary preferences were recorded in the care records and staff spoken to were aware of people’s dietary needs, so that those living at the home received a wholesome and nutritious diet. The AQAA also showed that the home felt that improvements could be made to involve the local community more, so that people living there remained in contact with people from outside the home. The AQAA showed that a number of improvements had been made in relation to daily activities, which focused on person centred care so that a more individualised approach had been adopted by the home. The AQAA also showed that there were policies and procedures in place in relation to the six values of care, including choice, fulfilment, rights and independence, showing that all those living at the home were given the same opportunities to make decisions and informed choices about their daily lives. Three of the six comment cards received from relatives indicated that people living at the home were always supported to keep in touch with relatives and friends. Two staff were employed solely for planning and implementing a programme of activities, so that those living at the home were stimulated and motivated. This programme was clearly displayed on each of the four houses, so that people could refer to it whenever they wished. However, one comment card received from a relative indicated that there was not much going on for people needing dementia care. People spoken to said that the routine of the home was relaxed and that they were able to get up and go to bed when they wanted to. One person said that they could have their meals in their room if they wished to do so and that there was always a choice of menu offered. Staff were seen offering people a variety of choices in relation to daily living and residents spoken to said that staff were very helpful. The plans of care showed that people’s choices had been taken into consideration and they included information about the leisure interests of people so that staff were able to provide activities in accordance with their preferences, showing that those who were less able to participate were given the same opportunities as others by the provision of 1:1 activities. The care plans recorded people’s social histories well so that staff could get a clear picture of each person’s life, interests and hobbies. One service user confirmed that religious ministers visited the home regularly to conduct services and the statement of purpose supported this information.
Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 22 Relatives were seen to be visiting people in comfort and visitors spoken to felt that they were made to feel welcome to the home at any time and that a friendly environment was provided for both those living at the home and visitors. The comment cards received supported this information. People were informed about access to local advocacy services and it was evident that these facilities were used if required, to enable people to have an independent individual to act on their behalf, if they so wished. Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 23 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints were well managed and people living at the home were adequately safeguarded. EVIDENCE: The AQAA showed that the policies and procedures in relation to complaints and safeguarding adults had been reviewed and up dated since the last inspection, showing that information provided to people was, in general, current. The complaints procedure was clearly displayed within the four houses and was included in the service users’ guide, so that people could refer to it whenever they wished. However, the complaints procedure displayed on Sabrina house contained an incorrect contact address, which should be amended to ensure that the people living on this house are provided with correct information, should they wish to make a complaint. The AQAA also showed that the home had received fourteen complaints since the last inspection, all of which had been responded to in accordance with the home’s complaints procedure. Comment cards received from people involved with the service indicated that they would know how to make a complaint if they needed to do so and that, in general, the home responded appropriately to any concerns raised. Those spoken to at the time of the site visit said that they would know what to do if they were not happy about something within the home. Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 24 A system was in place at the home so that any complaints received could be recorded and any recurring patterns identified and regularly monitored. Policies and procedures were in place at the home in relation to safeguarding adults, which were in accordance with Department of Health guidance, so that people were fully aware of the action to take should an allegation of abuse be reported to the home. However, we felt that staff spoken to on Ribble house were not fully aware of the correct procedure to follow, as although they said if they should have any concerns about actual or possible abuse then they would report it to a senior member of staff, but they also said that they would speak to the member of staff, who they felt was in the wrong. It is recommended that the registered manager ensures that staff are clear about the policies and procedures of the home in relation to safeguarding adults. Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 25 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available 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 the inspection and, in general we found it to be of a satisfactory standard. Beech house. Beech house was seen to be, in general, clean and comfortable, providing a pleasant home for people to live in. However, the kitchen area could have been cleaner than it was, so that a good level of hygiene was maintained. 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
Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 26 any work required was carried out promptly. An enclosed sensory courtyard was available outside, with a large mural painted on the wall, next to the 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. A discussion took place with the housekeeper of this unit, who was very keen to do a good job and she was obviously proud of her work, which showed a commitment to the home. Sabrina house People living at Sabrina house had easy access to a secure, but pleasant sensory courtyard, so that they could sit outside and enjoy the fresh air at their leisure. Pictures were displayed around the house and were possible personal possessions adorned bedrooms. The house was uncluttered, therefore providing a safe environment for people living there. We felt that of the four units Sabrina house was the one, which appeared to need some minor redecoration in order to make it brighter and more homely. However, the manager later said that the unit had recently been redecorated, but due to the client group it was difficult to keep it looking as nice as the other houses. It was noted that the bath panels in bathroom 10 needed attention, as they were not fixed properly and therefore posed a possible risk for people bathing in this facility. 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. One person living on Ribble house said, “The home is always warm and comfortable. My bedroom is cosy and I am quite happy living here”. General It was noted that a lot of the radiators throughout the home had not been guarded and were not of the low surface temperature type. A discussion took place with the manager about this issue, as a recommendation had previously been made. The registered manager stated that the estates manager, appointed by the company had said that the type of radiators installed at the home did not need to be covered. This recommendation will remain outstanding. It is suggested that the surface temperatures of radiators be
Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 27 taken and recorded at intervals, particularly when the colder weather arrives and the heating is turned up to ensure that the safety of people living at the home is consistently protected. The main kitchen and laundry departments are situated in a separate administration block, central to the four houses. 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 Meadowbank 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.V338094.R01.S.doc Version 5.2 Page 28 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care staff working at the home were not all fully trained, but the numbers of staff on duty were sufficient to meet changing needs of residents and the recruitment practices adequately safeguarded those living at the home. EVIDENCE: At the time of the site visit there were a total of 99 people living at Meadowbank Nursing Home. Beech house. At the time of our visit there were 29 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. There were people living on this unit who required 1:1 care and this was evidently being provided to ensure that the assessed needs of people were being fully met. Ribble house. There were 29 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, which made staff spoken to feel under some pressure. However, this had been raised with the manager of the home, who from the results of a dependency audit had obtained agreement for additional staff to be deployed to this house so
Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 29 that the needs of people living there could be consistently met and so that there is less pressure on the people working on Ribble house. Despite this the four staff spoken to, who were working on this house were motivated and interested in their work. They said that they were happy to be working on Ribble house and felt that there was a good team of staff. They also said that there was plenty of in house training provided for staff. A discussion took place with a senior member of staff working on Ribble house, who was very motivated and obviously committed to the welfare of the residents living there, which was pleasing to see. 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 Meadowbank, 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. Formal induction processes had been adopted by the home so that staff understood their role and were able to perform the duties expected of them. . The AQAA showed that a wide range of training was provided for staff so that people working at the home were competent to look after the people in their care. Staff spoken to said that the amount of training provided for staff had greatly improved over recent months they confirmed that a variety of mandatory core-training courses were provided to ensure that there was a skilled workforce and that people had the necessary knowledge to meet the needs of the people they were caring for. Staff spoken to felt that a lot of training was provided to meet their needs, including training specific to the care of people living in the home and staff training certificates available on files supported this information. The AQAA showed that there were a total of forty three care staff employed at the home, eighteen of whom had achieved a qualification in care, but it was recognised that a number of others had commenced this training and so the home was working towards achieving 50 of care staff with a National Vocational Qualification at level 2. However, we established that care staff are now not being supported to progress to achieve a National Vocational Qualification at level 3 once they have completed level 2. They understood that the home is trying to get all care staff through the level 2 award before progressing on to level 3, which some members of staff were not entirely happy about.
Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 30 The AQAA showed that all staff employed by the home had undergone thorough recruitment checks and three staff files examined at random confirmed this, showing that recruitment procedures were being followed in day-to-day practice to ensure that those living at the home were adequately protected. 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. Residents spoken to felt that their needs were being fully met and that the staff were kind and caring. One person said, “The staff are lovely and they look after me well”. A comment card was received from one person using the service, who said that staff were usually available when needed. Three of the relatives responded by saying that staff always had the right skills and experience to look after people properly and three said that staff usually had the appropriate skills and experience needed for the job. Records showed that on commencement of employment all staff were taken thorough an induction period and were initially additional to the numbers of staff on duty, so that they were able to shadow an experienced member of staff, until they were competent to perform the duties expected of them. 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. Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 31 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available 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: 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 Meadowbank. Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 32 The AQAA showed that the policies and procedures of the home had been reviewed since the last inspection 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 periodically and notes of the meetings were available for people to read, should they wish to do so. Customer satisfaction surveys had been conducted in December 2006 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 Meadowbank were being fully met. Accident records were examined on Sabrina and Ribble Houses and these were appropriately maintained in line with data protection in order to protect the confidentiality of people living at the home. It was noted that clinical waste bins were present in a small number of bedrooms, so that any infected products could be appropriately disposed of. However, these bins were not covered, which did not always promote infection control. 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. The registered manager of Meadowbank 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. One person living at the home said, “The unit manager is very good” and staff spoken to said that
Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 33 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 Meadowbank 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, in general, 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. Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 34 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 2 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 35 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 17(1)(a) Schedule 3 Requirement Medication records must be accurately completed to ensure that mistakes do not happen when giving medications, which may affect the health and wellbeing of people living at the home. The bath panels in bathroom 10 on Sabrina house must be properly fixed so that the safety of people using this facility is adequately protected. Timescale for action 20/07/07 2. OP19 23(2)(b) 31/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations The registered manager should review the provision of activities to ensure that people suffering from a dementia related illness are stimulated and kept motivated in order to prevent boredom.
DS0000025569.V338094.R01.S.doc Version 5.2 Page 36 Meadowbank Nursing Home 2. 3. 4. OP16 OP18 OP19 5. 6. 7. OP26 OP28 OP33 The complaints procedure displayed on Sabrina house should be amended in order to provide correct contact details. It is recommended that the registered manager ensures that staff are clear about the policies and procedures of the home in relation to safeguarding adults. Pipe work and radiators should be guarded or have guaranteed low temperature surfaces. It is recommended that the surface temperatures of radiators be taken and recorded when the heating is turned up to ensure that the radiators cannot cause any harm should a resident fall against one and be unable to move. All clinical waste bins should be covered with lids in order to promote infection control practices. The home should progress towards 50 of care staff achieving a National Vocational Qualification at level 2 or above. 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. Meadowbank Nursing Home DS0000025569.V338094.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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