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Inspection on 26/10/05 for Meadowbank Nursing Home

Also see our care home review for Meadowbank Nursing Home for more information

This inspection was carried out on 26th October 2005.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users were able to have visitors at any time and visits could be held in private or in the communal areas of the home. Links with the local community were evident and those living at the home were able to make choices in their daily living arrangements. The policies of the home demonstrate that complaints were taken seriously and that they were fully investigated. The houses were clean and tidy and service users were able to have their personal possessions in their bedrooms to promote a comfortable and homely environment. The registered manager demonstrated clear lines of accountability within the home showed a commitment to the welfare of those living at the home.

What has improved since the last inspection?

A variety of risk assessments have been introduced to ensure that potential hazards are identified and as far as possible minimised or eliminated. A variety of external professionals were involved in the care of those living at the home to ensure that health care needs were being fully met. The activities programme was written in a clear format so that service users were able to easily identify the activities to be provided and those living at the home felt that activities had improved of late and they enjoyed the activities on offer. The standard of food had served had improved since the last inspection.

What the care home could do better:

More information should be obtained during the pre admission process and the plans of care should ensure that staff are provided with sufficient information to ensure that individual needs are appropriately met. A small number of improvements should be made to the home, both internally and externally, as identified within the body of this report, to ensure that environmental standards are maintained. The ratio of care staff to service users should be determined according to the assessed needs of residents, and a system operated for calculating staff numbers required in accordance with guidance recommended by the Department of Health. The home should progress towards achieving a minimum ratio of 50% of care staff with a National Vocational Qualification. The home should make arrangements for service users to be able to access their money held at the home at any time. The systems in place for monitoring the quality of service provided should be further developed to incorporate views of stakeholders within the community on how the service is achieving its goals.

CARE HOMES FOR OLDER PEOPLE Meadowbank Nursing Home Meadowbank Nursing Home Meadow Lane Clayton Green Bamber Bridge Lancashire PR5 8LN Lead Inspector Vivienne Morris Announced Inspection 26th October 2005 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.V260596.R01.S.doc Version 5.0 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.V260596.R01.S.doc Version 5.0 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) BUPA Care Homes Mrs Bernadette Maclean 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.V260596.R01.S.doc Version 5.0 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. 25th May 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, those suffering from physical disabilities 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. Meadowbank Nursing Home DS0000025569.V260596.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was conducted over one day during October 2005 by two regulatory inspectors from the Commission for Social Care Inspection. The pharmacy inspector assessed the management of medications during the course of the inspection. The inspection process focused on the outcomes for people living at the home. During the course of the inspection service users, relatives and staff were spoken to, 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. The Commission for Social Care Inspection had not received any complaints about this service since the previous inspection. What the service does well: What has improved since the last inspection? A variety of risk assessments have been introduced to ensure that potential hazards are identified and as far as possible minimised or eliminated. A variety of external professionals were involved in the care of those living at the home to ensure that health care needs were being fully met. The activities programme was written in a clear format so that service users were able to easily identify the activities to be provided and those living at the home felt that activities had improved of late and they enjoyed the activities on offer. Meadowbank Nursing Home DS0000025569.V260596.R01.S.doc Version 5.0 Page 6 The standard of food had served had improved since the last inspection. What they could do better: 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.V260596.R01.S.doc Version 5.0 Page 7 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.V260596.R01.S.doc Version 5.0 Page 8 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): 3 The pre admission procedure was inconsistently applied so that people coming to live at the home could not be sure that their needs had been fully assessed and understood. EVIDENCE: The standard of pre admission work carried out at Meadowbank varied between units so that the quality of needs assessments was inconsistent. For those residents placed by social services care management summaries gave a clear picture of identified need and how those needs were to be met. The pre admission assessments carried out by the home were less detailed and did not involve residents or a representative to ensure that people wishing to live at Meadowbank were given the opportunity to be involved in their care. Willow House: - Although 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 in general, assessed needs were being fully met, the level of support required by one person when mobilising was unclear and therefore the needs in relation to mobility were inconsistent. Meadowbank Nursing Home DS0000025569.V260596.R01.S.doc Version 5.0 Page 9 Beech House: - The details obtained by the home during the pre-admission process was found to be very basic, not covering items identified within standard 3.3 and some contradicting information was provided, which did not demonstrate that the resident’s needs were being adequately met. The preadmission assessment had not been signed to show who had obtained the information. Information had been obtained from the hospital prior to admission in relation to the needs of one individual. However, some of this information had not been transferred onto the care plan and therefore not all assessed needs were being fully met. 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. The home should not be providing accommodation to residents unless their needs have been fully assessed so that both parties can be sure the home is able to meet their needs and residents or a representative have been given the opportunity to be involved in the process. As occasionally the home accepts emergency admissions, an emergency admissions policy should be implemented to incorporate details, as identified within standard 5.3 of the National Minimum Standards for Older People so as to ensure that these residents are provided with relevant information and sufficient details are obtained so that adequate care may be provided. Meadowbank Nursing Home DS0000025569.V260596.R01.S.doc Version 5.0 Page 10 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 and 9. The care planning process was not thorough enough to ensure the needs of residents were consistently met. Risk assessments were in place to ensure that any potential hazards were eliminated or minimised for the safety of those living at the home. EVIDENCE: Care records seen showed that each resident had a plan of care drawn up, but these were not always developed from the information gathered during the pre admission process. Therefore, some assessed needs were not always being met. The standard of care planning varied between the units and needs to be improved in some areas as good record keeping is an important tool in promoting high quality care. Willow House: - The plans of care seen were of a satisfactory standard and covered all assessed needs. However, the information provided in relation to the mobility of one person living at the home was unclear and therefore the inspectors could not determine if this individual’s needs were being adequately met. The social care needs for one individual had not been fully considered and were not recorded on the plan of care to ensure that the individual was supported in maintaining their interests and hobbies. Meadowbank Nursing Home DS0000025569.V260596.R01.S.doc Version 5.0 Page 11 Beech House: - Care plans seen were too brief and instructions for staff not specific enough to help the care process and promote the welfare of residents. The care records for one person living at Beech House provided staff with conflicting information in relation to continence needs and therefore assessed needs were not being consistently met. Some care records on Beech House had not been fully completed to provide staff with a clear picture about individual needs and some documents provided unclear information in relation to foot care, of which staff spoken to on this house were also unsure. Therefore, staff were not consistently providing appropriate care to meet individual assessed needs. One inspector was speaking with a service user in their bedroom when a laundry assistant entered without knocking, which did not promote privacy for the service user. Sabrina House: - The care records examined on Sabrina House demonstrated that the plans of care were well written and very detailed, providing staff with clear guidance as to how individual assessed needs were to be met. However, there was little information provided in relation to social care needs to ensure that those living at the home were supported to maintain their interests and hobbies. The records of one service user living at Sabrina House indicated that a specific decision had been made in relation to the care of an individual. However, the inspectors were unable to determine who had made this decision and discussed the matter with the manager of the home at the time of the inspection, who will investigate further to ensure that the service user or relatives had been involved in the decision making process. Ribble House: - The plans of care seen on Ribble House were well written, providing staff with clear guidance as to how individual needs were to be met. However, the plan of care for one service user had not been updated to ensure that their current needs were being fully 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 met. The inspectors observed a member of care staff speaking about a service user to another member of staff in a disrespectful manner. The comment made was within hearing distance of the service user and a number of relatives and other service users sitting in the lounge area. This was unacceptable practice and was discussed with the registered manager at the time of the inspection, who was advised to investigate the incident further. It was later established that the staff member responsible had come from a nurses’ agency. The incident being reported to the relevant agency. A variety of risk assessments had been conducted on all four houses to ensure that any potential hazards were 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 health care needs were being appropriately Meadowbank Nursing Home DS0000025569.V260596.R01.S.doc Version 5.0 Page 12 met. The plans of care had not consistently been drawn up with the involvement of the service user or their representative. When asked about care they received service user’s comments included, “it’s smashing here” and “the staff are really lovely”. The pharmacy inspector assessed the management of medications at this inspection. A detailed report of the findings will be forwarded to the home under separate cover. Meadowbank Nursing Home DS0000025569.V260596.R01.S.doc Version 5.0 Page 13 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): 13 and 14 The home encouraged those living there to maintain contact with family, friends and the outside community. Service users were able to exercise choice and control over their lives as far as possible. EVIDENCE: 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 to ensure that all interested parties were aware of the visiting arrangements of the home. Visitors and service users confirmed that they were able to meet in private if they so wished. One visitor spoken to felt that visitors were welcome at any time and felt that staff were approachable. Comments from those living at the home included “activities are much better now, although what is on the programme doesn’t always happen” and “ I am happy that I can join in when I want and I am not forced to join in”. There was evidence available to suggest that links with the local churches and schools were encouraged so that those living at the home were able to maintain community contact. A PAT dog was visiting at the time of the inspection, which those living at the home seemed to enjoy. Meadowbank Nursing Home DS0000025569.V260596.R01.S.doc Version 5.0 Page 14 The inspectors noted that outside each service user’s bedroom door glass cabinets had been wall mounted so that the individual living in the room could display a variety of small personal items should they so wish, which promoted orientation and individualisation. The inspectors felt that this was a nice touch for those living at the home. The inspectors noted that personal possessions adorned individual rooms, where appropriate and audits of service users’ belongings had been conducted on admission. Comments received in relation to the standard of food served included “The food is very good”, “A top class hotel could not have served a meal like we had yesterday” and “The food is a lot better that it was”. 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 service users would be supported to manage their own financial affairs should they so wish to ensure personal autonomy and choice. Meadowbank Nursing Home DS0000025569.V260596.R01.S.doc Version 5.0 Page 15 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 Complaints were well managed. 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. The contact details for the Commission for Social Care Inspection were also incorporated. A record was maintained of all complaints received, including the details of investigations and any action taken. Meadowbank Nursing Home DS0000025569.V260596.R01.S.doc Version 5.0 Page 16 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 Some improvements should be made to ensure that the environment is safe and well maintained for those living at the home. The home, in general was clean, pleasant and hygienic. EVIDENCE: The inspectors toured the four houses on site at Meadowbank, which in general were found to be clean, tidy and well presented. Sabrina House This house was well presented. The lounge area was pleasantly decorated and well furnished, providing a comfortable 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. Meadowbank Nursing Home DS0000025569.V260596.R01.S.doc Version 5.0 Page 17 Ribble House The bedrooms in this house well presented, and provided a modern lino type flooring with rugs for those who wanted them. People had their own possessions around them and rooms looked individual and were set to best suit the service user. The large lounge/dining area was being used by service users who were watching TV, sitting chatting, or sitting in quiet areas reading. Service users confirmed that they were free to access areas of the home as they wished. 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. Beech House On the day of the visit to this house although there was some improvement to the previous unpleasant odour throughout the building, a slight odour was still present and so service users were not offered a pleasant environment to be in. Cleaning staff were seen to be working hard in the unit and informed the inspector that various chemicals were being tried to combat the odour. The inspectors noted that the kitchen trolley was in a poor condition and in need of replacing to ensure adequate infection control measures are in place and to ensure the safety of service users is promoted. The intermescent strip on the fire door to bedroom 23 on was coming loose and needed reaffixing to ensure adequate fire protection. There were some broken tiles at the foot of the bath in bathroom 15. These should be replaced to ensure the safety of those living at the home. Willow House This house provided a pleasant environment. Items such as bookcases and display cabinets were placed in the corridors making the place look more homely. Some service users had keys to their rooms and felt this was good to help them have privacy in the home. Bathrooms were clean and well presented, offering the choice of baths and showers to the service users. The window next to bedroom 12 should be restricted to ensure the safety of those living at the home. Meadowbank Nursing Home DS0000025569.V260596.R01.S.doc Version 5.0 Page 18 One service user commented “I am quite happy with my room, and as you can see I have my things around me”. General Outside areas of the home were in general well cared for, and provided a pleasant outlook from the houses. However, the inspectors noted that the gutters of the houses were overgrowing with moss and grass in places and should be cleared to prevent an overflow. Some of the concrete flags around the home were uneven and insecure presenting trip hazards for service users, staff and visitors. The concrete flags must be made safe to protect those utilising the grounds of the home. There were a number of clocks within service users bedrooms showing the incorrect time and should be readjusted to aid in reality orientation. Policies and procedures demonstrated that infection control protocols were in place and staff had received training in relation to infection control and COSHH procedures to ensure 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. Comments from service users included “The laundry is excellent, my clothes are brought back nicely ironed”. A number of recommendations in relation to the environment remained outstanding from the previous inspection. These should be addressed as a form of good practice: Not all radiators were guarded and guaranteed ‘low surface temperature’ radiators had not been installed. Therefore, this could in certain situations cause a hazard to individuals. Not all bedrooms were lockable. All service users should be offered the option of a lock if they want one to offer them some privacy. Where nurse call leads are not provided in service users private accommodation, then individual risk assessments should be conducted to demonstrate that such provision would create a potential hazard. Bedside cabinets and nurse call leads should be accessible by the service users when in bed, unless individual risk assessments suggest otherwise. Doors to Meadowbank Nursing Home DS0000025569.V260596.R01.S.doc Version 5.0 Page 19 service users private accommodation should be fitted with locks suited to service users capabilities and accessible to staff in emergencies, unless risk assessments and care records demonstrate that this may create a hazard for service users, in which case the agreement of service users or representatives should be obtained. Each service user should be provided with the key to their lockable facility within their bedroom, unless the reason for not doing so is explained in the care plan. Meadowbank Nursing Home DS0000025569.V260596.R01.S.doc Version 5.0 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 28. The numbers of staff on duty did not consistently meet Service users’ needs. Further progress should be made to ensure that sufficient numbers of care staff are adequately trained. EVIDENCE: At the time of the inspection there were 92 people living at Meadowbank Nursing Home. The ratio of care staff to service users on Willow house was being calculated in accordance with Department of Health guidance. However, the three other units were still referring to 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. The inspectors noted that on Beech House there was a lot of staff sickness, 26 shifts over a two-week period, of which only 6 shifts had been covered with a replacement member of staff. One member of staff was on long-term sickness. However, forward planning for this absence had not been prearranged to ensure that adequate numbers of staff were deployed. A number of dates were identified on Beech House when staffing levels dropped due to staff sickness. The registered manager must ensure that sufficient numbers of staff are on duty at all times to ensure that service users assessed needs are adequately met. Meadowbank Nursing Home DS0000025569.V260596.R01.S.doc Version 5.0 Page 21 At the time of the inspection there were 46 care staff employed at the home, of which 22 had achieved a National Vocational Qualification at level 2 or above. A further 8 were due to commence National Vocational Qualification training in the near future. The home should continue to progress towards achieving a ratio of 50 care staff with a National Vocational Qualification to ensure that sufficient numbers of staff are adequately trained. Meadowbank Nursing Home DS0000025569.V260596.R01.S.doc Version 5.0 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 35. The home is run and managed by a person who is fit to be in charge, of good character and able to discharge her responsibilities. The quality of care was monitored to ensure that the home was run in the best interests of those living at the home. Service users’ financial interests are safe guarded. EVIDENCE: The manager of Meadowbank Nursing Home is a first level registered nurse and has been registered with the Commission for Social Care Inspection. The inspector was informed that the Commission for Social Care Inspection Performance Relationship Manager has agreed that personnel records for the Mangers of BUPA care homes can remain centrally at Head Office. Therefore there was no evidence available to demonstrate that the registered manager had undertaken periodic training to update her knowledge, skills and competence, whilst managing the home. However, the registered manager’s Meadowbank Nursing Home DS0000025569.V260596.R01.S.doc Version 5.0 Page 23 job description was available, which demonstrated her responsibilities and clear lines of accountability were evident to ensure that the home was well managed. Recorded evidence was available to demonstrate that feedback from service users had been obtained about the quality of service provided and this information had been published so that interested parties were able to determine the views of those living in the home. Feedback had also been obtained from service users’ relatives or their representatives to determine their views from a visitors’ perspective. This process should now be extended to seek the views of stakeholders within the community on how the home is achieving goals for service users. The registered manager had commenced some internal audits in order to assess the quality of care provided. However this should be extended to incorporate all aspects of quality assurance. Money, which was held at the home on behalf of service users, was retained securely to ensure that service users’ financial interests were safe guarded. However, service users were unable to access their money out of office hours. 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. Meadowbank Nursing Home DS0000025569.V260596.R01.S.doc Version 5.0 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 Score X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X X Meadowbank Nursing Home DS0000025569.V260596.R01.S.doc Version 5.0 Page 25 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 OP3 Regulation 14(1)(a, c) Requirement Timescale for action 31/12/05 2. OP7 15(1) 3. OP8 15(1)(2) (b)(c)(d) 4. OP19 13(4)(a)(c The home must not provide accommodation to residents unless they have been fully assessed and involved in the assessment process. (Timescale of 30.11.04 and 31.07.05 not met) 31/12/05 A written plan of care that clearly shows how a residents needs in respect of his health and welfare are to be met must be in place. The plan must give clear instructions for staff to follow and be specific to individual needs, including personal, health and social care needs. Residents or a representative must, wherever possible, be involved in the decision making in relation to the care planning process. (Timescale of 5.11.04 and 31.07.05 not met) A system for reviewing and 31/12/05 updating plans of care must be established and maintained to ensure that current needs are accurately reflected. The registered person must 31/01/06 DS0000025569.V260596.R01.S.doc Version 5.0 Meadowbank Nursing Home Page 26 ) 5. OP27 18(1)(a) ensure that all parts of the home to which service users have access are so far as reasonably practicable free from avoidable risks and unnecessary risks to the health and safety of service users are identified and so far as possible eliminated, including: making the concrete flags safe, replacing the kitchen trolley on Beech House, reaffixing the intermescent strip on the fire door to bedroom 23, replacing the broken tiles at the foot of the bath in bathroom 15 on Beech House. The registered person must, 30/11/05 having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP3 OP5 OP7 OP18 Good Practice Recommendations Details obtained in relation to the needs of service users should not provide conflicting information. An emergency admissions policy should be implemented to incorporate details, as identified within standard 5.3 of the National Minimum Standards for Older People. The plans of care should be generated from the information gathered during the pre-admission process. Service users should be able to have access to their own DS0000025569.V260596.R01.S.doc Version 5.0 Page 27 Meadowbank Nursing Home 5. OP19 6. OP22 7. OP24 8. 9. 10 11 12 OP24 OP27 OP28 OP31 OP33 13 OP35 money at any time. The registered person should ensure that items identified within the body of the report are addressed as a form of good practice, including: - restricting the window next to bedroom 12 on Willow House, clearing the gutters of the houses from moss and grass and ensuring that clocks within service users bedrooms are set at the correct time. Where nurse call leads are not provided in service users private accommodation, then individual risk assessments should be conducted to demonstrate that such provision would create a potential hazard. Bedside cabinets and nurse call leads should be accessible by the service users when in bed, unless individual risk assessments suggest otherwise. Doors to service users private accommodation should be fitted with locks suited to service users capabilities and accessible to staff in emergencies, unless risk assessments and care records demonstrate that this may create a hazard for service users, in which case the agreement of service users or representatives should be obtained. Each service user should be provided with the key to their locked facility within their bedroom, unless the reason for not doing so is explained in the care plan. Pipe work and radiators should be guarded or have guaranteed low temperature surfaces. The levels of care staff on duty should be calculated in accordance with the dependency levels of service users and Department of Health guidance. The home should progress towards 50 of care staff achieving a National Vocational Qualification at level 2 or above. The registered manager should retain copies of her training certificated on site to demonstrate continues personal development. The monitoring of the quality of service provided should be further developed by extending the scope of audits conducted 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.V260596.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection Chorley Local Office Levens House Ackhurst Business Park Foxhole Road Chorley PR7 1NW 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.V260596.R01.S.doc Version 5.0 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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