CARE HOMES FOR OLDER PEOPLE
Meadowbrook Care Centre Twmpath Lane Gobowen Oswestry Shropshire SY10 7AH Lead Inspector
Pat Scott Unannounced Inspection 7th December 2005 08:45 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 Meadowbrook Care Centre DS0000022262.V268711.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. Meadowbrook Care Centre DS0000022262.V268711.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Meadowbrook Care Centre Address Twmpath Lane Gobowen Oswestry Shropshire SY10 7AH 01691 653000 01691 662927 meadowbrook@bettercare.co.uk 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) BetterCare Group Limited Sheridan Lesley Chetwin Care Home 80 Category(ies) of Dementia (21), Old age, not falling within any registration, with number other category (41), Physical disability (18) of places Meadowbrook Care Centre DS0000022262.V268711.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. The home must comply with the minimum Staffing Notice issued with the National Care Standards Commission in April 2003. The home may accommodate a maximum of 80 service users. The home may accommodate a maximum of 62 Older Persons of whom up to 21 may have Dementia, in the specified unit for that category of service user. The home may accommodate a maximum of 18 Younger Adults with a Physical Disability in the specified unit. 28th July 2005 Date of last inspection Brief Description of the Service: To be completed Meadowbrook Care Centre DS0000022262.V268711.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 7th December 2005 and commenced at 08.45am for a duration of two and a half hours by two inspectors. The National Minimum Standards for Care Homes for Older People focus on achievable outcomes for service users – that is the impact on the individual of the facilities and services of the home. Evidence was looked for that the standards were being met and a good quality of life enjoyed by service users through: • Discussions with service users, families and friends, staff and managers. • Observation of daily life in the home • Scrutiny of written records (including care plans for 4 service users). The statement of purpose was used to assess how far the home’s objectives to be able to meet service user requirements and expectations were being met. Reports regarding an overview of the conduct of the home are sent to CSCI on a monthly basis by a representative of Four Seasons Healthcare. These, as well as the risk assessment from the last inspection were taken into account to determine the core standards focused on and depth of inspection. The commission does not have any concerns with this home. What the service does well:
The home provides for the needs of young people with a physical disability and elderly people including those with dementia very well. Service users were seen to be treated in a respectful and dignified way. Although the home can accommodate a large number of service users the way in which this is managed protects the privacy of service users whilst allowing the building to be used for different client groups. Meadowbrook provides thorough induction training to equip new staff with the necessary skills to adequately care for the service users in the home. Service users living in care are often vulnerable both physically and emotionally and the manager ensures that staff are trained to be able to carry out personal services for people sensitively and tactfully.
Meadowbrook Care Centre DS0000022262.V268711.R01.S.doc Version 5.0 Page 6 The manager sets the tone and style of the home in terms of its efficiency, probity, concern for service users and staff and its relationships with the outside world. A good leader can have a major impact on the way care is delivered and the National Minimum Standards that are achieved or exceeded. Evidence at this inspection showed that Ms Chetwin has such leadership qualities. What has 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.
Meadowbrook Care Centre DS0000022262.V268711.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 Meadowbrook Care Centre DS0000022262.V268711.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): These standards were not assessed at this inspection EVIDENCE: Meadowbrook Care Centre DS0000022262.V268711.R01.S.doc Version 5.0 Page 9 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): 9 The medication at this home is well managed promoting good health. EVIDENCE: The morning drug round on the EMI unit was observed at 09.10am. This was to administer the 9am drugs and is usually conducted around breakfast time when the majority of the service users have been assisted with personal care. As part of the case tracking process three service users were observed having their breakfast and being administered their medication. The nurse was observed to give the medication in professional manner following the procedures of the home. A care assistant stated that some tablets are put in the food. The care plans seen for these three individuals did not contain a plan relating to their medication on days when their behaviour may not be so compliant. The nurse stated that tablets are destroyed that are refused and where there is no agreement to administer them through the diet. The recording in the administration charts confirmed this. The nurse on the elderly unit confirmed that all medication that is refused is destroyed. Meadowbrook Care Centre DS0000022262.V268711.R01.S.doc Version 5.0 Page 10 This area was discussed with the manager who stated that all areas are discussed with the GP and families/supporters and in some cases medication may be administered via the diet of that individual with agreement from all parties. It is strongly recommended that this is recorded in the care plans with the informed consent of the individual or that of their GP and representative to avoid possible allegations of covert medication. Meadowbrook Care Centre DS0000022262.V268711.R01.S.doc Version 5.0 Page 11 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): 13,14,15 Dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. Staff have an excellent understanding of the service users support and leisure needs and use this to assist them to exercise choice and control in their lives. EVIDENCE: Menus seen demonstrate that the food provided is nutritious and well balanced. New choices are available and the budget for this service has been increased. Six service users were seen sitting quietly in the lounge having their breakfast unaided. A variety of breakfasts was on offer and the nutritional care plans of the three service users case tracked detailed the requirements of that individual regarding eating and drinking including their preferences and whether they required assistance or supervision to eat their meals. Weights are regularly monitored. Meadowbrook Care Centre DS0000022262.V268711.R01.S.doc Version 5.0 Page 12 A care assistant was concerned re the temperature of food and having no probes to monitor this. This was brought to the attention of the manager who agreed to address this issue. Service users spoken to on the Younger physically disabled unit stated that they were very happy with the quality of the food and that they “ could not wish for better”. Activity co-ordinator input into the home has increased with two 18hr posts now filled. The home produces a monthly newsletter that is packed with information and includes input from service users. Service users are fully informed of events happening in the home. Healthcare information is displayed in the foyer. Work to refurbish the therapy room has been quoted for and although the progress for this service improvement is slow it has now commenced. Meadowbrook Care Centre DS0000022262.V268711.R01.S.doc Version 5.0 Page 13 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): 16,18 The home’s complaints procedure is clear and residents are protected from abuse of any kind. EVIDENCE: The complaint log was examined. Complaints received in the home have been appropriately dealt with. On the whole, all service users spoken with were very happy with life at Meadowbrook. They said they knew whom they could speak to if they were worried about anything. The service users on the YPD unit for very vocal about this and had nothing but praise for the way in which they were cared for and how staff listened to them. Staff training portfolios showed that regular training is provided on the subject of abuse. Two staff had recently been to adult protection training and had been asked to feed back information to the staff team. Regulation 37 incident reports are sent to the CSCI as required by legislation. Meadowbrook Care Centre DS0000022262.V268711.R01.S.doc Version 5.0 Page 14 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): 26 The laundry is well organised ensuring that service users clothes and bed linen are always clean and fresh. EVIDENCE: Domestic staff were on duty during the inspection and all areas had been maintained to a high degree of cleanliness and hygiene. The laundry service is well organised and service users stated that their clothes are washed nicely and are always returned to them. A hand-wash basin has not been installed in the laundry room and the organisation has been very slow to act on this requirement from the previous two inspections. Meadowbrook Care Centre DS0000022262.V268711.R01.S.doc Version 5.0 Page 15 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): 30 The arrangements for the induction and training of staff are good with the staff demonstrating a clear understanding of their roles. EVIDENCE: The staff file of a new recruit was examined. This contained details of the induction process with certificates to verify initial training attended that included manual handling, needs of the service user, adult protection, fire, challenging behaviour, first aid and food hygiene. Induction booklets are signed off to demonstrate areas covered at induction. Meadowbrook Care Centre DS0000022262.V268711.R01.S.doc Version 5.0 Page 16 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): 31,32,35 The manager is experienced and competent and management systems and practices ensure that the home is well run for the benefit of the residents. EVIDENCE: Discussions demonstrated that the manager continues to strive for excellence and find innovative ways to provide the service to the ‘community’ that is involved with the home be it service users, visitors, relatives, in-house staff and outside health care professionals, etc. A service user commented during the inspection that they looked positively to the days ahead and had no complaints but would know who to talk to if they needed to. The manager was seen around the home talking to service users and was receptive to opinions that they had. Meadowbrook Care Centre DS0000022262.V268711.R01.S.doc Version 5.0 Page 17 Residents’ valuables and sums of money lodged with the home for safe keeping were accounted for satisfactorily. Meadowbrook Care Centre DS0000022262.V268711.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X 2 STAFFING Standard No Score 27 X 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 X X 3 X X X Meadowbrook Care Centre DS0000022262.V268711.R01.S.doc Version 5.0 Page 19 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 OP26 Regulation 13(3) Requirement To install the hand-basin in the laundry Timescale for action 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP15 Good Practice Recommendations Care plans should contain information regarding administration of medication to service users who cannot give consent. Food should be probed on units and staff trained accordingly Meadowbrook Care Centre DS0000022262.V268711.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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