Inspection on 02/03/09 for Meadowcare Home

This inspection was carried out on 2nd March 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Meadowcare Home 08/01/09

Meadowcare Home 30/10/08

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Meadowcare Home 2-3 Belvedere Road Westbury Park Bristol BS6 7JG     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Odette Coveney     Date: 0 3 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 38 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 38 Information about the care home Name of care home: Address: Meadowcare Home 2-3 Belvedere Road Westbury Park Bristol BS6 7JG 01179730174 01179739919 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Meadow Care Homes Ltd care home 34 Number of places (if applicable): Under 65 Over 65 0 34 dementia old age, not falling within any other category Additional conditions: 34 0 The maximum number of service users who can be accommodated is 34. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) Date of last inspection Brief description of the care home Meadow Care Home opened in the summer of 2008. It is a 34 bed registered care home, with nursing support for people. The home is located near to Clifton and the main Bristol city centre shopping centre. There are good bus routes and the home is within close walking distance to Park Street which has a broad range of shopping and facilities. 3 0 1 0 2 0 0 8 Care Homes for Older People Page 4 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced Key inspection completed by one inspector for the Commission over two days. Our last visit to the home was in January 2009 and at that time we rated the service as one which provided poor quality outcomes for those living at the home. The purpose of this visit was to review the requirements and recommendation which had been set by us and to review compliance and improvements in these areas. Since our last visit to the service there have been two safeguarding meetings, the registered provider and his management team have been present and have fully engaged with the process. They have provided information and an improvement plan Care Homes for Older People Page 5 of 38 upon request and have kept us informed of changes and improvements within the home. What the care home does well: What has improved since the last inspection? The registered provider and his management team have worked diligently since our last key visit in order to meet the requirements and recommendations that were set by us during our last visit to the home. Whilst the registered provider has put in place a manager to cover at Meadowcare home formal arrangements must be put in place. The manager must submit an application to The Commission in order that they can register with us. Once received we will undertake an assessment of their fitness to manage the care home.This is to ensure that people live in a home which is run and managed by a person who have the previous knowledge, skills, experience and qualifications and is fit to be in charge. The registered person has consulted with service users who are able and/or their relatives in order that improvements could be made to the plans pf care and that these incorporate within the plan individuals wishes, preferences and choices. This evidences that individuals have been asked their opinion about how they wish their care to provided and care plans are being further developed in order that they are more person centered, rather than only being task orientated. We will continue to monitor improvements in this area. The registered person has ensured that a record of any nursing provided to the service user has been maintained by the home. This records the treatment, monitoring and review of wound and pressure areas care. The registered person has made arrangements for service users to receive where necessary, treatment, advice and other services from healthcare professionals. This has ensured that people have been supported with their pressure area, wound care and mental health needs. Specialist support services were requested for one individual who lives at the home.This was to ensure that this person had an assessment of their mental capacity undertaken and to demonstrate that decisions made have been done so through consultation and in line with the individuals assessed needs. Care Homes for Older People Page 7 of 38 The registered person must continue to ensure that the care home is conducted to ensure that people are treated with dignity and respect. The registered person has ensured that there have been improvements to the systems of medication administration at the home, they have ensured that people are fully assisted to take their prescribed medication. Records and systems for auditing stock held medication has been improved in order to demonstrate that medication has been given appropriately. The registered person has also ensured that medication records are fully completed. This provides evidence that people are being given their medication correctly and in line with the general practitioners instructions. To ensure a clear audit trail and accountability the home has improved upon the recording of stock held medication. Records of medication administered on a daily basis within the home have also improved. The home have ensured that pressure relieving equipment is provided when a need for this equipment is identified. The registered person has ensured that criminal records bureau checks in place for those staff employed at the home and also that all staff employed at the home have in place two written references. This is to evidence that suitable staff are employed at the home to support people who are vulnerable. The registered person has ensured that staff employed at the care home have received manual handling training appropriate to the work they are to perform, staff have been trained in manual handling techniques and are able to support individuals in a safe manner, The registered person has ensured that manual handling risk assessments are in place for all who live at the home, This records how individuals are to be supported in a safe manner. the risk assessments outline individuals needs, staff support and any equipment which is needed. The registered person has made suitable arrangements to provide a safe system for the moving and handling of service users this is to ensure people are assisted in line with their assessed needs using safe techniques and equipment where needed. The registered person has ensured that the unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. The registered person has ensured that those living at the home are able to summon staff for assistance and staff have been reminded of their responsibility in this area and a monitoring process to check that all nurse call bells are working correctly in now in place. The registered person has established a system for reviewing and improving the quality of the care provided at the home, however due to the poor quality of the previous assessments which was sent to us The registered person should re submit the Annual Quality Assurance Assessment in order to demonstrate how the service delivered is being monitored and kept under review. Care Homes for Older People Page 8 of 38 The Annual accounts of the care home certified by an accountant have been forwarded to CSCI. We also received a reference from the bank expressing an opinion as to the registered providers financial standing. We are satisfied that the financial viability of the business is stable. The home has informed the Commission of incidents, which have affected the wellbeing of those who live at the home. These notifications have demonstrated that the service has dealt with issues effectively and in the best interests of those who live at the home. The registered provider has taken appropriate action to prevent against the risk pf fire and have implemented a suitable, effective fire risk assessment this was forwarded to us from the provider after our last visit to the service. Weekly and monthly safety checks are being completed, as required to ensure the safety and protection of those who live and work at the home. What they could do better: In order that full information is obtained about people in order that staff can obtain a better understanding of the needs, wishes and choices of people life history information should be in place for all where possible. Activities have commenced at the home and the person co ordinating this is very motivated and keen to provide a good service for the residents living in the home, in order to facilitate this it is recommended that items, such as craft work, quizzes, puzzles or games should be provided in order to facility meaningful activities which are tailored to individual ability and choices. The home is well maintained, is decorated well and furnished to a good standard. It is recommended that further consideration should be given to the environment in order that it can meet the needs of those with dementia. Staff must undertake training about the Mental Capacity Act in order that they are fully conversant with the rights of people living in the home and have an understanding of their own role and responsibilities. The registered person should make arrangements for staff to receive training in the protection of vulnerable adults and first aid. These requirements were set at our last visit to the service in January 2009 and has not been met. The home should forward to The Commission a copy of their response and proposed actions when they have received all of the completed quality assurance questionnaires from service users and others. It is required that a full audit is undertaken to evaluate the falls which have occurred to review what action should be taken to prevent reoccurrance, a referral to the falls prevention advisory service should also be undertaken to ensure that people are being supported in line with their healthcare needs and furthermore recording must be Care Homes for Older People Page 9 of 38 improved within accident reports to record what recommendations/actions have been taken to prevent reoccurrance, where possible and to incorporate the review of individuals care plan and risk assessments. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 38 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is provided about the services and facilities which are provided at the home, contracts are in place which also outline the terms and conditions of the placement. Evidence: We reviewed that Statement of Purpose and the Service Users Guide during our last visit to the service, we were told at this visit by the manager that there had been no changes to these documents. At our last visit we recorded that these documents contained information about the aims, objectives and the philosophy of care for the home and also provides details about the services and faciltities available for those who live at the home. the manager informed us that this information is available upon request. There have been no admissions to the home since our last inspection to this service Care Homes for Older People Page 12 of 38 Evidence: and therefore we were unable to fully assess the admissions process for people. We noted that the home has a comprehensive admissions procedure and when we spoke with the manager he was able to tell about how this is implemented at the home. He told us that each individual has a care management assessment which incorporates all aspects of their physical health, social and emotional care support and also records the wishes and choices of people moving into the home. The manager informed us that the home use this information upon which to base their assessment and that prior to coming into the home either the manager or deputy manager would visit people and also undertake their assessment prior to admission into the home, this would form the basis of the care plan that would be recorded at the home. People moving into the home complete a minimum of a months trial period, this is a two way processess for the individual and the home in order to determine if the persons identified needs are able to be met at the home. We have seen in peoples care files that after this months initial trial period a review meeting is held to discuss the placement, incorporating the views of the person living at the home, their relatives and a representative of Meadowcare home. The manager confirmed to us that should a decision not be able to be reached at this point then the trial period could be extended. Of the four people whose records we viewed we saw that each individual had within their care records had a copy of the homes Service User Guide in place. Within this was was a contract which outlined the responsibilities of the provider. This document contained information about the fees, the admission process and liability insurance. Intermediate care is not provided at this home. Care Homes for Older People Page 13 of 38 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to the quality of information recorded within care plans. Requirements which had been made at our last visit in respect of medication administration practices at the home have improved, however a recommendation about medication to be taken as and when required has not been met and this remains. People are supported to access primary and specialist healthcare services when a need has been identified. Evidence: During this visit to the home we reviewed the care and associated records for four of the people who live at Meadowcare Home. We saw that since our last visit to the home care files had been audited and put into an improved more accessible format. Each person had in place a life history questionnaire which, where they were able, they had Care Homes for Older People Page 14 of 38 Evidence: supplied information about where people were born, their children, religious beliefs, favorite foods and memories of their wedding day and something which they were proud of. Information had been provided by individuals themselves and their relatives. Within each care file was an assessment of individuals daily needs which incorporated both a physical and mental health assessment. Care plans recorded individuals needs within areas such as personal hygiene, communication, wound care, eating and drinking, sleeping, behavioral support, mental capacity and end of life care. Each plan recorded individuals assessed needs, the aims and objectives of the plan of care and what action would be taken to meet these needs. We saw that there had been significant improvement within the recording of information within care records, care plans had been reviewed on a monthly basis and in one persons file we reviewed we saw that this had occurred earlier than this due to changes in their level of need. During our last visit to the service we also reviewed the care plans for five people living at the home, a requirement was made that the registered person must consult with the service users and should incorporate within their care plan individuals wishes, preferences and choices. This was to evidence that people had been asked their opinion about how they wished their care to be provided, this would also enable the home to develop care plans in order that they are more person centered rather than task orientated. We have already said we have seen improvements within the recording of care plans and we have seen that individuals and their relatives had been consulted and their views incorporated. The requirement had been met, this is an important area and it is essential that the individual is central to the care planning process we will continue to monitor progress in this area at future visits to the care home. During our last key visit to the home in January 2009 we found that although people we accessing primary healthcare services referrals for specialist services for people when a need had been identified had not been arranged in a prompt and timely manner. A requirement was made that the registered person must make arrangements for people living at the home to receive where necessary, treatment, advice and other services from any healthcare professional. This was to ensure that people were supported with their pressure area, wound care and mental health. Within records we saw that services had been arranged as needed, the tissue viability nurse had visited and provided treatment and advice for pressure area and wound care for people living at the home, mental health support had been arranged and professionals had visited people at the home. All people living at the home are registered with a general practitioner who is a regular visitor to the home and is available to visit and for advice as needed. We saw that some people had had their medication reviewed in order that medication prescribed is an effective treatment. Care Homes for Older People Page 15 of 38 Evidence: During our last key site visit at the home in January 2009 requirements were made that the home should improve upon medication practices within the home. The requirements made were that The registered person must ensure that people are fully assisted to take their prescribed medication and also that records and systems for auditing stock held medication must be improved to demonstrate that medication has been given appropriately. It was also required that The registered person must ensure that medication records are fully completed. This is to ensure that people are being given their medication correctly and in line with the general practitioners instructions. During our visit to the service we found that the home were in the process of auditing the stock held medication and were implementing a new monitoring system, a staff member told us that the new system had been fully discussed during a staff meeting and methods of implementation were agreed. We found no errors in recording and medication checked was accounted for. There are no people living at the home who are able to manage their own medication and all are supported by staff at the home for this area of their care. There are people living at the home who are prescribed medication to be taken as and when required this medication is prescribed for people who experience anxiety and can become distressed. We discussed this with a staff member and asked them in what circumstances would the medication be given, clear reasons were given, however clear protocols and guidance should be provided and these should be linked into the individuals plan of care in order to ensure a consistent approach and continuity of care. This was a recommendation from the last key inspection and will remain and will be reviewed by us when we next visit the service. The home have a record of medication which is no longer required and is returned to the pharmacist for safe disposal, records showed that two staff within the home record what is to be returned and the pharmacist also signs as a form of receipt.We also noted that one person had a sheet monitoring their diabetes care, the sheet recorded that the person was an insulin diabetic, they are not. records must accurately reflect the support required and must be accurate. We saw in staff records and were also told by staff that they had received medication competency training, this had been provided by Boots, the pharmacist which dispenses medication for those living at the home. People living at Meadowcare Home have a diagnosis of dementia and there can be occasions when people refuse to take their medication. We discussed this with a member of nursing staff who explained to us what their responsibilities were and what response they would have in this situation in order to ensure that peoples healthcare needs were met, they told us that the general practitioner would be contacted and advice from them would be sought, alternative methods of medication giving would be discussed with the GP and records would be updated and concerns shared with relevant staff members. This staff member demonstrated a sound understanding of Care Homes for Older People Page 16 of 38 Evidence: the importance of medication and the involvement of other professionals when needed to ensure the best interests of individuals are met. When we completed a random visit to the home in November 2008 we were concerned that one person was not receiving full specialist support in respect of their mental health. A requirement was made and we reviewed this in January 2009. The requirement had not been met and again the requirement remained. The requirement was that specialist support services must be requested for one individual who lives at the home. This was to ensure that this person has had an assessment of their mental capacity undertaken and to demonstrate that any decisions made have been done so through consultation and in line with the individuals assessed needs. During this visit we reviewed the care documentation and spoke with the manager about this individual. We saw that a mental health referral had been made by the home and the individual had been visited. We further saw that the home had arranged for a review of this persons whole care package as part of the care management process. During our last visit to the service a requirement was made that The registered person shall make arrangements for service users to receive where necessary, treatment, advice and other services from any healthcare professional. This is to ensure that people are supported with their pressure area, wound care and mental health. The manager and staff spoken with told us that specialist services have been arranged for people when a need for this had been identified. Within records we saw confirmation of this and saw that people have been visited by a tissue viability nurse, a community psychiatric nurse and the general practitioner. During our last visit to the home we reviewed the records of an individual who had a pressure area wound. We were not satisfied with the level of recording and monitoring of treatment for this person. A requirement was made that the registered person must ensure that a record of any nursing provided to the service user is maintained. We reviewed this same person records at this visit and saw that improvements had been made. The home have improved upon recording within individuals care plan and daily notes. Since our last visit the home have introduced a wound dressing diary to record dates of dressing changes and any changes in the wound are recorded. We also noted that the tissue viability nurse had visited and provided treatment and advice to support individuals with this area of their care. During our last visit to the service we saw one person having their leg wound re dressed in the main lounge, in full view of everyone else. A requirement was made that the registered person must ensure that the care home is conducted to ensure that people are treated with dignity and respect. This was to ensure that people are supported with any healthcare treatments in private. Some discussion took place with Care Homes for Older People Page 17 of 38 Evidence: the manager and registered provider about this and the difficulties that can be faced when an individual refuses to move to a private area and wishes to stay in a public area for their would to be dressed. We spoke about balancing the rights of the individuals, the homes duty of care and the respect and dignity of people living in the home, including the other people present in the lounge. Mr Baryah confirmed to us that all individuals are consulted and where possible they are escorted to a private area for treatment, in situations where this is not possible a screen has been purchased and is available to provide some degree of privacy. At our last visit we noted that people did not have recorded what their wishes were in the event of their death, whilst we appreciate the sensitive nature of this subject we recommended that the the home seek information about individuals end of life care and that this should be recorded in order to ensure that peoples wishes are respected. The manager and administrator told us the following our visit a letter had been sent to relatives of all of those who live at the home in order to request this information. Within the records of people we viewed we saw that three of the four people had an end of life care plan in place and the manager informed us that the were awaiting information for the fourth person in order that this part of their care plan could be completed. Care Homes for Older People Page 18 of 38 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some activities are provided for people living at the home and this is an area for ongoing development in order that people are supported on an individualised basis in line with their abilities and preferences. Evidence: At our last visit we reported that there was no activities co ordinator in post, this person had left due to poor relations with the former manager. The home have appointed an individual to undertake this role, this is a carer at the home. We spoke to this person who told us about their new position and what plans they had to improve. This person told us about the recent training they had attended which was about supporting people with dementia, they told us that they would attending some training later in the month specifically about providing meaningful activities. We saw that a new folder had been developed, we also saw that some people had in place a life history and some of those seen by us were extremely detailed, others were not, whilst we appreciate that obtaining information may be difficult this is an area which should be fully explored to obtain as much information as possible about the person being supported as this will enable a greater understanding for staff about the person as an individual. We saw that each person had an activities sheet in place this recorded on Care Homes for Older People Page 19 of 38 Evidence: an individual basis what activities had been offered and what the response had been and the benefits were for the individual person. Examples of individuals art work were in place. We did note that in the lounge colored in pictures were on display, these pictures appeared to have been taken from a childs coloring book and it was felt that these pictures were not appropriate for this age group, for adults. Both the manger and the activities co ordinator agreed. This person was highly motivated and had many ideas and suggestions, this should be encouraged and supported. During our visit one of the people living in the home went out for walk with a member of staff and upon their return told us how much they had enjoyed the fresh air and the one to one time. We also witnessed the activities co ordinator playing a game of catch with the people in the lounge, a plastic container and handmade balls of paper were being used. When we asked why we were told that this was all they had, whilst we acknowledge the use of this imaginative improvisation and that people were enjoying the activity it is recommended that items, such as craft work, quizzes, puzzles or games should be provided in order to facilitate meaningful activities which are tailored to individual ability and choices. Also during our visit one of the people living in the home went out with their relative and told us that they get lots of visitors. We spoke to four relatives of individuals who live at the home, all told us that they had noted improvements within the past few weeks. We asked people did they know who to speak with if they had any concerns or complaints, people told us they would either speak with the manager or Mr Baryah. Other comments from relatives were my relative is happy and settled here The food is always very nice, I have eaten here and the food is lovely I am happy with the care given to my relative. During our visit we spent time with people in the lounge drinking tea and generally chatting with people about their life in the home. we also spent time with three individuals in the privacy of their room. People living in the home have a diagnosis of dementia and have some additional health and communication difficulties. People told us that staff are very kind People help me when I need it I like it here. The kitchen was found to be clean, tidy and well stocked with fresh fruit and vegetables. During our visit we saw that individuals had a jug of cold drink in their rooms and in the lounge areas, hot drinks and biscuits were also available at various intervals during the day. Staff were seen supporting people with their meal at lunchtime, this was done in a calm manner with individuals being given sufficient support and encouragement to eat at their own pace. Care Homes for Older People Page 20 of 38 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints procedures are in place and there are well written Adult protection and whistle blowing procedures in place. Staff would benefit from Protection of vulnerable Adults training in order that they can be fully aware of their role and responsibility in this area. Evidence: During our last visit to the home the manager was unable to find a record of any complaints which had been made to the home and therefore we were unable to review fully what complaints had been raised to the home and how these had been responded to, in line with the homes complaints procedure. A requirement was made that the registered person shall ensure that any complaint made under the complaints procedure is fully investigated. This is to evidence that information has been fully evaluated and issues raised have been investigated and outcomes and any required actions must be recorded. We saw that since our last visit to the home that they have introduced a folder to record and monitor issues which are raised to them. We are aware that the provider had dealt with an issue prior to our visit and had kept us informed of the outcomes of their investigation. The homes investigation and response to the complainant was detailed and thorough. When we reviewed the homes complaints folder we saw that one other issue had been raised to the home. Recorded were details of the concern raised, times, dates, those involved and investigation and Care Homes for Older People Page 21 of 38 Evidence: resolution. In between our last visit to the service in January 2009 and our visit on this occasion no complaints had been raised to The Commission, we did receive a letter from a relative of an individual living at the home who told us of the improvements which had been implemented at the home and that the current manager in post communicated well with relatives and responded well to comments and suggestions made. During our last visit to the service we found that there were a number of staff who had not undertaken training within the area of adult protection. A requirement was made that the registered person should make arrangements for staff to receive training in the protection of vulnerable adults. At this visit we saw that the home have ensured that this important area of staff training is incorporated within the homes induction and many of the staff had undertaken a refresher induction in this area. The manager also confirmed to us that protection of vulnerable adults training was a priority for the home and that this would be arranged as soon as a training provider was found, the requirement we made during our last visit to this service for this area has not been met, the requirement will remain and will be reviewed by us when we next visit the home. Since our last visit to the care home there have been two safeguarding strategy meetings, this is because at our last visit to the service it was rated by us as being one which provided poor outcomes for those living at the home, the purpose of the meetings was to meet with the providers of the service and discuss with them how improvements could be made and what actions were being taken by them to improve the quality of service provided for people who live at Meadowcare Home. The registered provider and his management team provided information to these meetings in order to demonstrate a commitment in compliance and meeting the requirements set and improving outcomes for those using the service. Care Homes for Older People Page 22 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Meadowcare Home provides a well furnished, well maintained environment for people. The home is clean, tidy and odour free. Evidence: Meadowcare Home is located in a pleasant residential area close to the city centre and Clifton Downs. The home is close to public transport links and shopping areas. The home is registered with The Commission to provide care, with nursing, for up to 34 people who have diagnosis of dementia. There were twenty one people in residence at the time of our visit. The home opened in the summer of 2008 and during the registration process it was found to be suitable for its intended purpose. Since our last visit a number of areas of improvement were noted by us. At our last visit we reported that the main lounge has a large dresser and that this is quite a feature of the room, at our last visit there was only one photograph and a number of pairs of residents glasses and a teddy bear on this unit. On this occasion the dresser had crockery and decorative china on display, there were also plants, books and puzzles for people to use. We also noted that the home have now put up clocks, this will assist those living in the home with their orientation. There is a passenger lift to all floors within the home, in the rear garden there is also a lift to enable those with mobility difficulties to reach the upper patio area of the garden. Care Homes for Older People Page 23 of 38 Evidence: There is a dining area which overlooks the patio and is near to the main lounge areas. All areas of the home, both communal, bathrooms, toilet and privates areas are well decorated, well maintained and well furnished. bathing aids, as required have been provided and are in place. Toilets are located within individuals en suite areas and are within close proximity of lounge areas. Prior to our last visit we had received a letter from a relative of an individual living at the home, they complained that whenever they visited the home the televisions were very loud and often had inappropriate young adult music channels. We also noted this at our last visit and also that the television screen had frozen for over an hour without any staff intervention. We saw both televisions in good working order and on the whole appropriate programs were on the television. We asked people watching if they were happy with what was on and they told us they were. A visitor told us that they visit the home every few days and had noted that more appropriate channels were on for residents, which they appear to enjoy. The home has a large conservatory which overlooks a patio area. When we visited the home in November 2008 we recommended that window coverings, either blinds or curtains should be fitted to this area in order to ensure it is not overlooked by neighbors and also to make the area more homely. This recommendation had not been met, whilst we accept that this area is not currently greatly used as the numbers of people living in the home increases this area will be in more demand. The recommendation remains we will review this when we next visit the home. During our visit we read a report from an interior designer who had been commissioned by the provider to provide advice about the home. The report was detailed and gave suggestions as to how improvements could be made, during our visit we saw that a number of these had been implemented, more pictures had been put up, plants were in the home and more seating had been arranged. We discussed with the provider that the home is registered as one which provides a service for those with a dementia and it is recommended by us that further consideration should be given to the environment in order that it can meet the needs of those with dementia and orientation difficulties. During our last visit to the service we noted that an individual who required pressure area care had recorded in their care plan that they should sit on a pressure relieving cushion at all times and sleep on a pressure relieving mattress, we saw the mattress in place and in good working order. During the visit in January we checked the individual on numerous occasions during the two days we were at the home and noted that this Care Homes for Older People Page 24 of 38 Evidence: person was never sat on the pressure relief cushion. A requirement was made that the registered person must ensure that equipment which may be required must be provided. The individual to whom the requirement pertained at our last visit has since left the home, however we did note that there were a number of people sitting on pressure relief cushions and the manager told us that a further twenty cushions had been ordered by the provider. Other aids in place at the home, noted by us were; a standard, hoists, bathing aids, bed rails, handrails, manual handling belts and pressure relieving mattresses and hi/low beds. It was also noted that during our visit a contractor was on site to repair a faulty air mattress, the fault had been noted that morning and had been repaired by lunchtime. It was also at our last visit that we recommended that staff should be reminded to support people at the home, who have short term memory difficulties, with the use of their aids in order that they may benefit from there use, this had been discussed with staff at a staff meeting. We saw pressure relieving, mobility and sensory aids in use at the home and witnessed no concerns in this area at the time. During our time at the home we viewed a number of individuals rooms and time was spent in the lounge areas chatting with residents. Individuals rooms had been personalised in order to reflect individuals tastes with ornaments, posters, photographs and pictures. One gentleman was sat in a chair which he had brought from home and told us that it made his room more comfortable. The home was found to be clean, tidy and odour free. Domestic and laundry staff are employed at the home and were seen by us going about their duties. Facilities are available for the disposal of clinical waste. Care Homes for Older People Page 25 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing numbers provided at the home are appropriate to the assessed needs of those who are living at the home. Those living at the home are supported and protected by the homes recruitment policy and practice. Since our last visit staff have completed training in a number of core areas, however, there are staff at this home who have not received training in first aid, furthermore, staff would benefit from training about the Mental Capacity Act in order that they can ensure that they are aware of the rights of individuals and that the service provided is in line with relevant legislation. Evidence: Upon arrival at the home the manager was on duty as were two nurse qualified staff, five care assistants, an administrator, cook, laundry and a domestic member of staff. Twenty one people were living in the home at the time of our visit. we viewed the staffing rotas and saw that these level of staffing are consistently provided, There are waking night staff on duty to support people during the night. During our last key visit to the home requirements we made in respect of the recruitment documentation which must be in place in order to protect those living at the home. These were that the The registered person must have criminal records Care Homes for Older People Page 26 of 38 Evidence: bureau checks in place for those staff employed at the home and also that all staff employed at the home must have in place two written references. This is to evidence that suitable staff are employed at the home to support people who are vulnerable. At this site visit we reviewed the files of staff, including two newly appointed members of staff and found these requirements to have been met. We saw that since our last visit that the manager had undertaken a full audit of records held for staff. Information which had been previously missing had been requested and obtained. We saw that staff had in place criminal records bureau checks, protection of vulnerable adults checks, verification of identification, completed application history (with no gaps), work permits and visas were in place for overseas staff and references. We saw that these staff had commenced their induction and certificates of previous qualifications and training attended were in place. During our last visit we recommended that contracts of employment or letters of engagement should be in place for all members of staff employed at the home, this was because these were not in place for all staff. It was on the second day of our last visit to the home that these letters were being issued to staff. At this visit we asked five staff, including the manager if letters of engagement had been given to all, the manager confirmed that this was the case and staff we spoke with also said the same, copies of these letters were also seen on staff files these outlined the number of hours to be worked each week, annual leave entitlement and rates of pay per hour. At our last visit to the home very little evidence was in place to demonstrate that staff had completed an induction in order to provide a basis for new staff employed at the home. We recommended that records of induction must be maintained by the home to evidence that this had taken place and also in order that a review of the quality and content of the induction may be reviewed. At this visit we reviewed the files of the most recently appointed members of staff. We saw that individuals had a records of the induction they had completed, these were in line with the requirements required by Skills for Care. During our last key visit we reviewed staff training. We noted that this was an area in need of improvement in order that staff had the knowledge and understanding in core areas in order to support fully the people who live at the home. A requirement was made that The registered person should make arrangements by training staff or other measures to prevent service users from being harmed or placed at risk. The registered person should make arrangements for staff to receive training in the protection of vulnerable adults and first aid. During this visit we reviewed the audit of training completed at the home, this had been completed by the manager. We saw that since our last visit to the home in January two staff have completed training to support people with their continence care, ten staff have completed care of aging skin, four Care Homes for Older People Page 27 of 38 Evidence: staff have undertaken manual handling training, fourteen staff have completed dementia awareness, with more training planned for this area. Also training has taken place in respect of basic food hygiene and control of substances hazardous to health. During our visit a number of staff were undertaking in house training, this involves watching DVDs and completing a questionnaire afterwords to check individuals knowledge and understanding. Those DVDs in place included health & safety, dealing with behaviour which challenges, first aid, fire hazards and fire prevention, food hygiene and manual handling theory. We saw that each member of staff had an individual training record in place, this is much improved as these were not at our last site visit and it was difficult to track what people had completed. we also saw that people had certificates in place to evidence that the training had been completed. At our last visit we recommended that the home undertake a full audit of the training which had been completed by staff as this would provide the basis of a strategy upon which to ensure that all staff have the necessary skills and knowledge to work in this care environment. The manager showed us the audit that had been undertaken, all staff had been included and a recorded they had undertaken, were booked into do were also recorded. Whilst we acknowledge that considerable efforts have been made by the home to provide training for staff and much training has been completed by staff since our visit to the home all staff have not completed training in core areas such as first aid and the protection of vulnerable adults. The manager of the home informed us of the measures taken to access these training courses for staff and however the requirement has not been met in this key area and will remain and will be reviewed by us when we next visit the home. Care Homes for Older People Page 28 of 38 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered provider and the manager have worked diligently in order to meet the number of requirements which had been been made during our last visit to the service. There remains two outstanding requirements in respect of the management arrangements for the home and the annual quality assurance assessment required by the Commission. New concerns were noted in respect of accident response and recording in this area must be improved an audit of accidents should also be undertaken in order to look at possible causal factors and how these may be eliminated or reduced to protect people and keep them safe. Evidence: During our last visit to the service the manager in post was suspended, this manager has since left and the home is currently being managed by Peter Kong, Mr Kong is currently the Registered Manager at Chatsworth House. Chatsworth House is also owned by the Registered Provider Mr Baryah. At our last visit a requirement was made that the registered provider must appoint an individual to manage the care home.This Care Homes for Older People Page 29 of 38 Evidence: is to ensure that people live in a home which is run and managed by a person who is fit to be in charge. The manager in post should submit their application to us in order that we can determine his fitness. The timescale for compliance for this requirement had not yet passed. Mr Kong confirmed to us that he was in the process of completing his application form and this would be forwarded to us for our consideration within the next six weeks. Supervision reports in staff files demonstrated that areas of discussions included work performance in terms of strengths and weaknesses and how these impact on staff practice, medication, policies and procedures were also covered. Since our last visit five members of staff have received formal, recorded supervision and within these records were saw that poor performance and practice issues had been addressed as well as providing staff with an opportunity to discuss their role and how they can be supported by the management of the home. Improvements have been made to ensure that the management of the home is monitored. We saw that the last recorded visit to the service took place in February 2009, those living and working at the home were consulted as part of the process and comments from these were recorded and comments were favorable about the service. Within the report we saw that the premises are reviewed to ensure that it is well maintained, clean and odour free. We saw that notifications about people living at the home and record keeping are reviewed. It was confirmed to us by Mr Baryah that the visits undertaken on behalf of the registered provider are now completed by someone external to the organisation, these visits would be unannounced and an addition to the formal supervision arranged for the manager. Prior to our last visit to the service in January 2009 we received an Annual Quality Assurance Assessment, this had been completed by the former manager of the home. We were not satisfied with the level of information provided and the quality of information recorded was not of a sufficient standard. We discussed this with the registered provider and required that the registered person must establish and maintain a system for reviewing and improving the quality of the care provided at the home. It was agreed that the registered person should re submit the Annual Quality Assurance Assessment in order to demonstrate how the service delivered is being monitored and kept under review. The timescale for compliance had not yet been reached, we were assured by the provider that this requirement would be met and the information requested would be forwarded to us. During this visit we reviewed how the registered provider monitors quality in the home. We saw that the questionnaire was detailed and covered areas such as quality of the environment, the quality of care received from staff employed at the home and Care Homes for Older People Page 30 of 38 Evidence: quality of meals. The questionnaire also asked people if they thought they are given the opportunity to express their views about the home and does anything need to be changed to make it better. These surveys had been sent to relatives of individuals who live at the home and also from people living at the home. We saw that levels of satisfaction have improved within the past few weeks and comments seen within completed questionnaires included; The only issue I have is communication, although this is getting better, communication is better now that Peter is in charge, things have been improving greatly over the past few weeks I am happier now with the care that my relative is receiving, the owner of the home has actioned some changes as a result of an initial complaint, The staff are very good indeed, in fact I dont think they could be much better. One person did comment that they felt their mother was being assisted to bed too early and that they were not happy with this situation. We were fortunate to meet up with this person during our time at the home and they told us that they had made this comment to the home, they told us that since they had raised the issue their relative was going to bed at a more reasonable time, in line with their own preference and choice. This relative also told us that things had much improved at the home and they were positive that things would continue to do so. This relative told us that if they had any concerns about their relatives care they would have no hesitation in reporting this to the manager. We asked the manager how the information provided within the completed questionnaires would improve the service at the home, Mr Kong told us that issues are discussed with both the owner of the home and with the staff team. We saw minutes of staff meetings and saw that these meetings are taking place each week. Care, health and support needs of those living at the home are discussed in order to provide some continuity of care and consistency in staff practice. We have recommended that the home forward to The Commission a copy of their response and proposed actions when they have received all of the completed quality assurance questionnaires from service users and others. During our last key visit to the service which was completed in January 2009 we reported that there were people living at the home who did not have a manual handling assessment in place and also that for those people who had assessments in place that these were confusing and had conflicting information recorded within them, A requirement was made that The registered person must ensure that manual handling risk assessments are in place for all who live at the home, This is to record how individuals will be supported in a safe manner. Within the care records we reviewed we saw that each person had a full and detailed assessment in place, it will outlined individuals needs, the staff support and equipment which is needed. We also saw that since our last visit the home had introduced a falls assessment which also linked into individuals plan of care. These had been well written. During our last visit we observed on three occasions staff using unsafe manual handling techniques which put both the service users and themselves at risk of injury. A requirement was made Care Homes for Older People Page 31 of 38 Evidence: that the registered person should make suitable arrangements to provide a safe system for the moving and handling of service users. Staff confirmed to us that they had received manual handling training and that they had found this both useful and informative. We did not observe any poor practice during this visit. During our last key visit to the home we noted that there are a number of people who require the support of rails in their bed in order that they do not fall out. The use of these aids can be seen as a form of restraint and sometimes may not be appropriate for those who have a dementia and may not understand the purpose of these aids. at out last visit we recommended that consent should be obtained for the use of bed rails in order to demonstrate that consultation over the use of this equipment had been obtained. Of the four people whose records were checked we saw that consent had been obtained, this was dated and signed for all four individuals. During our last visit to the home in January 2009 we were concerned to note that one of the residents call bell was not inserted into the wall connection fully and therefore they were unable to summon assistance from staff. This person also told us that when they called out for staff that they did not respond. A requirement was made that The registered person should ensure that the unnecessary risks to the health or safety of service users are identified and so far as possible eliminated, that the registered person shall ensure that those living at the home are able to summon staff for assistance. Upon arrival and during our visit we checked the connection for this emergency call bell and found at all times it to be connected. We also observed staff responding to the individuals request for assistance and this was done in a timely prompt manner. Since our last visit the home have also introduced a daily bell check procedure, there were some broken nurse call sockets and these have now been repaired. Staff have also been informed that it is a disciplinary offense to remove a nurse call lead. When we were at the home in January 2009 we noted that there had been incidents which had not been reported to us, a requirement was made that The registered person should ensure that incidents which adversely affect the wellbeing of individuals living at the home are reported to us. This is to ensure that incidents which adversely affect the wellbeing of individuals living at the home are responded to appropriately. This requirement has been met. The home have completed notification forms and have sent them to us, the reports had been fully completed and recorded what actions had been taken to support people. During this visit we reviewed the accident records for people living at the home. We reviewed records covering February 2009 and were concerned to note that four falls were recorded as occurring between two and five thirty pm. It was also found that Care Homes for Older People Page 32 of 38 Evidence: although immediate first aid responses were recorded these did not provide sufficient detail to evidence that sufficient and appropriate actions had been taken to prevent recurrence and to evidence that the imput of healthcare professionals had been considered, furthermore there was no evidence to show that the care plans, or risk assessments had been updated to reflect falls which ad occurred. It is required that a full audit is undertaken to evaluate the falls which have occurred to review what action should be taken to prevent reoccurrance, a referral to the falls prevention advisory service should also be undertaken to ensure that people are being supported in line with their healthcare needs and furthermore recording must be improved within accident reports to record what recommendations/actions have been taken to prevent reoccurrance, where possible and to incorporate the review of individuals care plan and risk assessments. During our last visit to the service a requirement was made by us that The registered provider must consult with the fire authority in order to take adequate precautions against the risk of fire. This was to ensure that those living at the home are not at risk and to also ensure that the home have a suitable, effective fire risk assessment in place. We also wanted to ensure that weekly and monthly safety checks are being completed, as required to ensure the safety and protection of those who live and work at the home. During this visit we reviewed fire safety. We reviewed the fire logbook and saw that that checks have been undertaken as required on weekly, daily and monthly basis. The home have a detailed personal emergency evacuation plan which records clearly what action staff must take in the event of the fire alarm being activated. We saw that staff have undertaken fire safety instruction training and fire drills are arranged to ensure staff know how to respond in the event of a fire emergency. We saw that the home have in place a fully recorded fire risk assessment which includes information about the premises, occupancy at the home and identified potential hazards and how these are controlled to reduce the likelihood of a fire occurring at the home. This risk assessment was forwarded to us by the provider following our last visit to the home. During our last visit to the home we had some concerns about the financial viability of the business and requested that the provider send to us within two weeks of the completion of the inspection the annual accounts of the care home certified by an accountant and also a reference to be obtained from the bank expressing an opinion as to the registered providers financial standing. This was to ensure that those living at the home are suitable protected and to evidence the financial viability of the business. The requested information was received by us within the timescale requested and our concerns had been unfounded. Care Homes for Older People Page 33 of 38 Care Homes for Older People Page 34 of 38 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 18 13 The registered person should 23/03/2009 make arangements by training staff or other measures to prevent service users from being harmed or placed at risk. The registered person should make arangements for staff to recieve training in the protection of vulnerable adults and first aid. 2 31 8 The registered provider must 30/03/2009 appoint an individual to manage the care home. This is to ensure that people live in a home which is run and managed by a person who is fit to be in charge. 3 33 24 The registered person must establish and maintain a system for reviewing and improving the quality of the care provided at the home. The registered person should re submit the Annual Quality Assurance Assessment in order to demonstrate how the service delivered is being monitored and kept under review 16/03/2009 Care Homes for Older People Page 35 of 38 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 13 The Registered Person shall 01/05/2009 make suitable arrangements for those who use the service that unnecessary risks to health and safety are identified as so far as possible, eliminated. A full audit of accidents should be undertaken in order to look at why these had occurred, to review if there are any patterns at to look at methods and actions required to prevent reoccurrance. 2 30 18 The registered person shall ensure that persons employed by the home receive training appropriate to the work they are to perform. Staff must undertake training about the Mental Capacity Act in order that they are fully conversant with the rights of people 05/06/2009 Care Homes for Older People Page 36 of 38 living in the home and have an understanding of their own role and responsibilities. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 12 Activities to be provided should be age appropriate and tailored to the needs and choices of people living at the home. Items should be provided in order to facilitate this. Life history information should be in place for all where possible. Further consideration should be given to the environment in order that it can meet the needs of those with dementia. The home should forward to The Commission a copy of their response and proposed actions when they have received all of the completed quality assurance questionnaires from service users and others. Recording should be improved within accident records in order to demonstrate what action has been taken to protect and ensure the safety of people living in the home and these should also record whether the care plan and risk assessments have been reviewed as part of the process. 2 3 4 12 20 33 5 38 Care Homes for Older People Page 37 of 38 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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