Inspection on 23/01/06 for Meadowcroft

This inspection was carried out on 23rd January 2006.

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

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

Other inspections for this house

Meadowcroft 04/12/06

Meadowcroft 05/09/05

Meadowcroft 04/01/05

Meadowcroft 31/08/04

Meadowcroft 11/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Meadowcroft 304 Spital Road Bromborough Wirral CH62 2DE Lead Inspector Inger Moynihan Unannounced Inspection 23rd January 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Meadowcroft DS0000035960.V279189.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Meadowcroft DS0000035960.V279189.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Meadowcroft Address 304 Spital Road Bromborough Wirral CH62 2DE 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) 0151 334 6325 Metropolitan Borough of Wirral Miss Sheila Hardie Care Home 23 Category(ies) of Dementia (6), Dementia - over 65 years of age registration, with number (17) of places Meadowcroft DS0000035960.V279189.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. A review of the day care facilities in light of the fact that a separate designated area or staff have not been allocated to this facility and that Until the review is completed no more than 23 service users can be accommodated for day care. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 5th September 2005 2. Date of last inspection Brief Description of the Service: Meadowcroft is a respite unit providing 24-hour personal care and accommodation for younger adults and older people. The unit is owned and managed by Wirral Social Services which is a part of Wirral Borough Council. The unit is located in Bromborough town centre close to shops, pubs, a post office and other town amenities. There is a public transport link close to the unit which gives access to Birkenhead and other parts of the Wirral. The front and side of the unit is mainly taken up with parking space for about 20 cars although there is a private and secure garden with a seating area at the back of the building. There is an also an inner courtyard which is made attractive with a fountain, seating areas and hanging baskets. Meadowcroft is a single storey purpose built unit. All bedrooms are single occupancy with en-suite facilities. The rooms are bright and spacious with emergency call points fitted. Specialist bathing facilities are provided in spacious bathrooms. There are two lounges as well as a separate lounge for service users who wish to smoke. There is also a large conservatory overlooking the inner courtyard. The unit is well furnished resulting in a spacious and bright environment. The furnishings are of a very high standard throughout. Meadowcroft DS0000035960.V279189.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 3.5 hours and was one of the statutory unannounced inspection for 2005 / 2006. A partial tour the building took place and service users case files were inspected. Staff were spoken to and observations were made on the service user group. What the service does well: What has improved since the last inspection? At the last inspection requirements were made in relation to improving the assessment and care planning process, staff training and formal supervision. Since this time, further training has been provided and staff now receive formal supervision which further improves staff support. The other requirements remain outstanding and are included in the requirements from this inspection. Meadowcroft DS0000035960.V279189.R01.S.doc Version 5.1 Page 6 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. Meadowcroft DS0000035960.V279189.R01.S.doc Version 5.1 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 Meadowcroft DS0000035960.V279189.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 Improvements have still not been made to the assessment procedure to ensure staff have the information they need to satisfactorily meet service users care needs. Although systems are in place to meet service users care needs, it was not entirely possible to establish whether this issue was fully addressed, as the assessment process had not been completed. EVIDENCE: A range of documentation was examined with the following points being raised: • A service user had been admitted into the unit without all of the necessary information relating to how her care needs should be met. This admission had been made by the registered person in light of the social services having a duty of care, even though the staff were of opinion that this service users care needs could not be met at the unit. Meadowcroft DS0000035960.V279189.R01.S.doc Version 5.1 Page 9 • • A service user had been admitted to the unit on an emergency basis with no information being provided with regard to their condition or behaviours. A service user had been admitted into the unit without an updated assessment of the care needs even though it was known that their health has a significantly deteriorated since their last admission. A discussion took place with the deputy manager about the importance of ensuring a thorough assessment of service users care needs is carried out prior to any admission into the unit. Without this information important aspects of a service users care needs may be missed and both staff and service users may be left vulnerable to the risk of harm. Also that the staff will not be able to fully promote service users physical and mental well being. The issue of the lack of proper assessment documentation has been raised at the last four inspections. Although an assurance has been given to the CSCI that this issues has been addressed, it is clear that the registered person still needs to carry out further work in order to fully demonstrate that the staff can provide the appropriate care and that service users are appropriately placed. In the light of this, the registered person is required to write to the CSCI and inform the inspector of the action being taken to address this matter. This issue will also be addressed with the registered person outside of the inspection process. Meadowcroft DS0000035960.V279189.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9 There is no clear or consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users needs. To ensure service users medical care needs are fully met, improvements need to be made to the record keeping in relation to the administration of service users medication. EVIDENCE: A range of documentation was examined with the following points being raised: • • • A service users care plan had not been updated following their admission into the unit even though it was known that their health care needs had deteriorated. A care plan had been written in pencil (5/12/05) and had not yet been typed into an official format. A care plan/management plan had not been drawn up for one service user who presented with challenging behaviour in the form of violence and aggression. DS0000035960.V279189.R01.S.doc Version 5.1 Page 11 Meadowcroft • • • • Guidance had not been documented about when additional medication should be given to a service user who presented with challenging behaviour in the form of aggression and violence. A care plan did not include guidance on how to support a service user who experienced hallucinations. Information relating to all of the service users care needs was recorded in a communication book. This does not offer any confidentiality to individual service users. It was confirmed by the deputy manager that although the care plans were generally reviewed prior to any service user being admitted, this did not always happen. These issues were discussed with the deputy manager and advice and guidance was given in relation to the importance of ensuring all care plans were an accurate reflection of service users care needs. Without this information important aspects of service users care may be missed and both staff and service users may be left vulnerable to the risk of harm. Where challenging behaviour is identified, a clear management plan must be in place to support the staff in the management of such complex behaviours. The importance of ensuring service users confidentiality was discussed in respect of the storage of information in the communication book. To ensure confidentiality all information must be stored in service users individual care plan. The issue of the poor care planning has been raised at the last four inspections and to date has not been fully addressed, despite assurances being given that the issue has in fact been addressed. In light of this the registered person is required to write to the CSCI and inform the inspector of the action being taken to address the issues raised. This issue will also be addressed with the registered person outside of the inspection process. A selection of service users medication administration record sheets were examined with the following points being raised: • • • A record of the medication returned to the supplying pharmacist had been made Staff had always consulted with the GP whenever additional medication was given. A record of this information had been made in service users care plan. All staff who administer medication have been provided with appropriate training. The following issues of concern were also raised during the inspection: • Handwritten entries on the medication administration record (MAR) sheets had not been signed by two members of staff. DS0000035960.V279189.R01.S.doc Version 5.1 Page 12 Meadowcroft • • • • • Information had been recorded on the MAR record sheet to indicate a change of medication, however this had not been signed or dated. In one instance it was recorded that a medication had been stopped by a GP. However, no record of this had been made in the service users care plan. Documentation indicated that one service user could be given extra medication if needed, however there was no guidance on the circumstances under which this should happen. The MAR sheets recorded O on a number of occasions. The senior member of staff could not account for the meaning of this code. The MAR sheets indicated that a number of service users used skin creams, however there was no evidence that staff had administered these creams. Although it had become custom and practice for only the night staff recorded when the skin creams were actually used. These issues were discussed with the senior member of staff on duty and guidance and information was given as to how to address the matters raised. It is vitally important that all aspects of service users medication are maintained in accordance with good practice and that staff are provided with the necessary guidance in relation to this aspect of care provision. In the light of this the registered person is required to write to the CSCI and inform the inspector of the action being taken to address these issues. Meadowcroft DS0000035960.V279189.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 14, A range of social activities are offered to service users to ensure an interesting and stimulating environment is provided. Service users family, friends and carers are able to visit the unit at any time. The routines in the unit are flexible which means service users can exercise choice and control in the way they spend their day. EVIDENCE: Documentation is in place to show service users social interests have been assessed and a member of staff spoken to during the inspection confirmed a range of social activities are provided. The purpose of this is to ensure service users interest and memory recall and also to encourage social interaction. During discussion staff confirmed service users family, friends and carers can visit at any time which goes some way to providing the service users with a sense of security and comfort. Meadowcroft DS0000035960.V279189.R01.S.doc Version 5.1 Page 14 The routines in the unit are flexible and service users can go about their day as they wish. This is a positive aspect of the unit and ensures service users can exercise choice and independence. Meadowcroft DS0000035960.V279189.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The unit has a comprehensive complaint procedure to ensure service users, carers and stakeholders views are listened to and acted upon. Documented procedures are in place to ensure service users are safeguarded from abuse and harm. Additional training does need to be provided to ensure staff at least have basic information on the complex nature of abuse. EVIDENCE: The CSCI has not received any complaints about the standards of care provided at Meadowcroft. Procedures are in place in relation to the protection of vulnerable adults from abuse. At the last inspection it was identified that not all staff had been provided with training in this aspect of care provision and a requirement was made for this issue to be addressed. In response to this requirement a rolling programme of training has now been set up, although it was acknowledged that it might take some months for all staff complete this training. At this time it was agreed that in the interim, the registered manager would provide staff with informal training to at least ensure they have an understanding of the sometimes complex nature of abuse. This informal training has not yet been provided and again the registered provider is required to address this issue to ensure service users safety and protection. Meadowcroft DS0000035960.V279189.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The standard of the environment within the unit remains very high and provides service users with an attractive and comfortable place to stay. EVIDENCE: The standard of the decor throughout Meadowcroft remains very high and provides the service users with a very comfortable and attractive environment. All bedrooms are single occupancy with en suite facilities which ensures service users privacy. A range of equipment has been provided to assist the service users with their bathing and mobility. All communal areas and a number of bedrooms were inspected and noted to be very clean and tidy. The domestic staff continue to work very hard to maintain the unit to this high standard. Equipment is fitted around the building to ensure service users safety and well being. Meadowcroft DS0000035960.V279189.R01.S.doc Version 5.1 Page 17 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 A range of appropriate training is provided to ensure suitably qualified and competent are employed to care for vulnerable adults. EVIDENCE: Staff have completed a range of appropriate training relating to the care of older people and arrangements have been made for further training to be completed within the forthcoming year. This is a positive aspect of the unit and ensures the service users are being cared for in accordance with their particular needs and in line with current good practice. Not all staff have received training in relation to dementia care although arrangements are in place for this be provided within the near future. In the light of this, the registered person must ensure all staff are provided with informal training to at least ensure they have some basic information on the complexities of this illness. Meadowcroft DS0000035960.V279189.R01.S.doc Version 5.1 Page 18 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): 38 The health, safety and welfare of service users is well promoted. EVIDENCE: Examination of documentation and discussion with staff confirmed that service users safety and safe working practices are promoted within the unit and staff are provided with appropriate training for this purpose. Regular fire safety checks and checks on all equipment and water temperatures is carried out. Meadowcroft is subject to its own internal health and safety audit and had been awarded a certificate of merit in recognition of the way in which this aspect of care is promoted throughout the unit. All of these issues demonstrate that the health, safety and welfare of the service users and staff are viewed as a matter of priority. Meadowcroft DS0000035960.V279189.R01.S.doc Version 5.1 Page 19 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 UNIT Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 4 x x x x x x 4 STAFFING Standard No Score 27 x 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x x x 3 Meadowcroft DS0000035960.V279189.R01.S.doc Version 5.1 Page 20 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 Units Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement The registered person is required to ensure an assessment is carried out prior to any service users being admitted into the unit to ensure staff know how to look after the service user properly. All of this information must be signed and dated with a review date in place. The registered person is required to ensure the care plans are an accurate reflection of service users care needs. The care plans must accurately reflect any changes to the support offered and any changes to medication. All of this information must be signed and dated with a review date in place. The registered person is required to ensure a management plan is in place for any service user who presents with complex or challenging behaviours. The registered person is required to ensure a member of staff signs the appropriate documentation to indicate when skin creams are administered. DS0000035960.V279189.R01.S.doc Timescale for action 01/03/06 2. OP7 15 01/03/06 3 OP7 15 01/03/06 4 OP9 17 23/01/06 Meadowcroft Version 5.1 Page 21 5 OP9 17 6 OP28 18 7 OP28 18 The registered person is required 23/01/06 to ensure information is recorded about when additional medication can be given to service users. The registered person is required 01/03/06 to ensure all staff are provided with training on the protection of vulnerable adults from abuse. The registered person is required 01/04/06 to ensure all staff are provided with training on dementia care. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. . . Refer to Standard Good Practice Recommendations There are no recommendations resulting from this inspection Meadowcroft DS0000035960.V279189.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Liverpool Local Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Meadowcroft DS0000035960.V279189.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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