Inspection on 24/02/06 for Meadowcroft

This inspection was carried out on 24th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Meadowcroft 30/09/08

Meadowcroft 13/10/06

Meadowcroft 25/08/05

Meadowcroft 15/03/05

Meadowcroft 19/08/04

Meadowcroft 12/02/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Meadowcroft Towersey Road Thame Oxfordshire OX9 3NN Lead Inspector Delia Styles Unannounced Inspection 24th February 2006 13:10 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 DS0000036097.V284906.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 DS0000036097.V284906.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Meadowcroft Address Towersey Road Thame Oxfordshire OX9 3NN 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) 01844 212934 01844 215630 manager.meadowcroft@osjctoxon.co.uk The Orders Of St John Care Trust Zalina Grazette Care Home 45 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (45), of places Physical disability over 65 years of age (7) Meadowcroft DS0000036097.V284906.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The total number of persons that may be accommodated at any one time must not exceed 45 As vacancies arise the number of persons in the PD/E category will be reduced to 4. The continued registration of this service past April 2007 is dependent upon the physical environment meeting standards. 25th August 2005 Date of last inspection Brief Description of the Service: Meadowcroft is situated in a quiet residential area near to the centre of the market town of Thame. It is close to local services – a health centre, community hospital, shops, library, pubs, clubs and churches. The home is registered to accommodate 45 older people, some of whom may have physical disabilities or are mentally frail. The accommodation is provided in 27 single rooms and 9 double rooms, on two floors that are served by a passenger lift. Three of the double rooms are used as single rooms for residents whose care needs are such that they need space for additional disability equipment. The home also provides day care for up to five elderly people a day. There is a large ground floor lounge and dining room, a second smaller ground floor dining room and two further sitting rooms and a dining room on the first floor. There are three assisted baths with over-bath showers and 14 toilets. None of the rooms have en-suite facilities but all have a washbasin. The home is set in its own grounds, with surrounding lawns, gardens and mature trees and shrubs, and is next to a secondary school, overlooking the school playing fields at the rear. There is an attractive central courtyard garden, accessible from the ground floor lounge and dining areas. Meadowcroft DS0000036097.V284906.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection visit that lasted four hours. The inspector focussed on ‘key standards’ not assessed during last announced inspection of the home done in August 2005. ‘Key’ standards are those considered by the Commission for Social Care Inspection to be important ones that should be inspected at least once every 12 months. Standards about which recommendations (good practice improvements) were made in August were also discussed. A partial tour of the home was undertaken. The medication storage and records, and a sample of residents’ care records were examined. The home’s accounting and finance systems were discussed with the home’s administrator. The inspector spoke to several residents, the home manager, care leaders and several care staff during the visit. Feedback was given to the manager at the end of the inspection. Meadowcroft is one of a group of Oxfordshire care homes that were formerly owned by Oxfordshire Social Services until transfer of ownership to OSJCT in 2003. OSJCT is replacing many of the old homes with purpose built new premises, so that the accommodation and facilities will meet the National Minimum Standards for Care Homes for Older People. Meadowcroft residents are looking forward to the new premises that are to be built in Thame that will replace the present building. What the service does well: What has improved since the last inspection? Rearrangement of the furniture in the main ground floor dining room has improved the access and seating for residents at mealtimes and for social events and entertainment. There is a marked improvement in the standard of most of the written care records for residents, so that care staff have more detailed information about Meadowcroft DS0000036097.V284906.R01.S.doc Version 5.1 Page 6 residents’ care needs and the help that staff should give to best assist residents. The activities leader for the home has had further training and is developing a varied programme of entertainment and activities for residents. The OSJCT catering consultant and the home manager and catering staff have worked together to review and improve the menus, taking into account residents’ opinions and choices. There was evidence that concerns raised by residents about the catering and laundry services had been addressed and improved. 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 DS0000036097.V284906.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 DS0000036097.V284906.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): 1&3 The homes Statement of Purpose and Service User Guide information provide residents and prospective residents with details of the services the home provides so that they can make an informed decision about admission to the home. The assessment procedure for prospective residents assures residents that their needs can be met by the home. EVIDENCE: The manager had produced an updated draft Statement of Purpose and Service User guide that was awaiting final approval of OSJCT managers. All residents had received a recent Registered Nurse Care Contribution (RNCC) assessment. Assessment by an NHS nurse identifies those residents whose condition has changed over time and who may need 24 hour nursing care, which this home cannot provide. All publicly funded residents have a social services ‘reviewing officer’ or care manager allocated who will periodically meet with them and their families and the homes’ staff, to check that they are receiving the level of care they need and are happy with the home. Meadowcroft DS0000036097.V284906.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 & 10 The system of care planning has improved since the last inspection and most records provide staff with the information they need to satisfactorily meet residents’ care needs. The medication at this home is well managed overall and provides a safe administration system for residents. Personal support and care is offered in a way that promotes and protects residents’ privacy, dignity and independence. EVIDENCE: Examination of a sample of care plans on each unit showed that there has been a marked improvement since the last inspection. The manager explained that one care leader has worked with colleagues to review and re-write all the residents care plans. There is one unit where some of the plans had not been reviewed or updated since August 2005, but this will be addressed. There was evidence that the home has sought the advice of specialist nurses in the community to improve the care of some residents – for example, someone at risk of increased falls and others with impaired memory and anxiety. Meadowcroft DS0000036097.V284906.R01.S.doc Version 5.1 Page 10 The improvement in the standard of written records is encouraging because care staff have more detailed information about the care needs of each resident and what they need to do to assist residents, rather than relying more on verbal information shared at handover reports, which can be forgotten. There was evidence that residents or their relatives (if the resident is not able) had discussed and agreed the information written by staff in their care plans. The homes systems and procedures for the ordering, safe storage, administration and recording of residents’ medicines are good overall. The keys for the clinical room and medicine cupboards and trolleys were held on one the same key ring as other master keys. The keys for medication storage areas should be on a separate key ring as an added safeguard so that only the senior staff member authorised to give out medications has access to them. The Medicine Administration Records (MAR) sheets were correctly completed, except that a few did not record accurately the reason for omitting a dose of prescribed medication. Also, where residents have prescribed skin ointments or lotions or eye drops that are applied by care staff, there should be a cross reference on the MAR sheet to the record kept in residents’ own rooms. This enables staff to be confident that the residents have had their prescribed treatments and that care staff can observe and report to the doctor whether these are effective. The home maintains a list of the signatures of all the staff who have been trained and are competent in administering residents’ medicines. However, staff use only their initials to sign the MAR sheets. It is advisable for staff to add their usual initials to the signature list, so that the identity of staff giving out medicines can be accurately traced and to reduce the risk of confusing a staff member’s initial(s) with any of the code letters used to record the reason for omitting a dose of prescribed medication. Staff were observed to be polite and respectful towards residents, and to knock on residents’ room doors before going in. Residents spoken with were at ease with care staff. One resident spoken with said it will be good, when the new home is built, to have their own en-suite toilet and washing facilities in their room. Meadowcroft DS0000036097.V284906.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 & 15 The home has made progress in developing the range of activities available for residents. Residents’ opinions and suggestions about the catering and menus have been sought and changes made to address these since the last inspection. EVIDENCE: The manager said that the activities leader had attended a training course organised by OSJCT and had worked with another home’s activities leader to help develop ideas for residents’ activities and social events in the home. Many of the residents were enjoying listening and participating in a musical entertainment in the ground floor lounge during the afternoon. The manager also reported progress with improving the menus and variety of meals through consulting with residents and regular meetings with the catering team. As at the last inspection, there was some evidence of assessment of residents’ nutritional condition on admission to the home, but not of a regular review of how well nourished individuals were (other than a record of their weight). Meadowcroft DS0000036097.V284906.R01.S.doc Version 5.1 Page 12 The recommended nutritional assessment process, and accompanying ‘risk’ assessment and care plan, is the one recommended by the community dieticians in Oxfordshire – the Malnutrition Universal Screening Tool (MUST). The OSJCT has not introduced this yet in its care homes, but is recommended to do so, so that it uses a consistent way of assessing someone’s risk of malnutrition that is also being used in NHS hospitals and in the community. Also, so that the homes can show in detail, if necessary, what actions have been taken to improve the resident’s nutritional status. Meadowcroft DS0000036097.V284906.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The home has training and procedures in place so that staff have a good understanding of adult protection issues, which protect residents from abuse. EVIDENCE: New staff receive training during their induction period about the reporting of suspected adult abuse and have mandatory training regularly thereafter. There was evidence that the homes managers had dealt with an incident of alleged abuse appropriately and promptly and have taken action to alter staffing work patterns to prevent any recurrence. The OSJCT policy on the reporting of suspected abuse was on display in the utility and staff rooms. Meadowcroft DS0000036097.V284906.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards not assessed on this occasion. EVIDENCE: Meadowcroft DS0000036097.V284906.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 Staffing numbers and skill mix are improving despite some staff turnover and sickness so that the home maintains consistency of care to residents. EVIDENCE: The manager reported that there were some shortages of staff currently due to staff sickness, annual leave and the resignation of a care assistant. There are 4 senior care leaders and a trainee manager on site to support the registered manager and the staff have all worked well together to cover staff shortages and maintain continuity of care for residents. Meadowcroft DS0000036097.V284906.R01.S.doc Version 5.1 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35 & 36 The manager has a good understanding of the aims and philosophy of the home and she communicates effectively with the residents, staff and relatives. The homes systems for accounting and safeguarding of residents’ financial interests are good. The programme of individual formal staff supervision meetings is not yet fully in place. EVIDENCE: Mrs Zalina Grazette became the registered manager for this home in 2005 on the retirement of the previous home manager, Mrs Helen Plant. As a registered nurse Mrs Grazette has had extensive experience in teaching student nurses and in working in a wide range of health care settings. Meadowcroft DS0000036097.V284906.R01.S.doc Version 5.1 Page 17 She communicates well with residents and staff and has a clear and consistent management approach so that the home is run in the way that focuses on the well being of the residents. The home has a part-time administrative assistant who deals with residents personal allowance funds if they are not able to do this for themselves. The homes system for receiving and accounting for small amounts of money, or valuables held on behalf of residents, is well managed and has auditing and safeguards to ensure that residents’ are not financially exploited. A separate account is held for donations given to the Friends of Meadowcroft who fund additional equipment or social events for residents. The trainee manager working in Meadowcroft home currently has set up a programme of individual formal supervision meetings with all the staff and this is due to be started, so that all care staff will have regular opportunities to discuss their work, training needs and progress confidentially with a more experienced staff member. Meadowcroft DS0000036097.V284906.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 2 X X Meadowcroft DS0000036097.V284906.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP1 OP7 OP9 Good Practice Recommendations Amend to the Statement of Purpose and Service Users Guide to include all the information required under Schedule 1 and supply an up to date copy to CSCI Continue to improve the standard of care plans and records by adding evaluation and making the daily statement entries more specific to the care plans. * Ensure that code letters used to denote the reason for omitting prescribed medication doses are correctly defined. * Keep the keys to medication storage areas separate from the master keys for other storage rooms in the home * Cross-reference the MAR sheet entries for external medications - skin creams, ointments and eye drops etc – to separate records held in residents’ own rooms, for example. Meadowcroft DS0000036097.V284906.R01.S.doc Version 5.1 Page 20 4. OP15 * A current record of the usual signature and initials of all staff authorised to administer medications should be maintained. Continue to implement the planned menu changes and catering quality audit. Access training for staff in the use of the MUST nutritional assessment tool for residents Meadowcroft DS0000036097.V284906.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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 DS0000036097.V284906.R01.S.doc Version 5.1 Page 22 - 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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