Inspection on 05/09/05 for Meadowcroft

This inspection was carried out on 5th September 2005.

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

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

Other inspections for this house

Meadowcroft 04/12/06

Meadowcroft 23/01/06

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 5 September 2005 th 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 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 F52 F02 S35960 Meadowcroft V248216 050905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Meadowcroft Address 304 Spital Road Bromborough Wirral CH62 2DE 0151 334 6325 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Metropoligan Borough of Wirral Mrs Sheila Hardie Care Home 23 Category(ies) of (DE) Dementia - (number of places 6) registration, with number DE(E) Dementia - over 65 (number of places of places 17) Meadowcroft F52 F02 S35960 Meadowcroft V248216 050905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 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. Date of last inspection 4 Januray 2005 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 F52 F02 S35960 Meadowcroft V248216 050905 Stage 4.doc Version 1.40 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 the statutory unannounced inspection for 2005 / 2006. A partial tour the building took place and service user case files were inspected. Three members of staff were spoken to and observations were made on the service user group. What the service does well: Thorough medication administration procedures are in place which ensures service users good health and safety. A range of social activities are provided to ensure an interesting and stimulating environment is provided. The home has a comprehensive complaints procedure to ensure service users, carers and other stakeholders views are listened to and acted upon. Systems are in place to ensure service users are safeguarded from abuse and a member of staff spoken to demonstrated they were aware of the action they should take in the event of them knowing or suspecting an incident of abuse had taken place. The standard of the decor within the unit remains very high providing service users with an attractive and homely place to stay. Staffing numbers and skill mix of staff meet the service users assessed needs and a rolling programme of staff training is in place to ensure staff are up to date with current good practice. Thorough procedures are in place for the recruitment of staff to ensure service users safety and welfare. There are clear lines of management and accountability within the unit which is run for the best interest of service users. Quality assurance systems are in place to ensure good standards of care are provided and maintained. Staff are appropriately supervised and supported within their role to ensure service users are cared for in accordance with good practice. The health safety and welfare of service users is well promoted. Meadowcroft F52 F02 S35960 Meadowcroft V248216 050905 Stage 4.doc Version 1.40 Page 6 The Wirral Social Services has clearly demonstrated a commitment to ensuring staff are well qualified and experienced to care for the service users staying at Meadowcroft. What has improved since the last inspection? What they could do better: At the last inspection requirements were also made in relation to the assessment and care planning processes as there were no clear and consistent systems in place to adequately provide staff with the information they need to satisfactorily meet service users needs. This requirement remains outstanding. Although service users physical and mental health is maintained through regular contact with healthcare professionals, it was not entirely possible to establish whether the information documented accurately reflected service users healthcare needs as the assessments and care plans were not always up to date. This inspection has resulted in five requirements being made which relate to the assessment and care planning process, staff training and supervision. The senior member of staff conducting the inspection demonstrated a commitment to ensure these issues were addressed as quickly as possible. Meadowcroft F52 F02 S35960 Meadowcroft V248216 050905 Stage 4.doc Version 1.40 Page 7 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 F52 F02 S35960 Meadowcroft V248216 050905 Stage 4.doc Version 1.40 Page 8 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 Standards Statutory Requirements Identified During the Inspection Meadowcroft F52 F02 S35960 Meadowcroft V248216 050905 Stage 4.doc Version 1.40 Page 9 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 standard(s) 3 There was no clear or consistent assessment system in place to adequately provide staff with the information they need to satisfactorily meet service users needs. EVIDENCE: A range of documentation was examined and found to be inconsistent in its content. While some assessments were comprehensive and covered a range of relevant issues the following points were raised in relation to the documentation examined: • • • • • Some documentation was not signed and dated no contact was made with service users carer or family in order to update staff of any changes to service users care needs prior to them coming into Meadowcroft for their respite stay service users carers or family are asked to provide documented information in relation to the service users care needs and past history. face to face assessments are not carried out and information is generally gathered over the telephone while an assessment of a service users care needs had been carried out prior to them moving into the unit from hospital after having suffered a F52 F02 S35960 Meadowcroft V248216 050905 Stage 4.doc Version 1.40 Page 10 Meadowcroft stroke, this information concentrated on the persons physical needs and did not address their mental health problems relating to their deteriorating dementia. These issues were discussed with the deputy manager who agreed the systems in place needed to be streamlined in order to ensure up to date information was available to support the care staff in their role of caring for the service users. Not having accurate information in this way could lead to important parts of a service users care needs being missed and both staff and service users being vulnerable to the risk of harm. The issue of the lack of information drawn together during the assessment process has been raised at the last for inspections and to date has not been fully addressed. In light of this the registered person is required to ensure the assessment process is more effective with more detailed information being compiled and more streamlined systems being set up. Meadowcroft F52 F02 S35960 Meadowcroft V248216 050905 Stage 4.doc Version 1.40 Page 11 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 standard(s) 7, 8 and 9 There is no clear and consistent care planning system in place to adequately provide staff with the information they need to satisfactory meet service users needs. Service users physical and mental health is maintained through regular contact with healthcare professionals. Thorough medication administration procedures were in place which ensures service users good health and safety. EVIDENCE: A selection of care plans were examined. A basic care plan detailing service users individual care needs was in place along with a manual handling risk assessment. A record of service users well being was kept on a daily basis. The following points were noted from the information examined: • • Some information was not signed and dated the care plans did not reflect the information gathered during the assessment process. The assessment addressed between 18 and 20 points in relation to service users care needs, however only 6 of these points were reflected in the care plan no review date had been identified in the care plans, although there was evidence of reviews having taken place F52 F02 S35960 Meadowcroft V248216 050905 Stage 4.doc Version 1.40 Page 12 • Meadowcroft • one service users care plan had not been updated prior him coming into the unit from hospital after having suffered a stroke. This is despite staff having visited him in hospital in order to reassess his needs and having recorded some information in his case file. To ensure service users receive the care they require, an accurate plan of care must be in place. Not having this information available could lead to important aspects of service users’ care being missed and both service users and staff may be left vulnerable to the risk of harm. Concerns have been raised about the care planning process in the last for inspections and to date this issue has not been fully addressed. In light of this the registered person is required to address the issues highlighted. Service users healthcare needs are met through the support of the care staff at the unit and regular contact with a variety of healthcare professionals. However it was not entirely possible to establish whether the information documented accurately reflected service users healthcare needs as some care plans were not up to date. Thorough systems were in place of the administration of medication which ensures service users medical needs are met. Meadowcroft F52 F02 S35960 Meadowcroft V248216 050905 Stage 4.doc Version 1.40 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 standard(s) 12 and 15 A range of social activities are offered to service users to ensure an interesting and stimulating environment is provided. EVIDENCE: Documentation was in place to show service users social interests had been assessed and a member of staff spoken to during inspection confirmed a range of social activities are provided to ensure service users interest and memory recall and also to encourage social interaction. Service users are always offered a choice at mealtimes and staff were observed assisting the service users requiring help with eating. The dining area was a pleasant room and staff ensured mealtimes were relaxed and informal. Special diets are catered for upon request to reflect service users medical needs and good health. Paying attention to this aspect of care is particularly important for older people as they can often experienced difficulty with eating and swallowing and need this informal and relaxed environment to ensure good nutrition. Meadowcroft F52 F02 S35960 Meadowcroft V248216 050905 Stage 4.doc Version 1.40 Page 14 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 standard(s) 16 and 18 The home has a comprehensive complaints procedure to ensure service users carers and other stakeholders views are listened to and acted upon. Systems are in place to ensure service users are safeguarded from abuse and harm although additional training does need to be provided to ensure staff are up to date with current good practice. EVIDENCE: The CSCI has not received any complaints about the standards of care provided at Meadowcroft. One complaint had been received by the unit in relation to the care provided; this was being investigated by the Social Services complaints department. A corporate complaints procedure is in place and staff knew what action to take in the event of them receiving a complaint. A copy of the Wirral adult protection procedure is in place and staff spoken to was aware of the action they should take in the event of them suspecting or knowing an incident of abuse had taken place. Not all staff have received training on the protection of vulnerable adults from abuse and while this training is provided on a rolling programme it may take some months for all staff employed at the unit to complete this training. In the interim the registered person is required to ensure all staff who have not received this training are provided with an in-house briefing in this aspect of care. The registered person is reminded that training can be provided in a variety of ways this being, formal training provided by an external trainer or the social services training department and informal in-house briefings provided by a suitably qualified competent member of staff. Meadowcroft F52 F02 S35960 Meadowcroft V248216 050905 Stage 4.doc Version 1.40 Page 15 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 standard(s) 19 and 26 The standard of the environment within the unit remains very high and provides service users with an attractive and homely place to stay. EVIDENCE: The standard of the decor throughout Meadowcroft remains very high and provides the service users with a very comfortable and homely environment. All bedrooms a single occupancy with ensuite 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. Clearly the domestic staff are working very hard to maintain the home to this high standard. The floor in the sluice has now been repaired. For service users’ safety an alarm has been fitted to the building. Meadowcroft F52 F02 S35960 Meadowcroft V248216 050905 Stage 4.doc Version 1.40 Page 16 The unit has a planned maintenance and renewal programme for the redecoration of the premises. There is ample communal living space which allows the service users to wander as they wish and provides a very bright and open environment. Meadowcroft F52 F02 S35960 Meadowcroft V248216 050905 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 29 Staff numbers and skill mix of staff meet the service users assessed needs. A rolling programme of staff training is in place to ensure staff are up to date with current good practice. Thorough procedures are in place the recruitment of staff to ensure service users safety and welfare. EVIDENCE: The staff rota indicated the staff were evenly deployed across the week with sufficient domestic staff to keep the home clean and tidy. Many of the staff are trained to NVQ level 2 and 3 and staff have undertaken a range of training appropriate for the care of the service users. Staff spoken to confirmed that a range of training is provided to support them within their role of caring for people with dementia. Training identified was in relation to first aid, health and safety, diabetes, Parkinsons disease and dementia care. Given the nature of the client group, the registered person is required to ensure all staff receive training in relation to dementia care as it has been sometime since this was last provided. Thorough recruitment procedures are in place to ensure the staff are suitably qualified and safe to work with vulnerable adults. A Criminal Records Bureau police check has been carried out prior to any member of staff being employed at the unit. For the most part the staff group is stable which is a positive aspect of the home as this provides consistency in the care provided and enables positive working relationships to develop. There are a number of staff vacancies which are currently being covered by the staff team. Meadowcroft F52 F02 S35960 Meadowcroft V248216 050905 Stage 4.doc Version 1.40 Page 18 A member of staff spoken to said they enjoyed their work and felt the staff worked well as a team. It is clear the Wirral Social Services is committed to ensuring the staff are well qualified and have an opportunity to develop within their role as care providers. Meadowcroft F52 F02 S35960 Meadowcroft V248216 050905 Stage 4.doc Version 1.40 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 36 and 38 There are clear lines of management and accountability within the unit which is run for the best interest of service users. Systems are in place to ensure good standards of care are provided and maintained. Staff are appropriately supervised and supported within their role to ensure service users are cared for in accordance with good practice. The health safety and welfare of service users is well promoted. EVIDENCE: The deputy manager demonstrated she was aware of her responsibilities with regard to the management of the home, supervision of staff and the care of service users. Although the registered manager was not available on the day of the inspection, it is clear she has established clear lines of accountability within the unit and that the unit is run for the service users best interest. Effective quality assurance systems are in place and it is clear the staff are working very hard to maintain high standards of care at all times. The Meadowcroft F52 F02 S35960 Meadowcroft V248216 050905 Stage 4.doc Version 1.40 Page 20 registered person also submits a monthly written report to the CSCI on the standards of care provided, any shortfalls that may have arisen and how these issues are being addressed. Staff do not receive regular formal supervision although the senior members of the staff team are always available for advice and guidance as and when required; this was confirmed by staff spoken to during inspection. For the support and development of care staff within their role, the registered person is required to ensure all staff receive formal supervision on a regular basis. During inspection an issue arose in relation to arrangements having been made for a therapist to be sited at Meadowcroft in order to provide therapeutic services to the Social Services staff from around the borough. This issue was discussed with the deputy manager and she expressed concern that having this service based at Meadowcroft was impacting upon her working day and her management of the home. It is also understood the therapist had asked this member of staff to find out whether or not any of the service users required his services. The inspector also raised concerns about this arrangement as it is not appropriate for a service, which is for the benefit of the Social Services staff, to be run from a residential care unit. Nor is it appropriate for the therapist to ask whether service users, who are unable to consent, require his services. In light of these concerns it was agreed that for the interim a room on the first floor would be used for this purpose. However the registered person is required to ensure this service is provided from another building. This issue will be taken up with the registered person following the inspection. Examination of documentation and discussion with staff confirmed that service users safety and safe working practices were promoted within the home and staff were provided with appropriate training for this purpose. Regular fire safety checks and checks on all equipment and water temperatures had been carried out. All of these issues demonstrate a high quality of care is being provided and that the health, safety and welfare of the service users was well promoted. Meadowcroft F52 F02 S35960 Meadowcroft V248216 050905 Stage 4.doc Version 1.40 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 4 x x x x x x 4 STAFFING Standard No Score 27 3 28 2 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x 3 x x 2 x 3 Meadowcroft F52 F02 S35960 Meadowcroft V248216 050905 Stage 4.doc Version 1.40 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 Regulation 14 Requirement The registered person is required to ensure staff at the unit carry out their own assessment of the service users needs before they are admitted into the unit. Also that all assessments of service users care needs are up to date. The registered person is required to ensure the care plans are an accurate reflection of service users care needs. All of this information must be signed and dated with a review date in place. The registered person is required to ensure all staff are provided with training on the protection of vulnerable adults from abuse. The registered person is required to ensure all staff are provided with training on dementia care. The registered person is required to ensure all staff receive formal supervision on a regular basis. Timescale for action 10/11/05 2. 7 15 10/11/05 3. 28 18 10/11/05 4. 5. 28 36 18 18 10/11/05 10/11/05 Meadowcroft F52 F02 S35960 Meadowcroft V248216 050905 Stage 4.doc Version 1.40 Page 23 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. Refer to Standard Good Practice Recommendations There are no recommendations resulting from this inspection. Meadowcroft F52 F02 S35960 Meadowcroft V248216 050905 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection 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. 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