Inspection on 11/07/08 for Meadows House

This inspection was carried out on 11th July 2008.

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

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

Meadows House 21/07/09

Meadows House 20/06/07

Meadows House 08/08/06

Extracts from inspection reports are licensed from CQC, this page was updated on 26/11/2008.

CARE HOMES FOR OLDER PEOPLE Meadows House Tudway Road Kidbrooke London SE3 9YG Lead Inspector Keith Izzard Unannounced Inspection 10:00 11 July & 21st August 2008 th 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 Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 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. Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadows House Address Tudway Road Kidbrooke London SE3 9YG 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) 020 8331 3080 020 8331 3099 meadows.admin@sanctuary-housing.co.uk www.sanctuary-care.co.uk Sanctuary Care Ltd Mr Keith Crowhurst Care Home 59 Category(ies) of Dementia - over 65 years of age (59) registration, with number of places Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 18 Service users in the category continuing care, nursing 5 Service users may be between the ages of 55 to 65 Minimum staffing levels are those set out in correspondence dated 18/03/02, `Explanatory notes (staff at LBG Resource Centres) No more than five Service Users may be admitted for respite / emergency placements 20th June 2007 Date of last inspection Brief Description of the Service: Meadows House is located on the Ferrier Estate, Kidbrooke, in the London Borough of Greenwich. The home is within 5 minutes walking distance of Kidbrooke railway station and two bus routes run from just outside the home. The home is situated equidistant between Eltham and Lewisham shopping centres and is a purpose built care home for older people. It is operated by Sanctuary Care and is one of a group of three neighbourhood resource centres in the London Borough of Greenwich. The home is divided into four units: Crownwood (12 residential dementia care beds) on the second floor; Queenscroft (15 residential dementia care beds) on the first floor; Jackwood (18 nursing beds) on the ground floor; and Harwood (15 residential dementia care beds) split between the ground and first floors. All units include dementia care for older people. The home has an integrated Day Centre in a dedicated area of the building on the ground floor, and these facilities are also available to long term service users. Accommodation is provided in single bedrooms, and all of these have en-suite shower and toilet facilities. Each unit has it’s own lounge and dining space, and there are additional communal rooms for reminiscence, a sensory room, activities room for crafts, and a hairdressing salon. Kitchenettes are available on each unit, and visitors are able to access these. Jackwood unit has a keypad security system for the protection of the service users in this unit; but service users from the other three units are free to wander between the different areas. Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 5 Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was unannounced and was carried out by two inspectors, on the first day of inspection. We visited four units all four units within the home. In preparation for the inspection we read all of the information that we had received about the service since the last inspection such as concerns and complaints, comment cards, notifications and the Annual Quality Assurance Assessment (AQAA) form. The latter was comprehensively completed and submitted in good time by the Registered manager. We used this information to plan how we would carry out the inspection and what issues we would look at. During the inspection we spoke with six residents, five relatives, and eight members of staff as well as the manager and deputy. We observed staff communicating with residents and visitors, supporting residents to eat and drink and take their medicines, in a professional and caring manner. All of the communal areas and several bedrooms were viewed on each of the four units that we visited. What the service does well: People were supplied with written information about the service and were actively encouraged to visit the home to view the facilities and ask questions. There is a good display of information about the home in the reception area, and accessible for visitors to see. Senior staff members assess potential residents considering a move into the home to see what help they required and if they had any special needs, this also included short- term carer breaks. This information was used to develop a plan of care for the person and establish a rapport with residents and relatives prior to admission. Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 7 Most relatives interviewed or who responded to Commission questionnaires were satisfied with the care and support that their family member received in the home. A number commented that activities could be improved. Positive comments, within returned questionnaires, were also made regarding the care provided, by two medical professionals who visit the home. Although, one felt unit leaders could benefit from more training provision and the other felt that more dementia training could be provided. Residents had access to community health care services. Health problems were monitored and advice was obtained from other professionals if necessary. Residents were appropriately dressed and looked relaxed. They told us that staff maintained their privacy and were polite and helpful. People could choose where and how they spent their time and staff encouraged people to make decisions for themselves where possible. All areas of the building were seen and were clean and free from unpleasant odour. Residents commented that the standard of cleanliness in the home was good. It was evident that service users had been given the opportunity to bring in personal possessions to personalise their bedrooms and overall a homely appearance had been created following efforts that had been made to hang pictures in communal areas. Maintenance and Health and Safety matters had been attended to in accordance with the Standards. What has improved since the last inspection? Two requirements to do with the recording and disposal of medication were complied with. A requirement to improver the structure of the filing and recording of complaints was complied with. The manager applied successfully to become the Registered Manager of the home. The entry system to the home has facilitated direct contact with the relevant unit reducing the waiting time for visitors and providing better security for the home. The process of recruitment of staff has benefited by involvement from relatives. Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 8 The home has received full accreditation as a practice development unit with Leeds University. Comments included “ the home has turned the theory of person centred care into a reality and that the residents are clearly at the heart of what they do” The home is part of an initiative and registered with the Liverpool care Pathway and Gold Standards Framework resulting in many of the residents remaining in the home with end of life care plans rather than ending their life in a hospital. Other initiatives in respect of improving activities for residents, are underway or being planned. 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. The summary of this inspection report can be made available in other formats on request. Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 9 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 Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Documentation relating to pre admission assessments and the admission process for both permanent and short- term care residents were available on residents’ care - files and retained on the relevant unit. EVIDENCE: Standard 3 We examined eight pre admission assessments for residents on all four units. There was evidence that comprehensive pre-admission assessments had been undertaken in relation to residents admitted to the home, including those admitted for carer relief breaks. One that was not on the care file was later produced as it had been misfiled. Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 11 On Jack Wood unit assessments were very detailed and included a comprehensive assessment by psychiatrists. Letters were available that confirmed that the needs of individual residents could be met by the home. Visitors spoken with stated that they are included in the review process and feel they are kept informed of important events affecting the well being of their relative living in the home. Standard 6 This Key Standard was not assessed, as this home does not provide an Intermediate Care Service. Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans showed the action that staff were taking to monitor and care for people with ongoing health care needs. Residents said staff treated them with respect and maintained their privacy and dignity. Staff members did not always follow good practice guidelines for the safe administration of medicines. This could compromise people’s health and safety. EVIDENCE: Standard 7 The provider has recently introduced a new care plan format, however the majority of care plans seen were completed using the older format. Nevertheless, guidance on how to meet residents’ needs had been provided Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 13 and there was evidence of reviews taking place with residents and their relatives being included in the process. It was noted that the manager had completed a care plan for a person who had recently moved into the home using the new format. He stated this was to familiarise himself with the system and to provide staff with guidance on how to complete the document. This was an excellent example and provided clear guidance for staff on how to meet residents assessed needs in a quick and easy format for people to follow. It was noted that one relatively new resident did not have a photo on the care file and management undertook to rectify this omission. Standard 8 All residents were registered with a GP and there was evidence in the records seen that residents had been referred to and seen by a GP, chiropodist and other professionals when needed. For example, at the time of the inspection visit one person on Jack Woods had a pressure area. The care record case tracked included a risk assessment in relation to pressure sores. Equipment such as pressure relief mattresses and cushions were provided for residents where needed. Records seen indicated that the District Nurse provided regular treatment and support for staff in managing this. On another unit care staff noted bad odour from a resident’s mouth, this was promptly referred and attended to by a visit from a dentist evidenced by appointments made within the diary of health appointments retained in the unit office. Standard 9 The home benefits from having a designated clinical room. This is used to store medication trolleys from each of the units. These need to be secured to the wall. The manager stated that he has taken action to address this and a contractor was expected in the near future to complete this task. See Recommendation 1 Recommendations were made at the time of the last inspection that the room would benefit from additional shelving. The manager has arranged for additional cupboard space and has ensured that the area has been cleaned and de-cluttered. There was evidence that action had been taken to address this. Unfortunately, on the day we visited two tablets were found laying loose on the clinical room floor and a card containing medication from one residents no longer required medication was also found on the floor. See Requirement 1 Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 14 A requirement was made at the time of the last inspection that a registered contractor should be appointed regarding removal of medication from the units providing nursing care. The manager stated that this had been addressed and that the contractor also removed medication from those units providing residential care as well. A requirement was made at the time of the last inspection that hand written entries on the MAR sheet should be countersigned to reduce the potential of errors occurring. One set of hand written entries was seen on this occasion and had correctly been countersigned. Records were examined for two residents being tracked. Some potentially unsafe procedures were identified in relation to the recording of medication. There were gaps on the MAR sheets without explanation. The number of Lorazepam tablets recorded on the MAR sheet did not tally with the number of tablets being held. Half a tablet was also found in one persons box of Lorazepam although according to the directions on the box the person was not being prescribed half a tablet. Records for a second person also prescribed this medicine were also examined and again the number of tablets recorded on the MAR sheet did not tally with the number of tablets in the box. Furthermore, the directions on one box of Lorazepam did not correspond with the directions for administration on the resident’s MAR sheet. Medication must not be omitted without written clarification of the reason and the written instructions on the medicine must be the same as the instructions on the MAR sheet for each individual. See Requirement 2 The original name of a resident’s prescribed Ibuprofen had been scrubbed out and another name had been handwritten on the bottle. Medicines are prescribed for individual residents and must not be used for anyone else even if they are in the category of homely medicines. Care staff must not alter labels attached to medication. Two MAR sheets did not have a photo attached, thereby not clearly identifying the resident to whom the sheet referred. See Requirement 3 A mortar and pestle was seen in the kitchen of Jackwood unit with the residue of some medication on it. A staff member interviewed stated that this device was used to grind up medication for two residents. This is not acceptable, as residue from other tablets could become mixed up and should be thoroughly cleansed after use. See Recommendation 2 It is very important and therefore a requirement if medicines need to be administered covertly that this information is included in the care plan and this must be agreed by the GP and written evidence given to support this practice. See Requirement 4 Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 15 Discussion also took place with the manager regarding the need to have a medicine profile for each resident, a protocol for the administration of ‘as required’ medicine for people who lack capacity. See Recommendation 2 Also evidence that staff who are responsible for medicine management are assessed, annually, as being competent to do so, must be implemented See Requirement 5 Failure to ensure that medicines are properly managed could result in enforcement action. Standard 10 Staff members were seen knocking on bedroom doors and asking permission to enter bedrooms. Good interaction was seen between staff and residents and assistance was provided to residents when needed. Bathroom and toilet doors had locks fitted, bedrooms were for single occupancy and all bedrooms had en-suite facilities. The home had a trolley telephone to enable residents to make and receive calls in the privacy of their bedroom and a number of residents had private phones in their bedrooms. Residents and relatives spoken with did not raise concerns as to how staff respected their privacy and dignity. We did discuss with the manager an issue regarding spare clothing that was not being stored for residents in an appropriate way. This matter was discussed with staff and rectified straight away. It was stated in the AQAA document that staff were putting do not disturb notices on residents’ doors when bed baths were being performed, this is commendable practice to maintain dignity and privacy. Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Attention was generally paid to establishing and recording residents interests prior to their admission to the home. However, the input made by individual care staff and the activity coordinator does need to be quantified in a clear way to enable an accurate assessment of the level of activities provided for residents. Visitors are welcome at anytime, and are actively encouraged and able to take part in the life of the home. A varied and nutritious diet is provided. EVIDENCE: Standard 12 Overall, it was difficult to accurately assess the level of activities provided as some are written within the daily notes on care files and others on weekly planners. It would not be possible to read through all care plans in order to Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 17 ascertain those provided directly by care workers. Also, the manager and unit managers acknowledged that not all activities provided by care staff are always recorded therefore understating the level provided. The manager stated that the new care documentation facilitated better recording of activities and this area would show improvement when the documentation is fully introduced. Several staff members we spoke to said they tried to find time to do activities with residents however most of their time was taken up providing care, serving meals etc. Evidence was available that outings were arranged via Day Care bus rides every Wednesday morning and trips had been arranged to the seaside both in May and June via posters widely displayed throughout the home. Also some residents attended activities in the Day Centre. However, three resident / relative survey forms returned to the Inspectors indicated the need for more activities and outings and similar comments were received from two residents spoken to. A previous requirement regarding clarification about an activities coordinator role is being developed, following an extensive piece of work by the Regional Manager. The Registered Manager stated that plans were afoot to appoint a specialist person who would be responsible for activities development across three homes and that activities would be specific to individual residents rather than a generic provision. The implementation of this appointment must now occur in order to further improve the level and quality of activities provision. See Requirement 6 Standard 13 The home has an open visiting policy to make it possible for residents to maintain contact with family and friends. Residents seen said they enjoyed family visits and relatives were encouraged to attend social functions and relative meetings. Relatives spoken with stated they were made feel welcome when visiting and found care staff approachable, helpful and informative. Standard 14 Some residents seen said they could make choices about issues such as meals, what to wear, where to sit and whether to participate in activities. Residents were able to bring in personal items from home to make their bedrooms more personal. Standard 15 A sample of menus provided for residents were examined for a four-week period and discussed with the chef. Records seen indicate that residents are provided with a varied and nutritious diet. Alternative food had been cooked for residents who did not like the main menu provided. Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 18 It was noted that that residents who needed to have their clothing protected at mealtimes were wearing aprons and napkins etc as opposed to a bib, this is good and respectful practice. One member of staff spoken to regarding lunch stated that generally there was not a choice of food, however in addition to the fried fish and chips the kitchen had provided egg and chips for two people. The alternative to fried fish was poached white fish and staff rightly pointed out that with mashed potato this would be difficult for some people to swallow. Some people required a soft diet and this had been appropriately prepared by the kitchen staff and appropriately served by care staff. Tables were appropriately laid and a choice of juice available. Tartar sauce was provided to accompany the fish. In relation to the recommendation made at the time of the last inspection regarding obtaining a copy of Eating for Health in Care Homes. There is now a new chef and relatives spoken with said that they had been invited to meet with the catering staff and new menus had been developed since we visited last. The general consensus of opinion was the things had greatly improved. Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory systems were in place to manage complaints and ensure residents’ protection. EVIDENCE: Standard 16 The complaints procedure was displayed in the main reception area. All residents and relatives interviewed knew how to make a complaint and said staff responded appropriately when they raised concerns. The AQAA showed that in the previous twelve- month period eleven complaints had been made to management and following investigation seven of these were substantiated and three not substantiated. All complaints had been dealt with in accordance with the required time frame. On viewing complaint records it was noted that three of the complaints were safeguarding adult issues referred to in the next Standard. Complaints were recorded in a file. The file had been reorganised since the last inspection, old complaints were removed and archived and information was now easier to follow. There was a summary sheet at the start of the folder so that the manager had an overview of complaints and could see if there were any reoccurring trends. Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 20 A previous requirement to reorganise and improve the way complaints were filed had therefore been complied with. One anonymous complaint about the home had been made directly to the Commission. We investigated the complaint and found it to be completely unsubstantiated. Standard 18 A policy and procedure was in place in relation to safeguarding adults. Staff spoken with had a good understanding of their role in safeguarding adults and understood the ‘whistle blowing’ policy. Staff members interviewed appeared confident that any concerns reported to management would be responded to promptly and that managers were approachable, thereby facilitating the sharing of any concerns. The manager notified The Commission for Social Care Inspection (CSCI) about significant events that occurred in the home such as serious accidents, and deaths and reported safeguarding issues to the local authority. Three concerns were referred under local authority safeguarding procedures in the period since the last inspection. Although none of the concerns raised were substantiated. It was noted that appropriate procedures were implemented by staff members of the home in relation to Safeguarding matters and prompt action taken to safeguard residents’ welfare. Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives were satisfied with the private and communal space provided. The home was kept clean and a rolling programme of maintenance and redecoration work maintained. Systems and equipment was in place to enable staff to practice infection control. EVIDENCE: Standard 19 Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 22 All of the residents benefit from having a large bedroom with en-suite facilities. The units were appropriately decorated and furnished for the purpose. There are both showers and baths suitably adapted for the purpose on each unit, thereby enabling choice for residents. All rooms have appropriate locks to the door and each service user is provided with a lockable drawer to house personal/valuable items. Day space for service users consists of a large lounge/dining room and all units were suitably decorated and furnished. There is a small kitchen area on each unit to enable staff to make refreshments and snacks for residents, these areas now need some renovation. Staff members have been proactive to help residents with memory loss by clearly displaying notices around the home for example pointing the way to the garden etc. Individualised murals have been provided for each unit and are strategically placed on walls to aid the identification of units to assist residents. A complaint had been made specifically in relation to the cleanliness of Jack Wood unit and we noted that the microwave would benefit from a clean, the manager agreed to arrange for this to be carried out at the time. On the same unit the kitchen cupboards has deteriorated quite badly, and deteriorating on other units to. The units look scruffy difficult to clean and one draw front completely missing. A lot bedroom walls were in need of a re paint as staff members had hung mobiles from smoke detectors in bedroom, staff were asked to remove and find a more appropriate place to hang. The manager stated that money had been earmarked in the maintenance budget for these areas to be addressed. See Requirement 7 Standard 26 All areas of the home viewed were clean and tidy. Sluice rooms were provided to store waste and staff had access to protective clothing and appropriate hand washing facilities. Staff said they had access to adequate supplies of protective clothing. The home benefits from a purpose designed and well organised laundry. Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home should continue to monitor and review staffing levels. Recruitment practices were satisfactory and protect the people that use the service. Staff were supported to develop new skills and to keep up to date with current practice. EVIDENCE: Standard 27 Staffing rotas were examined over a four-week period and found to comply with the minimum requirements and no regression from the time of registration of the home. Standard 28 The home recruits care staff members that have already been trained in care up to NVQ 2, where possible and also supports staff in taking this qualification. Over 50 of the care staff that worked in the home had a National Vocational Qualification in Care (NVQ). The number of care staff with a recognised care Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 24 qualification had increased and it was evident that the home was working towards meeting this standard, as other staff were engaged in gaining the qualification. Standard 29 Four personal staff member files were examined, in relation to recruitment and training. Records seen indicate that there are sound recruitment procedures in place to protect residents living in the home. Part of the providers recruitment procedure/guidance is written to enable senior staff to establish prospective employees understanding of the English language. Standard 30 A training matrix is maintained to ensure that statutory training such as manual handling and food hygiene is updated on a regular basis. It is recommended Safeguarding procedures be added to the list of areas that require annual updates. See Recommendation 3 Whilst generally positive comments, within returned questionnaires, were made regarding the care provided by staff by two medical professionals one felt unit leaders could benefit from more training provision and the other felt that more dementia training could be provided. The manager of the home also holds appropriate teaching qualifications and provides additional training for staff in relation to working with people who have dementia. The manager also stated he accesses training for staff from the local authority and relevant universities. Staff spoken with stated they were provided with good training opportunities and copies of training certificates are retained on staff files to evidence courses undertaken by employees. Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed by a registered manager, respected by staff members and regarded as approachable by both residents and staff alike. The home ensures that relatives and service users are able to voice their opinions and contribute their views on the running of the home. The home is well maintained, and observes good health and safety practices. EVIDENCE: Standard 31 Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 26 The manager is very well qualified, experienced, and well suited to perform the tasks required as manager of the home. It was evident that both the residents and staff members interviewed felt positively about the manager and all stated he was very approachable, neither residents or staff members would hesitate to speak to him should they have any concerns regarding the running of the home or the welfare of residents. The manager has now become the Registered Manager for the home following a successful application to the Commission. Standard 33 The home is subject to an annual audit by Sanctuary Care. The home is also and the home is visited regularly, on a monthly basis, and a report compiled on the conduct and running of the home, as required, under Regulation 26. These reports have been made available to the CSCI and copies are retained within the home. The home is also monitored on a regular basis by the Commissioning unit from the London Borough of Greenwich Social Services Department and the subsequent reports of these visits are made available to CSCI. The last report was positive. The home has a good record of compliance in respect of both CSCI reports and those from the London Borough Of Greenwich. Standard 35 Records pertaining to the personal allowances of two service users were examined. The amount of money being held for each service user tallied with the amount recorded in the ledger book records, examined. All service users money remains in individual named envelopes. The staff stated that receipts are given to people depositing money into service users accounts. Receipts are kept for all items that are purchased by staff on behalf of service users. The home has appropriate facilities to keep service users money and valuables secure in a locked safe with restricted access only to specific staff members. Standard 38 The home has regular access to two maintenance persons employed by the provider, who between them carry out regular health and safety checks, the undertake routine repairs etc. Safety records seen showed attention was given to providing a safe environment for residents and others. Records seen were up to date and showed that service checks had been done when due, however it is Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 27 recommended that areas covered by inspection be filed in more easily identifiable sections to assist inspection. See Recommendation 4 Records seen included service for hoists the fire alarm, the lift, the assisted baths, the gas and electricity certificates. The maintenance technician completed in-house safety checks on items such as bed rails, wheelchairs, hot water temperatures and window restrictors. Fire safety arrangements were good. Regular checks were undertaken to ensure that the fire alarm system, emergency lights, fire extinguishers and fire doors were in working order. Staff received fire safety training and attended fire drills. Accident records were viewed and were generally well completed. The records showed that where required residents received medical attention following accidents and notifications were sent to the Commission as required by regulation 37. A system was in place to monitor residents for up to 48 hours following an accident. The manager monitored accidents and completed a monthly audit, which was sent to head office. Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 29 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. 1. 2. Standard OP9 OP9 Regulation 13 13 Requirement Medicines must be retained safely within the home. Medication prescribed must not be omitted without clarification of the reason. Medication on the MAR sheet must correspond exactly to that recorded on the label of the container of the medication. The label for medication on the container must not be altered to show another resident’ name as the medication is prescribed for one named person only. Covert administration of medication must be agreed by the GP and written evidence provided to support this provided in the care plan. Evidence that staff responsible for medicine will be assessed, annually, as being competent to do so must be implemented. The appointment of a specialist activities person must be implemented as soon as possible. Kitchen cupboards on individual DS0000067469.V366418.R01.S.doc Timescale for action 01/11/08 01/11/08 3 OP9 13 01/11/08 4 OP9 13 01/11/08 5 OP9 13 01/01/09 6 OP12 16n 01/01/09 7 OP19 23 (2) 01/03/09 Page 30 Meadows House Version 5.2 had deteriorated quite badly and need replacement completely missing. A lot bedroom walls were in need of a re paint. 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 OP9 Good Practice Recommendations Medication trolleys from each of the units stored in the clinical room need to be secured to the wall. Implements used to crush medication should be cleansed immediately after use to prevent contamination between different medications. It is recommended Safeguarding procedures be added to the list of areas that require annual updates. The maintenance files should be organised to more easily to reflect the areas examined during inspection. 2. 3 4 OP9 OP30 OP38 Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Meadows House DS0000067469.V366418.R01.S.doc Version 5.2 Page 32 - 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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