Inspection on 20/06/07 for Meadows House

This inspection was carried out on 20th June 2007.

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

Meadows House 21/07/09

Meadows House 11/07/08

Meadows House 08/08/06

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

CARE HOMES FOR OLDER PEOPLE Meadows House Tudway Road Kidbrooke London SE3 9YG Lead Inspector Keith Izzard Unannounced Inspection 20th June 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Meadows House DS0000067469.V340243.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.V340243.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 vacant post Care Home 59 Category(ies) of Dementia - over 65 years of age (59) registration, with number of places Meadows House DS0000067469.V340243.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 8th August 2006 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.V340243.R01.S.doc Version 5.2 Page 5 Meadows House DS0000067469.V340243.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection was completed over a period of 7.5 hours by two Inspectors on 20/06/07. The previous full inspection was an unannounced inspection on 08/08/06. The inspection included a complete tour of the premises, examination of individual resident care records and other documentary evidence of health and safety recording. During this time discussions took place with a number of residents and staff members. Prior to the inspection survey questionnaires were sent by the Inspectors to a larger number of residents, relatives and involved external professionals with the home. Five resident care plans were case tracked and the personnel files of four staff members recently employed were examined in respect of the recruitment practice of the home. Overall, practice was found to be of a good standard and fifteen questionnaire responses at the time of writing this report were largely complimentary of the service provided. Three adverse comments were made regarding the level of activities and outings provided for residents and one from a professional who commented that medication prescribed by the Community Mental Health Team was not always continued beyond the prescription given by the Consultant. Since the appointment of the new manager it was noted that good efforts had been made to address all the requirements made at the previous inspection and he submitted a detailed pre- inspection questionnaire to CSCI. The manager has instituted a number of initiatives that should benefit resident care including linking with a national dementia research project and “end of life best care practice”. In respect of the latter the manager is hoping that he will gain the wholehearted support from both the GP’s attached to the home and the wider medical support team in order to make a success of this initiative. What the service does well: 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. Service users were seen to be comfortable and good interaction was observed between staff and service users. Service users were seen to be appropriately dressed for the very warm weather and well cared for in clean laundered Meadows House DS0000067469.V340243.R01.S.doc Version 5.2 Page 7 clothing. Residents and relatives commented that most staff members were caring and professional in their approach. What has improved since the last inspection? 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.V340243.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Meadows House DS0000067469.V340243.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 & 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an up to date Statement of Purpose and Service user Guide. A copy of the latter is available within the reception area and has been given to all service users, individually. Documentation relating to pre admission assessments and the admission process are available on all service user care files retained on the relevant unit. Service users are assured their needs can be met by the home prior to their moving in, relatives and friends of residents are encouraged to visit the home prior to any admission to assess the quality and facilities of the home. EVIDENCE: Standard 1 Meadows House DS0000067469.V340243.R01.S.doc Version 5.2 Page 10 Following the previous inspection requirements were made to update both the Statement of Purpose and Service user Guide to reflect the recent change of ownership and copies sent to the CSCI as soon as possible. Also a copy of the Service User Guide must be given to all service users, including those on short- term placements. Both requirements had been complied with and this Standard is now met. It was also noted that a copy was also available within the entrance area to the home along with the previous inspection report, this is good practice. Standard 3 At the previous inspection requirements were made to ensure that all initial assessments must be retained on service user care plan files and all documentation relating to the admission process must be retained on the current care file on the appropriate unit. There was evidence that relevant health and social care professionals had been involved in collating information at the time of the pre- admission assessment and that they had also been part of on going reviews. Records also indicated that care plans and reviews also involved residents relatives or advocates. Both the requirements were, therefore, complied with and are now met. Standard 4 There was evidence that the manager had written to prospective residents advising them that following the assessment the home was able to meet their needs at the time of their admission. This was identified in care files examined by both Inspectors on all four units and the requirement made previously is also, now met. Meadows House DS0000067469.V340243.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 &10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans examined were comprehensive, particularly those using the new format. Health care needs were appropriately attended to and recorded on residents care files. Medication was generally well managed but a requirement was made to ensure handwritten entries are countersigned. EVIDENCE: Standard 7 A total of five residents’ care plans were case tracked. Two on Jack Wood, one on Crown Wood unit and one on each of Queenswood and Harwood units. Meadows House DS0000067469.V340243.R01.S.doc Version 5.2 Page 12 Care plans on Jack Wood were good. Staff members stated Sanctuary were looking at changing the format of their care plans and staff have been asked to use the prospective format on a trial basis. Both the new and older format had been completed appropriately but the other three units were still, largely, using the older documentation. There was evidence that staff had identified problems within care plans described intended outcomes and provided written guidance of the action required by care staff members to achieve the outcome. Evidence was available that care reviews had been undertaken appropriately that relatives had been involved and signed care plans. In one instance the home had provided a Chinese interpreter for the wife of a resident, as she could not converse in English. Standard 8 Records seen indicate that residents receive appropriate medical intervention from relevant health care professionals. A psychiatrist who visits residents on Jack Woods on a regular basis completed a CSCI survey and spoke positively about improvements made in terms of communication since a new acting manager had been working on the unit. Information provided in the pre inspection questionnaire indicated that one person had a pressure sore.. At the time of the inspection staff stated that this had now healed and no one was receiving treatment for pressure areas. Overall, care files were comprehensive and up to date. Standard 9 Medication was seen in relation to the four of the residents being case tracked as well as the general storage for the whole house. A requirement was made at the time of the previous inspection regarding the unsatisfactory temperature that medication was being stored at on Crown Woods unit. Staff members have addressed this by ensuring that all medication trolleys are now housed in the ground floor clinical room that is generally cooler. Medication records for residents residing on Jack Wood unit were appropriately completed. Although the majority of handwritten entries made to medication records pertaining to residents living on Crown Woods unit had been signed by two people a minority had not and is a requirement that this practice be implemented to reduce the risk of error. See Requirement 1 Meadows House DS0000067469.V340243.R01.S.doc Version 5.2 Page 13 The trolley used to store medication for residents on Jack Wood unit has a number of bottles of Lactulose stored on the bottom shelf that is not secure. Discussion took place with the manager regarding the need to purchase a larger trolley to ensure that all medication is stored securely at all times. Although the clinical room is a good size there is a very limited work surface available, staff will benefit from having greater space to process medication coming in and going out of the home. See Recommendation 1 One resident on Crown Woods unit has been prescribed Warfarin on a regular basis and the unit manager has implemented good protocols to manage the information provided by the hospital Warfarin clinic when changes are required to the dose prescribed. Following training staff members sign to say they have received and understood the homes medication policy. Controlled drugs were managed safely and records checked were accurate. It was noted that any unused medication generated by Jackwood nursing unit was being removed by the pharmacist; the home must have a contract with an approved contractor for the removal of medical waste from the nursing unit. See Requirement 2 Generally the clinical room would benefit from reorganisation to remove items being stored in the area that do not relate to residents medication or health and additionally a thorough clean. See Recommendation 2 It was noted that an error had occurred in respect of one resident on the day of admission from another home. The mistake was understandable given the two different operating systems of the homes. The resident was not adversely affected by the error. It was also good to note that the unit manager noticed the mistake the same day and took immediate action and notifying all staff both verbally and in writing on the MAR sheet. Standard 10 Staff members were seen to respect residents privacy and dignity when assisting with personal care, ensuring that bedroom and toilet doors were closed and knocking before entering rooms. Meadows House DS0000067469.V340243.R01.S.doc Version 5.2 Page 14 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): 12-14 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 able to take part in the life of the home. A varied and nutritious diet is provided. EVIDENCE: Standard 12 Staff members interviewed stated that the activities coordinator is the designated manager of the day centre attached to the home. She arranges and undertakes activities with residents in Meadows House when possible. There Meadows House DS0000067469.V340243.R01.S.doc Version 5.2 Page 15 was no organised activities seen to take place on any of the four units during the course of the day apart from one resident who spent a short time dancing with a member of staff. A member of staff on Crownwood unit was asked how many times the activity coordinator had been on the unit the previous week and she stated none. Additionally, some residents attend activities in the day centre, The extent of the hours allocated to involvement by the activities coordinator should be clarified in respect of input to the individual units and the time allotted to involvement of residents in the day centre quantified. See Requirement 3 Records pertaining to the resident being case tracked on Crownwood did not indicate any involvement in activities other than visits from relatives. The unit manager stated that staff were responsible for arranging these and gave examples of staff spending time with residents for hand massages, manicure and hairdressing. Whilst individual one to one activities initiated by care staff is commendable, it is less clear how feasible this might be to provide at peak times of personal care or in response to the increasing dependency needs of this resident group and has implications in terms of staffing numbers required, please see (Standard 27). Two residents were being taken out from Queenscroft unit on the morning of inspection via the day centre and sessions of nail care and dancing had been arranged for some other residents. Overall, it was difficult to 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 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. Three resident / relative survey forms returned to the Inspectors indicated the need for more activities and outings and physiotherapy type sessions for those less mobile. Information regarding residents’ activities on Jackwood unit is held in a separate book from care plans, however entries were predominantly the same as those recorded on Crown Woods with the addition that residents on Jack Woods benefit from an appropriately equipped sensory room. The care plan for a resident on Jackwood indicated the person enjoyed playing cards and indoor games and evident good practice by staff within the admission process. Discussion took place with the staff that if this had been highlighted as an interest, action should be taken by them to address this in order to promote the retention of interests the resident had prior to admission to the home. The home should devise a system that records the level of activities provided to individuals, when they participated, if they declined to be involved and why. See Recommendation 3 The Inspectors were told that the home is fund raising in order to respond to a previous recommendation that the home has its own transport to facilitate Meadows House DS0000067469.V340243.R01.S.doc Version 5.2 Page 16 outings. This is commendable, but the recommendation is repeated and also that consideration is given by the organisation to share a minibus between the four local homes run by the organisation. See Restated Recommendation 4 Standard 13 There are additional rooms on ground and second floor units to enable residents to meet with relatives in private in a room other than their bedroom. There is also a trolley telephone that can be moved around the home to enable residents to make all receive calls in private. All of the residents bedrooms seen were individually personalised with personal effects, photos and mementos. Standard 14 Residents told the Inspectors that they were able to choose where and how they spent their time and said they were consulted about significant issues. 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. Although the chef has a number of years experience in the catering field she has not previously cooked food specifically for older people. The manager was advised to obtain a copy of the publication Eating For Health in Care Homes published by the Royal Institute of Public Health. This document would provide some guidance, both in terms of the additional nutritional needs of older people, as well as the practical suitability of some foods. See Recommendation 5 The chef stated that she endeavoured to meet with residents and care staff to enable her to take into account individual peoples likes and dislikes. Food provided for residents requiring a soft diet was appropriately presented. Care staff members stated that of eighteen people currently living on Jackwood unit twelve people required assistance from staff with eating. Staff members were also serving meals and administer medication. Two residents were receiving one-to-one support from a relative and a volunteer was also providing assistance. Discussion took place with staff regarding the need for the volunteer to receive training in relation to this task. Meadows House DS0000067469.V340243.R01.S.doc Version 5.2 Page 17 It was apparent that staff members were endeavouring to create a calm relaxed environment in spite of all the activity that was taking place attending to the needs of residents. Meadows House DS0000067469.V340243.R01.S.doc Version 5.2 Page 18 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): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear complaint process readily available to residents, relatives and involved professionals and all can be confident that complaints will be investigated and acted upon. Some recommendations were made in respect of reorganising the complaints log. The home has a Safeguarding Adults policy and procedure. Staff members have received training and displayed a good understanding. EVIDENCE: Standard 16 The complaints procedure complies with The Care Homes Regulations 2001. Information about the contact details for the CSCI had been updated and there were timescales for staff to follow when investigating concerns. Guidance was provided about the stages that complainants could follow if they were not satisfied with the response provided by the home. No complaints had been received directly by CSCI and the complaints log retained within the home showed that since the previous inspection four complaints had been received, one of them was not actually directed at the home. Two complaints were substantiated and apologies given to the complainant and appropriate action Meadows House DS0000067469.V340243.R01.S.doc Version 5.2 Page 19 taken in respect of the staff members concerned. Those complaints were in respect of a member of staff, inadvertently not maintaining the dignity of a resident and abruptness from a member of staff toward a care manager. The third complaint was very recent and still being investigated, therefore the outcome has yet to be determined. Whilst all complaints had been dealt with satisfactorily the Inspector found some difficulty in tracking the progress of complaints as not all documents pertinent to the complaint were retained on the file, but were made available on request. These must be retained in the following chronological order; initial complaint and acknowledgement, investigation and final response and finally recorded as to whether substantiated, partially so, or unsubstantiated. See Requirement 4 Standard 18 Staff members that were interviewed by the Inspectors were aware of the procedure for reporting poor practice and abuse and were confident that senior staff would act to address any issues they raised. No issues in relation to safeguarding adults have arisen within the home since the previous inspection in August 2006. Meadows House DS0000067469.V340243.R01.S.doc Version 5.2 Page 20 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): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a safe, well-maintained environment The home is clean, pleasant and hygienic EVIDENCE: Standard 19 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. Meadows House DS0000067469.V340243.R01.S.doc Version 5.2 Page 21 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 service users. 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. Unfortunately, on the day of inspection the laundry door was left open despite not being occupied at the time, discussion took place with the manager as equipment and chemicals could be potentially hazardous to residents. Standard 26 All four units were clean and free from unpleasant odour. Foul waste was appropriately managed and sluice areas were clean and tidy. The home benefits from a purpose designed and well organised laundry. Meadows House DS0000067469.V340243.R01.S.doc Version 5.2 Page 22 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): 27- 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are satisfactory staffing levels, and sufficient senior staff to oversee different levels of training and managerial duties. The capacity of care staff to perform activity tasks with residents should be reviewed to determine feasibility. Recruitment procedures are managed well. The company ensure staff members are suitably trained for their different roles. 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. However, in view of the expectation that care staff members are required to be involved in activities for residents it is recommended that the numbers be reviewed in order to facilitate this. See Requirement 5 Meadows House DS0000067469.V340243.R01.S.doc Version 5.2 Page 23 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. The percentage of staff with this training was assessed at just below the required minimum of 50 qualified to NVQ level 2, although this should be achieved shortly, as five members of staff were currently undergoing this training. 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 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. 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.V340243.R01.S.doc Version 5.2 Page 24 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): 31,33,35 & 38 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 manager respected by staff members and regarded as approachable by both residents and staff alike. A formal application to be the Registered Manager should now occur. 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 health and safety practices. EVIDENCE: Standard 31 Meadows House DS0000067469.V340243.R01.S.doc Version 5.2 Page 25 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. Two members of staff commented that the manager takes time to explain things and clearly demonstrates an educative approach to staff members. The manager stated that he intends to apply to the Commission to become the Registered Manager for the home. A requirement is given that the application be submitted as soon as is practicable. See Requirement 6 Standard 33 The home is subject to an annual audit by Sanctuary Care and this was completed six weeks prior to this inspection and the manager informed the Inspectors that there had been a very positive response about the home from the audit team. 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. The manager stated that he is looking at ways of improving the quality of the service provided and to this end a Consultant has been reviewing dementia care within the home and it is hoped that this will result in improved monitoring and the development of the service provided. 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, that were 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. Meadows House DS0000067469.V340243.R01.S.doc Version 5.2 Page 26 Standard 38 The manager stated that the home has regular access to two maintenance persons employed by the provider, who between them carry out regular health and safety checks, undertake routine repairs etc. 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. Fire safety equipment was serviced regularly and staff received fire safety training and attended fire drills. Health and safety records were sampled. All of the records seen were up to date. Two members of the domestic staff were interviewed and displayed a good understanding of COSHH assessments and procedures. Unfortunately, as noted in Standard 26 the door to the laundry room had been left open when unattended, but this matter was addressed at the time. Meadows House DS0000067469.V340243.R01.S.doc Version 5.2 Page 27 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 3 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 2 17 X 18 3 4 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.V340243.R01.S.doc Version 5.2 Page 28 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 Handwritten entries on MAR sheets must be countersigned to reduce potential errors. In respect of Harwood Nursing unit, unused medication, must be removed by a registered contractor. The home must devise a system to record the level of activities provided to individuals. It should be recorded when activities are are offered and whether accepted or declined. All documentation pertaining to complaints must be retained on the complaints log. They must be filed chronologically and clarify outcomes as to whether substantiated or not, or partially substantiated. The care staffing level must be reviewed, given the expectation that care staff be involved in the provision of activities as well as personal carte for residents. The manager must now submit an application to CSCI to become the Registered Manager. Timescale for action 01/08/07 01/09/07 3. OP12 16 (20 n 01/09/07 4 OP16 Schedule 4 para.11 01/09/07 5 OP27 16 (2) n & 18 (1) a 01/10/07 6 OP31 8 01/09/07 Meadows House DS0000067469.V340243.R01.S.doc Version 5.2 Page 29 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 OP9 OP9 OP12 Good Practice Recommendations The clinical room has limited shelf space and would benefit from the installation of additional shelving. The clinical room would benefit both from the removal of unnecessary items and a thorough clean. The extent of the time allocated to the involvement of the activities coordinator to the units in the home should be clarified and also the “allowance” made for residents to attend activities in the day centre. The provision of a mini bus would further facilitate outings for residents and consideration should be given to the four local sanctuary homes sharing a mini bus. Restated. It is recommended that the manager obtains a copy of “Eating for Health in Care Homes” published by the Royal Institute of Public Health to provide guidance for the catering staff of the home. 4 OP12 5 OP15 Meadows House DS0000067469.V340243.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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.V340243.R01.S.doc Version 5.2 Page 31 - 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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