Inspection on 21/07/09 for Meadows House

This inspection was carried out on 21st July 2009.

CQC 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 11/07/08

Meadows House 20/06/07

Meadows House 08/08/06

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Meadows House Tudway Road Kidbrooke London SE3 9YG Lead Inspector Mary Magee, Lynne Field, Alison Pritchard, Vashti Key Unannounced Inspection 21st July 2009 09:30 DS0000067469.V376615.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Meadows House DS0000067469.V376615.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 Care Home 59 Category(ies) of Dementia - over 65 years of age (59) registration, with number of places Meadows House DS0000067469.V376615.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 11th July 2008 Date of last inspection Brief Description of the Service: Meadows House is a purpose built care home for older people. It is located on the Ferrier Estate, Kidbrooke, in the London Borough of Greenwich. 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 continuing care nursing beds) on the ground floor; and Harwood (15 residential dementia care beds) split between the ground and first floors. All units accommodate people needing dementia care. 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. Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 5 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 four inspectors. We spent two days in the home and visited all four units. The pharmacy inspector examined the medication procedures. We were assisted on day two by an “Expert by Experience” who made observations of the environment and of the lifestyle afforded by residents. Prior to the inspection we received a completed AQAA. It was fully completed and provided all the details we requested. We examined other documentation too, received at CQC, this included the service history, complaints and concerns, incidents and accidents, personnel files for residents, and for staff. We received completed surveys from seven relatives, four mental health professionals, also received surveys from the GP and district nurses. We spoke by telephone to four members of the mental health team that work closely with people placed at the home. We spoke to over twenty residents, the residents’ capacity to relay information is quite limited but body language and gestures were recognised as a means of communicating. We made direct observations of working practices on all four units Over the two visits to the home we met with eleven relatives individually. A relatives meeting was held, twelve relatives attended this. We used this as opportunity to observe the forum used for relatives to raise issues with management. While we visited the home we met with the regional operations manager, the acting manager, the deputy manager, administrator, and fifteen members of staff were spoken to. We conducted a tour of the premises which included the communal areas and a selection of bedrooms in each unit. We are grateful for the cooperation of staff and residents who facilitated the inspection and contributed to our findings. Observations made and information gained from viewing records are used to inform the inspection and contribute to judgements made. What the service does well: Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 6 The home benefits from occupying premises that are spacious, clean and pleasant, and suitable for people with dementia. It is well designed, and has a good amount of natural light due to the large windows, this people finds makes it feel less restricted. Residents and relatives find staff to be kind and caring. Observations made over the two days were that staff are skilled and competent and that they respond in a calm and reassuring manner. Residents feel assured by staff that are familiar to them; we received comments and observed the sense of wellbeing experienced, comments such as “I like it here”. “Nice people” “lovely food” demonstrated the many positives people using the service experience... They presence of many regular staff help to give stability to people who have advanced dementia. Staff are experienced with managing very challenging situations and respond appropriately to situations. We heard from mental health specialists of the progress made by people with very challenging and chaotic behaviour. Comments from mental health professionals include the following “The home provides a relaxing environment where people are able to mobilise freely in the spacious areas provided.” “Staff are skilled and experienced at managing challenging situations”. Mealtimes are usually enjoyable with individual tastes and dietary needs catered for. Comments received from relatives include the following, “we sometimes visit at tea time, mother comments on how enjoyable her food is and say that she enjoys all the meals.” Very few residents are receiving medicines for agitation, indicating that staff are managing people with dementia well without the use of medicines. The use of multi-sensory therapy is being used instead, and there is evidence that this is quite successful. What has improved since the last inspection? The service has appointed an activities leader which gives more structure. The improvement in the activities programme has greatly enhanced the lifestyle of people using service, more development including the use of therapy rooms is needed to achieve maximum potential benefit for people with dementia. Comments were received from relatives about this with some emphasing that further development is needed in this area. “ the range of activities is much better now with a sensory room available for people to use”, “we feel that the home does a good job, sometimes in difficult circumstances when people can be quite restless”, “ sometimes residents sit round the television too much and are not involved in conversations”. Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 7 Medication procedures are much improved and are now safe. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Meadows House DS0000067469.V376615.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.V376615.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 2 3 4 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service does not accept people for admission unless the needs have been fully assessed and staff are confident that they can meet these needs. The home has the capacity including a suitable environment to meet the needs of people with dementia. EVIDENCE: Case tracking was used to evaluate the quality of care delivered, also the referral and admission process. We selected the care plans developed for ten people using the services. Six of these were for people living in the residential units, four care plans were for people living on the continuing care Jackwood Unit. All the beds except for one are block booked and funded by Greenwich Local Authority. Details on the service including service user’s guide, a copy of the Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 10 complaints procedure are displayed with the information booklets in the reception area. Relatives we found are not clear about the funding as the contract contains some misleading information regarding fee reduction while a resident is hospitalised. This is not applicable for those funded by the PCT or Greenwich. It is recommended that the contracts are amended to reflect accurately the contracts for people funded b the local authority. Present on the care files were records of pre admission process, these are seen as an integral part of the pre admission process. The records give a full description of all the areas of need and support. The needs assessments are comprehensive and consider areas such as sleep patterns, insight into safety, risk of wandering. We found pro formats of advance directives on each file with relative’s signatures. These are not relevant and have the capacity to mislead relatives on decision making, the Deprivation of Liberty Assessment should now be considered. It is recommended that the use advanced directives on admission is discontinued. We heard from the professionals in mental health team, care coordinators and social workers, they find that the home has good pre admission arrangements. We found that information is gathered from a range of sources including other relevant professionals to inform the needs assessment and the admission criteria. For people admitted to Jackwood a psychiatrists’ report is also used to inform the needs assessment. Present on the four files seen were copies of letters sent by the home confirming that, based on the assessment, they could meet the person’s needs. Relatives spoken to find that staff at the home complete the necessary care needs assessments, and know and acknowledge the issues before a person is admitted to the home. We found that there are demands from external referral sources on accepting new referrals; these often do not consider the pressures on staff at the home. The needs and numbers of residents with challenging behaviours may not always be fully considered when considering the needs assessments of new referrals. It is important that this is given consideration. We are told by relatives that people re encouraged to visit the home before an admission takes place. Residents spoken to were unable to recall the arrangements. We are informed by the management the home is designed as a pathway of care for people who need dementia care. Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 11 The majority of those admitted to the home will have experienced a connection with the home either through the day centre, or through carers’ breaks for respite care. While speaking to relatives we heard how the admission process is made as smooth as possible for individuals. The spouse of one resident shared his experiences; he likes to be included and attends the home most days to participate in daily routines with his wife. He is pleased with the way she is supported as he had some very negative experiences with her care prior to admission to the Meadows. The service is recognised as a specialist place for people with dementia. Care staff engaged have the desired skills and competencies to meet the needs of people admitted to the home. A number of staff are long term employees and are highly experienced, and familiar with residents. This provides stability and consistency. Relatives feel that people with dementia and challenging needs are enabled to settle in quickly as many are familiar with the environment before they move in. There is evidence of external specialist advice and input on care for people with dementia. We heard from mental health specialist of the progress made by people with very challenging and chaotic behaviour. A social worker told us, “The home provides a relaxing environment where people are able to mobilise freely in the spacious areas provided”; another social worker said “The home has staff that are skilled and experienced at managing challenging situations”. Meadows House DS0000067469.V376615.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home operates in a manner that promotes the privacy and dignity of people using services. The needs of people living at the home are assessed; care plans are developed to respond to areas of need. The care arrangements focus on dementia care and give less attention to how the physical care needs are met. EVIDENCE: We selected ten people using the service, and case tracked their care. Residents chosen are from all four units, six are living on the residential care units, and four from the nursing unit (Jackwood). Each individual has a care plan, but the care plans vary in quality and detail. On Jack wood unit we found that the care plans were generally more informative. Residential units are less detailed and the formats vary. Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 13 We found that for all those admitted individual needs are fully assessed prior to admission. These assessments are used to establish a detailed picture and care plan that reflects the resident’s life history, strengths, abilities, interests & promotion of well-being. The needs assessments consider behaviour patterns especially those that are quite challenging. We saw copies of good night time care plans on files, these are beneficial, and describing how often a person should be checked, also record important information such as ‘leave the bathroom light on with the door ajar’. The care plans reflect the actions that staff need to take to aid and promote the psychological and physical health, personal and social care needs of residents. We found that staff have a good knowledge of the people they are caring for; they record the care and support given on a daily basis. The care is delivered according to written care plans. Risk assessments also are in place that identifies areas of risk associated with individuals and their presenting conditions. Those at risk of wandering out into the community if left unsupervised are identified. This is referred to in more detail in outcome are 16- 18. Residents appeared well cared for, clothes kept laundered and pressed. Residents generally appeared at ease with staff; we observed several occasions on various units when residents quite agitated were reassured by calming words from members of staff. All eight relatives spoken to on day one told us how pleased they are with the way staff promote privacy and dignity. We spoke to over twenty residents during the course of our visits; some had little insight into their time at the home or the time prior to this. We did see signs that they found the home to be a stable place to live. Residents indicated that they felt comfortable although they some moments when they become restless. We found that they had a sense of confidence in the care staff, and that relationships with carers were good. The privacy and dignity of residents is promoted, practices observed confirmed this. Bathroom doors were closed when in use; people were treated with sensitivity when responding to personal care giving, including assistance with toileting. We found that a high number of people on the continuing care unit have advanced dementia and display challenging behaviour. We observed that although situations became challenging staff were patient and supportive. The view of three social workers is that they manage these conditions well at the home, the majority of relatives too commented positively on this practice. Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 14 The continuing care unit (Jackwood) is for people with advanced dementia care in addition to challenging behaviour. It has direct involvement from the hospital mental health team. Staff were observed to communicate appropriately with service users i.e. keeping calm & patient. They allow sufficient time to enable residents to acknowledge what is being said and for responses. Other observations were made, these include approaching residents within line of vision; speaking simply and slowly; we observed them using touch appropriately to reassure and confirm what was said. Over the two days we found some variations in staff practices, in Jackwood day one was more calm, staff approach displayed experience in working with the group of residents. Both inspectors on the three residential units observed staff to be kind and attentive. The “Expert by Experience” reported the following, “I found the carers on Harwood were very pleasant and treated the residents in a kindly and gentle way”. On day two, members of staff on duty on Jackwood appeared busy and did not respond to a resident that was restless and distressed. On checking out the care plans we found that the person was distressed as she had come to the home for a short respite break. We acknowledge that staff appeared busy but carers did not prioritise and acknowledge the lady’s distress and try and reassure her. It is recommended that staff receive additional training and develop an awareness of the one to one support and reassurance required by residents. In addition to behavioural issue we found that three of those individuals we case tracked were identified as at risk of malnutrition due to poor nutritional intake. In addition when these individuals become over active and agitated it contributes to the weight loss. There are care plans in place to respond to this and to respond to low body weights. For people requiring attention to prevent risks associated with swallowing we found that pureed foods fortified with full cream milk, and food supplements are given. We viewed copies of referrals made to the dietician and speech and language therapist. Following recommendations made by the professionals appropriate care plans were developed to acknowledge the consistency of food and the help required at mealtimes by three of the people case tracked. Some inconsistencies were found for one person regarding the weight monitoring and weights were not recorded as frequently as required. Recommendations made for individuals regarding weekly weight monitoring should be followed. Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 15 There is evidence of staff taking action to promote the health of people using the service. All residents are registered with the local GP practice. He visits the home at least once a week. He responded to our survey and commented positively on the quality of care delivered by staff, he said “residents are well cared for, the care offered is generally very good, and residents’ dignity and needs are always respected”. He also responds to all call out requests from staff. Records were seen of the frequency of consultations. One resident has deteriorated in recent months. She has been seen four times by the GP in the last two months. Her daughter told us that she finds the staff kind and sympathetic and is hopeful her mother will not have to move to another home for nursing care. We found much variation care planning arrangements and in how these particular areas are identified and responded to. We found that records demonstrate that these plans are regularly evaluated every month; however this is more a confirmation that tasks were completed according to the plans. The registered person should ensure that the care plan is reviewed by staff at least monthly, the review should specify if the current objectives for the health and personal care are met. The home is good at focusing on care for people with dementia and mental health related issues. Psychological needs are constantly monitored. We found records of several occasions when emergency calls to psychiatry were made for a home visit. Staff responded promptly where conditions arose that gave rise to concerns. It is important that in addition to dementia care for all residents a holistic approach is taken. For the majority we found that appropriate arrangements are in place to promote the health and well being of residents. Daily records are good and give a good indication of progress and setbacks. Regular consultations take place with the GP, the psychiatrist and the mental health team. There are consultations too for residents with the podiatrist, dentist. We heard from four professionals from the mental health team, the GP and the district nurse. Comments were positive from these people on the quality of care provided. None of the residents currently living in the home have pressure sores, none have catheters in situ. Pressure relieving equipment was seen in use for a number of residents. All residents have profiling beds. For a resident on a residential unit we found an agreement following an assessment on the use of cot sides. Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 16 We viewed the falls assessments in place for a number of residents that experience frequent falls. The health and safety of residents is promoted by minimising risk and hazards in the environment. We found that relatives are kept informed of incidents and accidents, however two relatives told us they would like to have more information given on the incidents and accidents occur. There are some shortfalls in the how physical care needs of residents are provided for. People with diabetes have this recognised in the initial needs assessment but appropriate care plans are not always developed, neither are these developed following reviews. Examples were found when care planning arrangements were not appropriate for residents on the residential units and for those on Jackwood Unit. Two people with diabetes do not have appropriate care arrangements in place to respond to diabetic conditions. The records of regular blood sugar levels for a person on the residential and another for a person on the continuing care unit were not maintained. We had no evidence available to confirm that regular monitoring of blood sugar levels is taking place. For residents with conditions requiring visits by the district nurse on the residential unit there are no records held in the home of the outcome of consultations. This also relates to people with diabetes. We found little reference on daily or monthly records of district nurse visits; no shared folder was available to demonstrate joint working. On one survey received from community nurses was a report that staff at the home were not always competent and trained in catheter care, or pressure sore prevention. One relative had concerns about the frequent falls experienced by her husband; she felt that they may be due to unstable blood sugars as the blood sugar is monitored just once a week. The environment is kept free from trips and hazards but despite this some residents experience a number of falls. People are referred either to the hospital or to the GP promptly when a fall or injury occurs, also if their condition changes. All of the above findings highlight shortfalls in the promotion of healthcare needs. For people at risk of falls we found that there were falls risk assessments in place, many were unchanged from first assessment despite many changes in circumstance. We found that these assessments are not always kept under review. Although all care plans and risk assessments were reviewed according to dates and comments we found that this is inconsistent. When one lady on the first floor residential unit came back from hospital after fracturing her hip there was no extra risk assessment in place or information. The person had several falls during the night since December 2008 but there was no extra information Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 17 about this and no further risk assessments on file. The incidents of the resident trying to leave the unit had decreased but at times she still tries to get out but the staff use distracting techniques. There were two additions to the care plan but these were around toileting and disturbed sleep but nothing about the falls she had been having. Most of these were not seen as they appeared to happen at night. We found that for another two residents recently hospitalised due to injuries from falls additional measures were not put in place following hospital discharge. The management of risk associated with change in condition was not reflected on the risk assessment or in the care plan. All of the above findings highlight shortfalls in the promotion of healthcare needs. Requirement (1) The registered person must make sure that the home promotes and makes proper provision for the health and welfare of residents. Req (2) The changing needs of people receiving services must be met. A review of health and risk assessments must be completed as circumstances change. During our two visits to the home we found that many residents require support with mouth care, this is not recorded in the care plans. Staff told us of assisting individuals with cleaning their teeth. However this was raised by relatives who report that staff are not always promoting good oral hygiene. We recommend that attention to oral hygiene forms is included in the care plan. We inspected medication records, medication storage areas, training for staff, and observed staff giving medicines to residents. At the last inspection in August 2008, 5 requirements and 2 recommendations were made on medication handling. At this inspection, evidence from medication records and storage areas showed that all these have been met and the home is now managing medication well. All prescribed medicines were available at the home, and medication records together with stock checks showed that residents are receiving their medicines on time and as prescribed. The GP and psychiatrist review medicines regularly. We observed staff giving medication and completing medication records accurately, providing evidence that staff are following the homes procedures, ensuring medicines are given safely. Records are kept of the receipt, administration and return of medicines, and inspection of these showed that the home can account for all medicines held on behalf of residents. No controlled drugs are being used or stored at the home. Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 18 Very few residents are receiving medicines for agitation, indicating staff are managing people with dementia well without the use of medicines. The Manager said that multi-sensory therapy is being used instead, and he has evidence that this has been successful. There are a few areas for improvement listed below. Requirements have not been made as the incidence is very small: -allergy information is missing for some residents, this is needed to ensure residents safety -a dose change (aspirin changed from one a day to one every other day) had been made on a medication record. This was not dated or signed by staff so it was not clear who had made the change and when. -there were 2 instances where the GP had discontinued medicines, a diuretic and a sleeping tablet, but it was not clear from the medication records that these had been stopped -acute care plans are now in place for 2 residents who have their medicines disguised in food due to constant refusals. The GP and next of kin have been consulted. The home has sought the advice of the pharmacist to ensure that crushing doesn’t alter the effectiveness of the medicine however this wasn’t documented and would be good practice to do so. -on one of the residential units, staff had given aspirin every day on 5 consecutive days instead of every other day. -two medicines did not have full instructions for use on the medication record. In these cases, staff should contact the GP for clarification and add the instructions onto the medication record. Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An improvement in the activities programme has greatly enhanced the lifestyle of people using service, more development including the use of therapy rooms is needed to achieve maximum potential benefit for people with dementia. Relatives are welcome at the home and feel able to participate fully in relatives meetings and share their views on the service. Mealtimes are enjoyable, people with special diets have their needs catered for EVIDENCE: The home responded to a requirement stated in the last inspection report and appointed an activities coordinator/leader. It was a popular appointment as the person was a senior carer previously and well liked by both residents and relatives. The activity programme has much improved the quality of life for people at the home. Wall murals are displayed to help residents identify the unit they live on Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 20 Photographs, posters of events, people involved in group activities, and one to one support as you walk around the home provided visual evidence of activities and daily life in the home. For each person living at the home a number of records are maintained to record individual interests, life history, interests and preferences. The daily activity participation of every resident is recorded in the activity log. The presence of an activities coordinator has made a difference to the people living at the home. A range of activities are available at the home. Pre admission assessments and life histories give good detail of the various hobbies and interest enjoyed by people prior to developing dementia, also recorded is information the areas that people find may be distressing such as fear of the dark, irregular routines, unfamiliar faces. The home makes available opportunities for residents to access the community. Individuals may attend trips and outings arranged when the weather is fine. Relatives are welcome at the home. Residents receive good support generally from relatives; this compliments the care given by staff at the home. We observed the assistance given at mealtimes, also the stimulation through one to one conversations. The coordinator said that they have arts and craft activities and join in with day centre events in the afternoon. We observed her organising a skittle game on Harwood Unit, and was impressed by her attitude, calm and respectful and interested in the residents. We also saw her with the residents asking what sports they used to play etc., and help a resident with her knitting. We were told of the sensory room and that residents find this to have a calming affect. This is well equipped and over both days this was open but not in use by any resident. Arrangements should be made to support resident’s access this facility. One of the quiet rooms was converted to provide a spiritual space where residents can sit quietly and enjoy relaxation therapy. Visiting clergy hold services for those that can and want to attend. On both Crownwood and Harwood, also on Queenscroft we saw residents with the day’s newspapers and magazines. Appropriate music was playing at a comfortable volume in the Crownwood lounge which some residents appeared to enjoy. We saw a member of the care staff lead a ball game with residents on Crownwood – gentle exercise – using arms and legs. All of the residents were smiling and looking very content while it was going on. We found examples of how peoples’ cultural needs are provided for. One of the residents on Crownwood is Indian and her religion is Sikh, her keyworker shares the same religion and language, they were seen enjoying conversations in their language. Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 21 The member of staff said that the chef prepares Indian food for the resident occasionally, and that it is good. According to the resident one chef is particularly good at it. The resident also likes the traditional menu at the home as well, she said that she doesn’t eat beef and for lunch on the day she had ordered a baked potato as she’s not keen on shepherd’s pie. The activities coordinator was commended at the relatives’ meeting for improving the amount of activities available, but we found that there is still scope for improvement. Our findings are that many improvements are evident in the lifestyles afforded for people using service. However the service should continue to strive for further development especially at weekends. Three relative did comment that the activity during the week was ‘brilliant’ but weekends less stimulating, two of the surveys we received from relatives suggested that weekends are less enjoyable. It is recommended that meaningful activities are developed around individuals for all seven days of the week. The AQAA supplied reports on the plans for the future of the activity programmes, this looks promising. It also plans to develop a sensory garden. We found observations made by inspectors were similar on units at mealtimes. When sharing lunch with residents we observed that staff assisted residents without being intrusive. We saw examples of how choice is afforded. One lady who wasn’t eating her meat was asked if she would like something else, she said no but could she have more potatoes, which she was given and ate. The food was hot and nicely presented. Most residents seemed to enjoy it and eat it all. The following observation was made by the “expert by experience” on day two of the inspection; two residents were left to their own devices even mildly agitated, when simple interventions such as a drink or a comforting chat might have helped to calm them. Staff on JackWood did not seem aware that the TV was unpleasantly loud and distracting. Also that a resident was making a good deal of noise needed some attention. We observed that staff were not responding to this appropriately. We found this to be the only unit where some care staff were less attentive to residents’ needs. Two of the carers have less experience working with this client group. We recommend that senior experienced carers are assigned to duties on Jackwood Unit. The daughter of another resident told us her mother is from the Caribbean, she takes her some homemade dishes. Her mother finds that the home prepares Caribbean meals on occasions but that she likes the dishes available on the home menu. Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 22 A resident’s spouse spoke of taking Caribbean meals to the home for his wife. He was asked to discontinue this for a period temporarily due to regulations. The area manager is responding to his request to resume this practice. Relatives said they could visit their family members at anytime and could spend as long as they liked in the home. We met eight visitors on day one; on day two three more visitors present spoke to us privately as they were not attending the relatives meeting. There are regular meetings for relatives and the minutes of these were viewed. The home has a group known as Friends of Meadows House, this was established when the service was transferred from the hospital to the home. It was made of members mainly from relatives of this unit. Over a period this membership has now reduced and the home is seeking to recruit interested parties. We attended a relatives meeting (twelve relatives) to observe how views are received. We will not comment in this report on the issues raised as these are addressed by the area manager, also with the head of contracts monitoring from the local authority. A relative recorded the minutes of the meeting. It provided a forum for relatives to express views and compliments, and raise concerns, and suggest areas for improvements directly with the area manager. The majority of the issues raised were from relatives of people on Jackwood unit. It is recommended that unit meetings are held monthly with relatives in addition to the usual home meeting. The area manager also informed those present of future developments for the home and agreed to respond to the items raised. We feel confident that these issues will be addressed in future plans and anticipate that it will be reflected in the next AQAA. Lunch time was observed on four units on both days. People are able to choose what they want to eat from the menu and may request alternatives if they did not like any of the listed options. We found that residents who choose to have alternatives to cooked meals were considered. Comments from residents and all relatives spoken to were complimentary on the meals supplied All three inspectors and the “Expert by Experience” were invited to share lunch. We found the meals to be tasty and quite nutritious. shepherds pie, vegetarian pasta dish, and fish and chips were sampled; steamed fish were some of the dishes sampled... People were encouraged to eat and assistance was provided for people that had difficulty eating independently. We found that more consideration should be given to people who remain restless and find formal mealtimes difficult. Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 23 In the earlier part of the day finger food was served in Jackwood unit. Finger food should be available throughout the day for people who may prefer to enjoy eating food this way, also for people that find it difficult to remain seated and become agitated at mealtimes. Mealtimes were relaxed, staff and relatives were observed assisting at mealtimes. Preparations in units varied for mealtimes, some were much better prepared. On day one dining tables on the units were attractively prepared for meals and had cold drinks provided. However Harwood Unit on day two did not serve drinks until these were requested. Drinks should have been available on the tables for the residents on Harwood, without special requests being raised. Consideration should be given to making mealtimes homely and preparing tables in advance for meal times, also to make drinks available for all. We found from records and from speaking to staff and relatives that recommendations from health professionals are followed. Provision is made for those with swallowing issues and four pureed meals were served on Jackwood Unit. These looked appetising and were prepared from the main course of shepherds pie and peas. Observations made during meals as follows. People were seen to enjoy the meals and that these were to their preferences. The “Experts by Experience” wrote the following on observations made, All residents should have some sort of napkin available at their dining table. Although a resident (my dining companion) did not need help feeding, carers might have noticed that she was struggling with the huge slab of pudding she was served and offered to cut it up, or served a smaller portion. We recommend that more care should be taken at meal times, staff should ensure that food served is suitably textured and in suitable portions. Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. As a result of training and supervision staff are knowledgeable on safeguarding procedures. Procedures in the home safeguard people from abuse or neglect, but occasional lapses in security arrangements at the home have resulted in vulnerable people being placed at risk as they wandered into the community unescorted and without staff knowing. A complaints procedure is effective at addressing any concerns raised. EVIDENCE: We found from discussions with staff that they have a good awareness of safeguarding procedures. Training for staff on how to safeguard vulnerable people is kept up to date. The home provides a specialist service to people with dementia; many residents have little insight into risks due to the degree of dementia and will leave the building if the opportunity arises. Keypads are used to enable residents remain safe. This is recorded as part of the risk assessments. For two of the residents an Assessment under the Deprivation of Liberties Act was completed by the social worker. Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 25 Staff we spoke to have a good awareness of the risks associated with advanced dementia including the risk of absconding from the home and the importance of vigilance. Occasions have arisen in the past twelve months when residents absconded from the home without staff realising this. Concerns were raised by the lack of security at Meadows House and the risk of vulnerable people leaving the premises unescorted. Safeguarding strategy meetings were held. Recommendations were made and an action plan agreed at the strategy meeting on how these issues should be addressed. A requirement is stated that all necessary steps must be taken to implement the action plan agreed at the Safeguarding Strategy Meeting 30th June 2009 including response to recommendations made by the safeguarding coordinator in relation to camera by the entrance to the home. The home has a complaints procedure that meets with statutory requirements. We observed a register of and the outcomes of complaints received in the past twelve months. All were responded to within the timescales agreed. Relatives spoken to gave views on the complaints procedures, the majority are satisfied that complaints are responded to appropriately and have confidence in the ability of the service to address issues. Some indicated that some of the issues continue to reoccur. Some relatives choose to address the complaints by referring directly to the local authority, two were sent to the Care Quality Commission. For two such complaint received at CQC the complainants were asked to refer the issue to the registered provider and placing authority. We observed that people attending the relatives meeting felt the relatives’ forum was appropriate to raise complaints. We recognise that more co working is needed to resolve issues. We recommend that the registered person should continue to build and maintain an open relationship with relatives through ongoing reviews, discussions and involvement. Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 23 24 25 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents benefit from living in a clean safe environment which is designed to enable people move freely around the home. Bedrooms are suitable to meet individual needs. Security can be inappropriate at times and vulnerable residents may be able to abscond into the community. EVIDENCE: The home is purpose built for people with dementia. Unfortunately the security arrangements have not always been appropriate in recent months, and as a result residents at risk were able to access the community without staff knowing this. A requirement is stated. The premises has a good amount of open spaces so that residents can move about safely and feel unrestricted. Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 27 There is a good use of daylight. Large windows contribute to the visual effects and are beneficial for people with dementia as it gives unrestricted feel to the environment. The standard of hygiene is good, all areas were found clean and fresh smelling. There was a slight mal odour in the lift which staff were informed about. This was dealt with promptly. All the bedrooms are single rooms with TV aerial points, phone points and internet points. Each room is ensuite with an inbuilt shower to maximise independence. Some of the rooms on the ground floor have French doors accessing directly into garden areas. We viewed a minimum of two bedrooms on each unit. Some were personalised, we were unsure if it was the choice of the residents not to have personal effects displayed in their bedrooms. The home has a large day centre where social events are held and this area remains open to residents in the evenings. There is an on site kitchen and laundry as well as a small hairdressers. Some relatives and appointees reported problems with laundry items. These are currently being dealt with by management. As well as the bedrooms all units have combined dining and lounge area except the Jackwood care unit where these are separate. Each unit has a separate quiet room and some of these are used as therapy rooms. There are dedicated training rooms and meeting rooms on site and a coffee bar area on the ground floor. The art work carried out in the home has given each unit a different character and the feedback received from visitors and family members is supportive of the claim that this is a positive environment for people with dementia to live in. The service has adapted some of the rooms and the gardens to provide psychosocial interventions for the well-being of the residents. This has indeed reduced the use of psychotropic medication to manage the behaviour difficulties of some of our residents. A gardening club with the introduction of a sensory garden is one activity planned for the residents to rediscover earlier hobbies. We viewed all communal areas and a selection of bedrooms on each unit. The home is well maintained. Maintenance is carried out by a separate company (Kier) as part of the PFI contract and failure to maintain the premises to the standards in the contract again result in financial penalties. The service is monitored within the Key Performance Indicators and therefore has to be maintained to a good standard. We were informed in the records supplied by the home that a redecoration programme is planned for this year. We observed that some areas are in need of redecoration. The following areas should be referred to the maintenance team for attention. Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 28 (1)The corridor on Jackwood Unit is poorly lit in one area and should be attended to. (2)The garden should be supplied with suitable furniture for residents to enjoy the outdoor space. (3) Parts of the garden are uneven and should be made suitable for use by the resident group. Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 29 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service benefits from the stability of a staff team that has a number of skilled and experienced staff. Staff are good at supporting people with dementia, but staff are less skilled and experienced in managing some physical conditions experienced by residents. Recruitment procedures are robust. EVIDENCE: We checked staff files for six new members of staff. Five were for care workers and one was for a more recently recruited RMN. We spoke to six staff in all, two were registered nurses. All were enthusiastic in their roles, and spoke of enjoying working with the client group. Our findings too were that the majority have the right qualities and characteristics for the role. We found generally good recruitment procedures, also that files are well ordered. There is a front check list sheet that is used to verify all the desired information is in place for the employee. At the home we found that all had confirmation of CRB Enhanced Disclosures before appointments were made. If there is concern about the immigration Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 30 status administration staff take advice as well as requesting additional documentation. We found an error on one file where only one reference was present. A fax was sent subsequently to us confirming the presence of the second reference. Another had a professional reference from a non registered service, we advised the administrator to check this out as it was inaccurate. The administrator agreed to follow these up and to keep us informed. The CQC should be sent confirmation that action was taken to address the shortfalls in the recruitment procedures. We found evidence of the disciplinary action taken by management when staff practices are found to be unsatisfactory. We were informed that currently, 83 of the care staff have completed at least NVQ level 2 and that all staff are up to date with the mandatory training. The spreadsheet has not been updated for the past six months; this must be updated with all training records up to date. A high proportion of our staff have completed at least one training in dementia care. Regular staff meetings are held and the minutes were made available for inspection. There is a notice board with ongoing training events and dates for staff to access. We viewed copies of appraisals. We spoke to six staff in all, two were registered nurses. All are enthusiastic in their roles, and spoke of enjoying working with the client group. Our findings too were that the majority have the right qualities and characteristics for the role. We observed that staff were kind and caring without being patronizing. One cleaned a resident’s glasses because she noticed they were dirty. Other carers too we found to be observant, they noticed small things that needed attending to and responded quickly to resident’s requests. Relatives commented and gave the following views on surveys we received, “mother’s mental health is variable, but she is always well looked after”, “staff are very good, patient and kind doing a job that is difficult”, “ everyone is treated with dignity and respect, family as well as residents” Staff say they have regular supervision, records too confirm this. One of the carers we observed was very good in the role, she related well to residents and she was a new member of staff working on the first floor residential unit. Another newly recruited carer said she felt supported and confirmed she had induction training. All the following training she reported was given to her in the first six months of employment, First aid which was a four day course, fire, safeguarding training, manual handling, food hygiene, medication. She said she had a good interview and had wait until the service received a CRB and references before she was allowed to start work. Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 31 The information supplied on the AQAA stated that new staff only start work when a CRB Enhanced Disclosure is received. Two members of staff spoken to had transferred from the local authority when the service was outsourced five years ago. The carers had achieved NVQ 2 and 3. One staff member said that she completed a team leader course and level 2 in dementia care as well as the annual mandatory courses. Both carers said they enjoyed their work and were senior carers. They had worked for many years with the local authority before the contract was externalised to the home. Many examples of good practice were seen over the two days visits, especially the gentle and caring approach by care staff on duty both day when reassuring individuals. Experienced good carers were observed to pass on good practice to new carers. A spreadsheet of training is displayed at the home. We found that mandatory training is delivered every year, however the record has not been kept up to date in recent months, it was not possible to evaluate that all the planned training was delivered. We were informed by the area manager that the training was delivered but that the spreadsheet was not updated. Staff training records for the past twelve months must be supplied to CQC for evaluation. We found that the service has shortfalls in how the physical care needs are promoted and that there are areas in which staff require additional training. Staff must receive training in the management of healthcare conditions affecting the residents; these include diabetes management, pressure sore prevention, risk management and falls prevention, reviewing health care. . We found that some weakness in the staff team. Some of the care staff on duty on Jackwood Unit on day two appeared to be less experienced with the user group. Our observations were two carers on duty (day two) in the afternoon did not respond appropriately when one resident continued to be agitated and upset. Relatives too although mainly complimentary on the staff team spoke of the difference individuals made and of the strengths and weakness in the more recently recruited members. It was evident that this continuing care unit needs the presence of senior experienced carers. We would recommend that only senior experienced carers are allocated duties on Jackwood unit. Staff on Jackwood were busy on both days completing various chores, four carers and one nurse were on duty but the needs of residents observed at this time may have required additional numbers. On residential units too we also found evidence that staffing levels need to be reviewed. Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 32 When we visited Crownwood unit there were 3 carers although there were only 10 residents (one is in hospital and the respite bed is currently vacant). We were told that normally there are only 2 carers for this number of residents and that is a bit tight to manage. We would consider this level (2) as inappropriate, considering there is a person who is in bed most of the time. A hoist is used which requires the presence of two staff. This leaves no member of staff available to attend to the other residents. We also observed that for residents experiencing falls additional numbers of staff are required following injuries. One of the residents on the continuing care unit needs two carers to help with personal care following a recent fall, some too have a greater physical dependency and the majority of nurses are RMN trained. The needs of residents varies, a high proportion of current residents require two carers for assistance with personal care. This places quite a demand on the staff team as at times staff struggle to respond to individuals. We observed too so recent hospital discharges, there was some evidence on records seen that the discharge arrangements were inappropriate at the time as readmission took place soon after return to the home. It is required that a review of staffing levels is completed, and that appropriate numbers of suitably skilled staff are available and on duty to meet these needs. Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 33 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has not progressed in the past year. Another change of management took place again earlier this year. This has left the service unsettled. Sanctuary have held recruitment drives, so far no manager was appointed. The current management arrangements are not giving the leadership and direction required. Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 34 The unit manager for Jackwood is also undertaking the acting manager’s role. This is not satisfactory as both the home and the particular continuing care unit need a manager solely dedicated to individual roles. Communication is affected and there no clear leadership. A Requirement is stated. The service must address the management shortfalls and have effective management arrangements in place. We were informed by the deputy manager 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. We received a copy of the annual service quality audit. This was very detailed and provided evidence of how the service evaluates the key areas. It also provided confirmation of the outcome of the quality audit and identifies where there are any shortfalls meeting requirements. We received confirmation on records that the premises are well maintained, water testing, electrical and mechanical equipment is fully functioning and fit for purpose. The records confirm that the premises are retained to a high standard. We also received confirmation that regular fire drills are completed and that fire fighting equipment is tested and serviced regularly. Staff fire training is kept up to date. The building has a current fire risk assessment. Health and safety policies and procedures promote the health and safety of residents and of staff. The records supplied by the service include the result of annual health and safety audit. We received information from the local authority that some of the regulation 37 reports were not submitted as required for residents in recent months. The most recent audit conducted did not identify any deficit in this area. A recommendation is made. Copies of these are held at the home as well as Regulation 26 reports. We recommend that at the monthly visit when completing regulation 26 visit reports a review is completed each month of all notifications made in accordance with regulation 37. We found that the service has a system in place to support people manage their money safely. The regional manager completes a visit to the service every month. The management of individual finances are audited at this time. We received confirmation on our detailed record that the financial affairs of residents are managed and that appropriate records are in place to confirm this practice. Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 35 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 3 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 3 3 x 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 3 3 2 Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 36 No 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 OP7 OP8 Regulation 12 (1) 13 (2) Requirement Following a fall or an accident a review of the individual’s risk assessment and needs must take place. The risk assessment and the care plan must be updated to reflect additional changes needed to minimise falls and accidents. Care arrangements must respond to these changes to prevent and reduce the likelihood of reoccurrence. The registered person must make sure that the home promotes and makes proper provision for the health and welfare of residents. People with diabetes must have a care plan in place to respond to this condition. Regular monitoring of blood sugar levels must take place with records held of these. The service must take the necessary steps required to safeguard vulnerable people living at the home, and improve the security to prevent people absconding. The action plan DS0000067469.V376615.R01.S.doc Timescale for action 30/08/09 2 OP7 OP8 12 (1) a, b. 30/08/09 3 OP18 OP19 13 (6) 30/08/09 Meadows House Version 5.2 Page 37 agreed at the Safeguarding Strategy Meeting 30th June 2009 must be implemented. Confirmation must be sent to the CQC y 30th August 2009. 4 OP27 18 (10 It is required that a review of staffing levels is completed in relation to the needs of current residents. A copy of this review must be sent to CQC. Also that appropriate numbers of suitably skilled staff are available and on duty to meet these needs. All staff must receive training in areas of healthcare promotion and particular to conditions experienced by current residents, namely diabetes, falls prevention and intervention, catheter care. The service must address the management shortfalls, and implement effective management arrangements. 30/08/09 5 OP30 12(1) 30/10/09 6 OP31 10 (1) 30/09/09 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 4 Refer to Standard OP2 OP3 OP5 OP7 Good Practice Recommendations It is recommended that the contracts are amended to reflect accurately the funding authority It is important that consideration is given to the needs and number of current residents when considering further referrals for admission It is recommended that the use advanced directives on admission of person is discontinued. We recommend that attention to oral hygiene is included in the care plan and that daily records are used to confirm that this is delivered. DS0000067469.V376615.R01.S.doc Version 5.2 Page 38 Meadows House 5 OP7 6 7 OP8 OP8 The registered person should ensure that the care plan is reviewed by staff at least monthly, the review should not be a paper exercise and should specify if the current objectives for the health and personal care are met. Recommendations made for individuals regarding weekly weight monitoring should be followed. It is recommended that staff receive additional training in order to develop an awareness of the one to one support and reassurance required by residents who are distressed. We recommend the following for action,-allergy information is missing for some residents, this is needed to ensure residents safety -a dose change (aspirin changed from one a day to one every other day) had been made on a medication record. This was not dated or signed by staff so it was not clear who had made the change and when. -there were 2 instances where the GP had discontinued medicines, a diuretic and a sleeping tablet, but it was not clear from the medication records that these had been stopped -acute care plans are now in place for 2 residents who have their medicines disguised in food due to constant refusals. The GP and next of kin have been consulted. The home has sought the advice of the pharmacist to ensure that crushing doesn’t alter the effectiveness of the medicine however this wasn’t documented and would be good practice to do so. -on one of the residential units, staff had given aspirin every day on 5 consecutive days instead of every other day. -two medicines did not have full instructions for use on the medication record. In these cases, staff should contact the GP for clarification and add the instructions onto the medication record. 8 OP9 9 10 OP12 OP12 Arrangements should be made to support residents to access frequently and enjoy the benefits of the sensory room. It is recommended that the meaningful activities are developed around individuals for all seven days of the DS0000067469.V376615.R01.S.doc Version 5.2 Page 39 Meadows House 11 OP15 week. Consideration should be given to making mealtimes as homely as possible, and to preparing tables in advance for meal times, also to make drinks available for all. More care and consideration should be taken at meal times, staff should ensure that food served as a soft diet is suitably textured, and that meals are served in suitable portions. Finger food should be available throughout the day for people who may prefer to enjoy eating food this way, also for people that find it difficult to remain seated and become agitated at mealtimes. We recommend that the registered person should continue to build and maintain an open relationship with relatives through ongoing reviews, discussions and involvement. Separate unit meetings should take place for relatives. It is recommended Safeguarding procedures be added to the list of areas that require annual updates. We recommend that senior experienced carers with the appropriate attitudes and attributes are assigned to duties on Jackwood Unit. (1)The corridor on Jackwood Unit is poorly lit in one area and should be attended to. (2)The garden should e supplied with suitable furniture for residents to enjoy the outdoor space. (3) Parts of the garden are uneven and should be attended to so that residents may access these freely. We recommend that at regulation 26 visits a review is completed each month of all notifications made in accordance with regulation 37 to avoid miscommunication. The maintenance files should be organised to more easily to reflect the areas examined during inspection. 12 OP15 13 OP15 14 OP16 15 OP30 16 OP27 OP12 17 OP19 18 19 OP37 OP38 Meadows House DS0000067469.V376615.R01.S.doc Version 5.2 Page 40 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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