Inspection on 08/08/06 for Meadows House

This inspection was carried out on 8th August 2006.

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

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

Other inspections for this house

Meadows House 21/07/09

Meadows House 11/07/08

Meadows House 20/06/07

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 Key Unannounced Inspection 8th August 2006 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.V299891.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.V299891.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 www.sanctuary-care.co.uk Sanctuary Care Ltd Grace Borrell Care Home 59 Category(ies) of Dementia - over 65 years of age (59) registration, with number of places Meadows House DS0000067469.V299891.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 27/02/06 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 beds) on the second floor; Queenscroft (15 beds) on the first floor; Jackwood (18 nursing beds) on the ground floor; and Harwood (15 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 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.V299891.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection completed over a period of 9.5 hours by two Inspectors on 08/08/06. The previous full inspection was an unannounced inspection on 27/02/06, and was followed by an additional visit inspection on 23/05/06, undertaken in response to two Complaints/ Adult Protection investigations. The inspection included a complete tour of the premises, inspecting records, and during this time a number of residents and staff were spoken to briefly and seven staff members formally and six residents formally interviewed. Nine service user plans and the files of four staff members recently employed were examined. All areas of the building were seen and were clean and free from unpleasant odour. Service users also voiced their appreciation regarding the cleanliness of their rooms. It was evident that service users had been given the opportunity to bring in personal possessions to personalise their bedrooms and overall the home had a more homely appearance as efforts 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 clothing. Drinks were readily available and staff members were observed to be ensuring that residents were encouraged to drink fluids because of the hot weather. Service users spoken to stated that staff members were caring and helpful and all staff members interviewed were positive about the inspection process and assisted the Inspectors in a helpful and constructive way. What the service does well: There was a relaxed calm atmosphere on all the units visited and the home has been made more homely over the past six months. This new home provides a very bright and airy environment throughout and individual en suite accommodation of a good standard for residents. Overall, the home was very clean, tidy and safe for residents who were cared for by staff members who were both caring and professional in their Meadows House DS0000067469.V299891.R01.S.doc Version 5.2 Page 6 relationship with residents. Health and Safety requirements had been attended to satisfactorily. The responses from residents interviewed were generally favourable and positive comments were made about the caring attitude of care staff by many of them. Comments that were received by the Inspectors from some residents, about the need for more activities and outings, were discussed with the manager. What has improved since the last inspection? What they could do better: A new Statement of Purpose and Service User Guide must be produced as soon as possible and copies of the latter given to all residents. Documentation relating to upgraded individual care plans must be implemented fully and the quality of recording improved to ensure that comprehensive assessments are effectively translated into care plans. These Care Plans should reflect needs comprehensively and, guided by risk assessments, clearly identify how needs will be met by the care staff. Recently identified training needs in relation to assisting staff members with the above now need to be implemented as per the action plan produced. Staffing levels need to be reviewed in view of the increased dependency needs of residents. The home could benefit from the appointment of a full time Activities Coordinator to assist care staff in the provision of activities for residents. The provision of a mini bus would further facilitate outings for residents. Please contact the provider for advice of actions taken in response to this Meadows House DS0000067469.V299891.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Meadows House DS0000067469.V299891.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.V299891.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home does not have an up to date Statement of Purpose and Service user Guide following the takeover of the home by Sanctuary Care earlier in April 2006; this matter should be addressed with some urgency. All residents, including short-term carer breaks, must be provided with individual copies of the Service User Guide. 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.V299891.R01.S.doc Version 5.2 Page 10 The home does not have an up to date Statement of Purpose and Service User Guide following the takeover of the home by Sanctuary Care earlier in April 2006, this matter should be addressed with some urgency. All residents, including short- term carer breaks must be provided with individual copies of the Service User Guide. Requirements 1 & 2 The manager also needs to review the following specific issues to avoid information errors in the new documents: This document describes the home as fairly close to Eltham and Lewisham town centres; this is misleading. The Statement of Purpose informs prospective service users that their bedrooms will be decorated to their personal choice before admission. The manager confirmed this does not routinely happen. During the course of conversation with the manager it became apparent that on occasions service users are moved from one unit to another if the manager feels this to be in the best interest of the service user. The manager was advised to put this in the Statement of Purpose and/or Service User Guide, to avoid any possible confusion or conflict at a later date. A previous shortfall regarding the Complaints Procedure, subject to a requirement in the previous inspection report on 27/02/06, should be addressed in the new documents. Restated requirement 3 Standard 3. The arrangements in place for the admission of new service users to all units was a particular focus of this inspection, following two incidents of complaint and adult protection. Please see Standard 16. In response to these two incidents an additional inspection visit took place on 23/05/06. Care files and plans were inspected in respect of eight service users who resided at the home prior to the incidents referred to. One other care file was examined in relation to the only subsequent respite care admission. In respect of the pre incident care files, it was noted that no pre admission assessment visits had been conducted by care staff, although care management referral assessments had been provided by care management staff from the placing local authority. It was also noted that in none of the cases had letters been provided for either the service user or their relatives confirming that the home could meet the needs of the service user, prior to their admission. Three requirements were made following the inspection, to be complied with by 01/08/06 as follows: 1) To ensure a comprehensive needs assessment is undertaken prior to admission and there has been appropriate consultation with the service user or their representative prior to their admission. Meadows House DS0000067469.V299891.R01.S.doc Version 5.2 Page 11 2) The Registered Person has confirmed in writing to the service users that their needs can be met by the home Prospective service users are given the opportunity for staff to meet them in their own home, or current situation if different. 3) Prospective service users are given the opportunity for staff to meet them in their own home, or current situation if different. The Inspectors were pleased to note that in respect of residents admitted to the home since the inspection of 23/05/06, Requirement 1 noted above, was complied with. However, it was noted that two initial assessments were located in the manager’s office rather than with the care files on the relevant unit. Therefore, a new requirement has been made that all documentation relating to the admission assessment and ongoing care must be retained on the current care file on the unit where the resident is placed. Requirement 4 Standard 4 Evidence was available that the home had provided written confirmation that the home could meet the needs of the residents in relation to new residents admitted since the inspection of 23/05/06 and therefore had complied with the requirement. However, it was noted that a number of longer-term residents did not have these letters of confirmation. In these circumstances, this omission must be noted on all care files where such letters were not sent, as this Standard cannot now be applied retrospectively to those individuals. Requirement 5 Standard 5. Ample evidence was available, both from records examined and discussion with residents and staff members, that this Standard was met. Staff members actively encourage potential residents, their relatives and friends to visit the home prior to any admission, and this practice is written within the policies and procedures for the home. Standard 6 Was not assessed as this home does not provide an Intermediate Care Service Meadows House DS0000067469.V299891.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A start has been made on implementing the action plan set out by the Regional Manager in relation to assessment and care planning documentation and procedures. However, it was evident that more training and checking of implementation will be necessary to achieve accuracy and consistency. There are some areas of medication practice that need improvement. Residents are treated with respect and staff members maintain residents’ privacy. EVIDENCE: Standard 7 In response to the two Adult protection/ complaint incidents referred to in Standards 3 and 16, an additional inspection visit took place on 23/05/06. Care files and plans were inspected on that occasion in respect of eight service users who resided at the home, prior to the incidents referred to. Whilst no untoward incidents were recorded in relation to these service users it was Meadows House DS0000067469.V299891.R01.S.doc Version 5.2 Page 13 noted that the information within care plans and the daily notes was variable in quality. For example, two did not have a photograph of the service user, one did not have a bed rail assessment, one did not have a moving and handling assessment and one had no care plan at all. Evidence was otherwise available that various other risk assessments had been completed, as necessary, but all files were loose leaf and some without any index; this made it difficult to find information. Most care plans had not been signed by the service users or their relative. Arising from the inspection of 23/05/06 the following requirements were made: 1) That a service user care plan is generated from the comprehensive needs assessment, involving the service user/ relative and signed by them. 2) Identified risks must be risk assessed, recorded and monitored appropriately. Also that the service user care plan contains a photograph of the service user and details in respect of medication, specialist health care needs or nutrition. The record is kept securely in the home. 3) Appropriate food / drink is provided in adequate quantities, at appropriate times for service users and precisely recorded on food/ fluid intake charts. 4) The Registered Person must ensure that a thorough review of accountability for care plans and daily diary notes is undertaken and a system for both care and senior staff to record they have been read and checked by both care workers and senior supervisory staff. Handover meetings between shifts must monitor the above and allow time for effective communication between staff. At this inspection 08/08/06 information provided at the time of service users admission to Jackwood unit was clear and indicated an assessment of the service users health, social and personal care needs. However, the format being used on Crownwood unit was bulky, consisting of various questions regarding service users’ choice and ability, which were either in a tick box or numerical scale. Staff spoken with stated they had only one hour for training in its implementation and did not really understand how to use it. Please see Standard 30 Requirement 14 The manager acknowledged that as a result of the recent major investigation there was an ongoing programme of training being implemented in relation to newly produced documentation and this needed careful introduction in view of the imminent change from Ashley Homes to Sanctuary Care documentation. Meadows House DS0000067469.V299891.R01.S.doc Version 5.2 Page 14 The care plan system being used on Jackwood unit highlighted the area of need to be addressed, or desired outcome, with guidance for staff on action to be taken to meet the assessed need. Newly designed daily diary sheets and handover sheets seen on Harwood and Queenscroft units were being used to good effect and provided evidence of the introduction of the new documentation provided in response to the investigation into the death of a resident. However, this documentation still needs more attention to detail. For example the care notes on a resident newly admitted on Harwood unit did not clarify the purpose of the admission, which was to give the carer a needed break to relieve stress. The night-time care charts stated staff should maintain an hourly check. The notes merely stated hourly checks were given but should have been initialled and the time recorded each occasion. Another file stated two care workers were required to assist with transfers; on one entry one care worker had assisted him; this could have been dangerous to both resident and care worker. Several care files did not have a photo in place on the care notes. Whilst overall there was good evidence of new care plan documentation being implemented to address the previous requirements 1,2,3 &4, more detail is needed and training provided in accordance with the schedule now being implemented to assist staff members make the necessary improvements. See Standard 30 Requirement 14 There was no evidence on Crownwood unit of MUST (Malnutrition Universal Screening Tool) being completed, even though it is relevant to all people of this age and particularly for the service user seen walking up and down the unit constantly throughout the inspection, in respect of the energy expended. Requirement 6 On Crownwood unit staff had signed and dated existing information to highlight that it had been reviewed and updated. However in one instance seen a service user was described as agitated and quite aggressive at the time of admission. Staff now verbally described this lady as being happy, settled and a delightful person to care for which is not an accurate reflection of information in her care plan. Restated Requirement 7 The files on Crownwood unit no longer closed effectively and documents were coming loose from the file. In a number of other instances file notes were not very securely held together on other units. Requirement 8 There was evidence of service user and relatives being involved in the process with signatures evident on care plans and following reviews Meadows House DS0000067469.V299891.R01.S.doc Version 5.2 Page 15 There was clear evidence on all units of service users care plans being regularly reviewed with relevant parties. A relative spoken with stated he was invited to attend formal reviews regarding his wife on a regular basis. Standard 8 At the time of the Inspection three residents were identified by the Inspectors as having a pressure area. Records seen indicated that that appropriate action was being taken to improve the service users’ condition. Service users with high “Waterlow” scores had been provided with appropriate pressure relieving equipment and residents were receiving District Nursing input. Records seen indicated that service users receive regular support from a range of relevant health care professionals. Standard 9 Action has been taken to address issues raised in the previous inspection report regarding the storage of medication on Jackwood unit. Medication is now kept securely in a large room. The person responsible for the day-to-day management of the unit was asked to keep a record of the room temperature. A few issues arose in relation to medication on Crownwood unit. Whilst there is ample space to store medication, internal and external medication was being stored together, which needs to be addressed. There was evidence of good practice with two members of staff signing the medication record when additional handwritten entries had been made to the MAR sheet. Some MAR sheets were without photographs (noted on three units) and this needs to be addressed. A small number of unexplained gaps were seen. Manager stated that this would be discussed with the relevant member of staff. Requirement 9 The thermometer in the medication room on Crownwood unit was registering temperatures in excess of 30°; if this continues to be the case the room will require air conditioning to ensure that medication is stored at a temperature below 25°. This was the subject of a requirement to take action on in the previous inspection of 27/02/06 and must be addressed as soon as possible. Restated Requirement 10 Standard 10 Good interaction was seen between staff and service users. Staff addressed service users by their preferred name, and spoke with them in a respectful manner. Staff were seen to provide assistance to service users requiring Meadows House DS0000067469.V299891.R01.S.doc Version 5.2 Page 16 personal care in a manner which respected their privacy and dignity. Service users spoken with stated that staff members were kind and helpful. Meadows House DS0000067469.V299891.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. More attention must be paid in respect of the level of activities provided for residents. Residents are encouraged to maintain good contact with their relatives and friends and exercise choice and control over their lives. Lack of staffing was impacting on the needs of residents on one unit in respect the quality of service provided during meal times and needs to be addressed. EVIDENCE: Standard 12 On the day of the inspection a trip to the coast had been arranged for some of the service users; one service user the inspector spoke with stated that she had been on a previous trip and enjoyed it very much. At present there is a part-time activity coordinator who spreads her time between all of the units. Staff members stated that generally they are expected to provide activities for service users around the care duties they Meadows House DS0000067469.V299891.R01.S.doc Version 5.2 Page 18 have to perform. A separate record is kept of activities undertaken by service users and was examined by the Inspector; it was evident that the primary activity consists of listening to music on the unit. The record was examined on Crown Woods unit and indicated very limited opportunity for service users to participate in any other social activity; entries for July/August prior to the inspection indicated two opportunities for service users to leave the unit, one of these being to meet with service users on another unit. The activity coordinator had provided one music and movement session. Staff had also recorded trips to the hairdressers and nail care as activities that are in fact personal care. It is apparent from the time that the Inspectors spent on the units that care staff have a minimal amount of time to spare as they are constantly needed by service users to perform routine basic care and support. This matter was highlighted in the previous reporting February 2006 as a recommendation for review but as it is a requirement that the home provides service users with appropriate social and meaningful activity this has now been made a requirement. A previous recommendation that the home considers having its own transport is again repeated as this would further facilitate outings for residents Requirement 11 & Recommendation 1 Standard 13 A relative spoken with stated that he visits his wife in the home on a daily basis and is always made to feel welcome, he is able to have lunch with his wife and they are able to choose if they wish to spend time in her room, garden or the lounge etc. Relatives that the Inspectors spoke to said that the care provided in the home was good. Relatives said they were able to visit at anytime and were made to feel welcome by staff. Standard 14. Residents told the inspector that they were able to choose where and how they spent their time and said they were consulted about significant issues. Standard 15 The home accommodates some service users from an Asian and West Indian background. The manager stated that she is currently liaising with the catering company to ensure an appropriate choice of food is offered. The Inspectors observed that members of staff offered service users a choice of refreshments on a regular basis. Meadows House DS0000067469.V299891.R01.S.doc Version 5.2 Page 19 On the day of the inspection the lunch process was observed on Crownwood unit. Records seen indicated that service users have been assisted to make a choice in relation to the meal being served. In addition staff record if a service user has been provided with an alternative meal to that indicated on the menu. The inspector was informed that lunch was served at 1 p.m. However at that time staff were still assisting service users to and from the toilet; this task was extended further by the fact that some of the service users required the help of two members of staff and a hoist. Care staff members are also responsible for collecting the heated food trolley from the kitchen, and then checking and recording the temperature of food once on the unit. It was a further 10 to 15 minutes before staff members were able to commence serving the meal. The food upon arrival looked appetising and food for service users requiring a soft diet was appropriately presented with meat and vegetables separately liquidised, although the fact that chicken had been provided on the bone created another task for staff to undertake. Five service users require the assistance of a staff member to eat on a one-toone basis. However the current staffing levels mean some people are left to sit and wait and watch other service users eating their meal before them. There is also the added risk that food in the trolley will become less hot and appetising as time passes. See Standard 27. Requirement 12 A service user who constantly walks up and down the corridor was persuaded by staff to come and sit down for her meal; however staff members had to continue to assist other service users and were unable to provide a further course for this service user before she left the table to continue her activity. Discussion took place with the staff on duty and the manager in relation to ensuring this person and others with the same behaviour receive sufficient nutrition. At present service users are provided with biscuits mid-morning and discussion took place regarding the possibility of introducing the option of fruit and other finger food throughout the waking day and when necessary night to ensure service users are provided with adequate nutrition. Meadows House DS0000067469.V299891.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints to the home had been dealt with satisfactorily. An amendment to the complaints procedure will be addressed within the new Statement of Purpose and Service User Guide. Service users legal rights were protected and they are protected from abuse. Two Complaint / Adult Protection allegations were thoroughly investigated and appropriately responded to. EVIDENCE: Following two incidents of complaint and adult protection, an additional inspection visit was undertaken on 23/05/06 The reason for this visit was to examine the care files and practice in relation to respite care provision in the home following an adult protection investigation into the death of a resident, placed in the home on respite care and a second incident when a service user was removed by a relative from the home, prematurely, and a complaint subsequently made about the standard of care. This second incident was fully investigated by an independent manager and at the time of writing the Inspector can confirm that the findings of the report produced were considered at a local Adult Protection Planning Meeting on 12th May 2006 and the outcome was that there were no issues in respect of an adult protection nature to be addressed. However, some shortfalls in the service provided were identified Meadows House DS0000067469.V299891.R01.S.doc Version 5.2 Page 21 within the report and action was taken to address these matters and confirmation provided in writing to the complainant by the investigating manager. The Inspector is satisfied that this investigation of the complaint was carried out thoroughly and in accordance with the National Minimum Standards and Care Homes Regulations and to the satisfaction of the complainant. In respect of the first incident the Inspector has attended three adult Protection meetings on 12/05/06 and subsequently, on 1/06/06 and 03/08/06. As the investigation cannot be concluded because of staffing / disciplinary proceedings that are protracted in nature, the final outcomes in respect of these areas cannot be confirmed at this time. However, it has been acknowledged by all in attendance that a very thorough investigation has been conducted by the Area Manager for Sanctuary Homes and that action has already been taken to address those areas necessary to ensure the current and future safety and well being of service users within the home. The extent of the response made by the staff of the home has already been reported on in Standards 3 and 7 of this report and the Inspector is pleased to report that most of the recommendations or requirements arising from both the CSCI report of 23/05/06 and the Adult Protection Investigation have either been complied with already or are underway. Some areas to do with additional training required for staff members are scheduled for implementation in the next few weeks and additional or restated requirements, as identified in this inspection have been included in this report under the Standards 3 & 7. The Inspector can confirm that the CSCI was notified of both incidents, promptly and in accordance with Regulation 37 of the Care Homes Regulations 2001 and notifications made simultaneously to the London Borough of Greenwich Adult Protection Service. Two other very minor complaints were logged and dealt with appropriately. Meadows House DS0000067469.V299891.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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: Standards 19 & 26 Service users’ bedrooms were individually personalised and residents spoken with stated they had been able to bring in photos and personal mementos at time of admission. The home has a portable payphone which service users are able to use if they wish to make telephone calls in private. On the day of the inspection all units were found to be clean and free from unpleasant odour. Meadows House DS0000067469.V299891.R01.S.doc Version 5.2 Page 23 Foul waste was seen to be appropriately stored and sluice areas were clean and tidy. The home provides all service users with a single bedroom with en-suite facilities. A service user spoken with stated that she liked her bedroom and had been provided with everything she needed. All service users bedrooms seen were individually personalised. Service users are able to choose if they would prefer to use the showers or baths; both are provided with appropriate equipment to assist service users with bathing. One service user told the inspector she liked to have a bath rather than a shower and this information was seen by the inspector to have been recorded in her care plan. 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. Meadows House DS0000067469.V299891.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In view of the increasing dependency needs of residents the level of staffing must be reviewed to assess whether the needs of residents can continue to be met with existing staffing numbers. Residents are protected by the recruitment policy but procedures need some extra checks to fully meet the Regulation. Residents are in safe hands but there are identified training needs about to be implemented and these must be concluded. EVIDENCE: Standard 27 From discussion with staff members and from observations made by the Inspectors, particularly on Crownwood unit, it is apparent that staffing levels need to be urgently reviewed. In addition to five service users requiring oneto-one assistance with eating meals, all of the current service user group require some assistance from staff in relation to personal care. Four service users currently require the assistance of two members of staff and a hoist for the purposes of transferring between bed and chair, toilet, bath etc. Meadows House DS0000067469.V299891.R01.S.doc Version 5.2 Page 25 Staff were asked what action is taken if a service user who needs assistance from two members of staff and a hoist needed personal care in the afternoon when only two members of staff are working on the floor. Staff stated that either the service user would have to wait until a member of staff from another unit could help, or more frequently they would get on and perform the task themselves. Staff confirmed that when this happened 10 or 11 service users were left without a member of care staff in vicinity. A member of staff stated they told one of the more able service users which bathroom or bedroom they were in and the service user would come and knock on the door if a member of staff was needed in the lounge. Staff members then have to make a decision as to whether to leave the situation they are currently involved in to go and deal with another service user needing their help. This practice is potentially stressful and hazardous for both staff and service users and raises serious concerns regarding the health, safety and welfare of service users and staff. As previously stated, in addition to care tasks, staff are also expected to make beds, provide activities for service users, collect and return food trolleys to the kitchen and update records etc. The manager stated that she was aware of the staffing difficulties within the home and that both she and the deputy manager also frequently spent time on the various units providing practical care to service users requiring assistance with feeding and other personal care. The manager also voiced concerns regarding the dependency levels of service users accommodated, and that she was aware that staff have left to go and work in homes accommodating service users who are not as dependent. The Inspectors were of the opinion that in view of the increasing dependency levels presented by residents throughout the units staffing levels must be reviewed as soon as possible in order to assess whether the current level of needs being presented can adequately be met by existing staff. Requirement 12 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 level 2, although this should be achieved shortly, as six members of staff were currently undergoing this training. Meadows House DS0000067469.V299891.R01.S.doc Version 5.2 Page 26 Standard 29 The manager stated staff files were currently being reorganised. Three staff files were examined in relation to recruitment, training and supervision. These indicated that each person had completed an application form and submitted the names of referees. Discussion took place with the manager regarding the need for references to be validated. For example two members of staff had references on their file that stated they were provided by nursing or care providers; however, there was no evidence to prove this was the case. The manager agreed that in future compliments slips attached to references would be retained or company stamps requested. There was evidence that staff had provided proof of identity. There were no photographs for two of the sample seen. Current photographs must be included in the staffing documentation. There was evidence that CRB/POVA checks are being undertaken. Copies of original CRB documents or photocopies are still being currently held on file; discussion took place with the manager in relation to current CRB guidelines. Requirement 13 Standard 30 Copies of staff training certificates in relation to nursing and care qualification and statutory training were seen on file. The manager was reminded of the need to ensure that all courses provided for staff should be competence based and it was no longer acceptable for certificates to be awarded solely on the grounds of attendance. The manager is currently developing a staffing matrix, to enable her to monitor more clearly staff training needs. When completed a copy should be sent to CSCI. Recommendation 2. The Registered Person must ensure that all the training / developmental requirements identified in agenda items 6 & 3 respectively, of the minutes of the AP meetings held on15/05/06 and 01/06/06, are implemented as soon as possible now that a schedule for implementation has been formalised as required in the Inspection of 23/05/06. The training matters highlighted were again relevant to a number of issues relating to the variable quality of recording and implementation of care plans described in Standard 7 of this report and it is essential that the training identified is implemented. Requirement 14 Meadows House DS0000067469.V299891.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35, 36 & 38 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 home run by a manager who is fit for the purpose and benefit from the leadership and management approach of the home. Procedures are in place to monitor and develop the quality of care and the service provided in the home. Service users are safeguarded by the financial and Health and Safety procedures adopted by the home. EVIDENCE: Meadows House DS0000067469.V299891.R01.S.doc Version 5.2 Page 28 Standard 31 It was evident that both the residents and staff members interviewed felt positively about the manager and all stated she was very approachable; neither residents or staff members would hesitate to speak to her should they have any concerns regarding the running of the home or the welfare of residents. Standard 33 The home will be subject to an annual audit by Sanctuary Care and 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 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 in addition to regular regulation 26 visits taking place by a representative of the company, managers are looking at ways of improving the quality of the service provided amongst themselves and acknowledged she also needs to devise her own mechanisms for monitoring and improving the service. 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 ledger records seen. 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. Standard 36. Notes of supervision sessions provided for staff members are retained in locked drawers by their supervisors. Those examined showed a good level of supervision is taking place and in accordance with the Standard. Standard 38 A sample of records to do with health and safety and maintenance checks were examined and found to be comprehensive and well documented. Records seen Meadows House DS0000067469.V299891.R01.S.doc Version 5.2 Page 29 indicated that regular maintenance and safety checks had been carried out and substantiated the dates recorded within the pre inspection questionnaire submitted by the manager. During the course of the inspection a number of fire exits and extinguishers were examined; there was evidence of routine checks taking place. There was also evidence of safety checks to portable appliances and lifting and hoisting equipment. Meadows House DS0000067469.V299891.R01.S.doc Version 5.2 Page 30 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 1 X 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 Meadows House DS0000067469.V299891.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? yes 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 OP1 Regulation 4 And schedule 2. Requirement The Statement of Purpose and Service user guide must be updated to reflect the recent change of ownership and copies sent to the CSCI as soon as possible. A copy of the Service User Guide must be given to all service users, including those on shortterm placements. Initial assessments must be retained on service user care plan files. All documentation relating to the admission process and assessment must be retained on the current care file on the appropriate unit. Confirmation of needs can be met letters not already issued before 23/05/06 must have a statement on residents’ files confirming they were not sent. The Registered Person must ensure competent /trained staff are employed and that appropriate training is provided in respect of care records and recording. DS0000067469.V299891.R01.S.doc Timescale for action 01/12/06 2 OP1 4 And schedule 4. 14 (2) 14 (2) 01/12/06 3 4 OP3 OP3 01/10/06 01/10/06 5 OP4 14 d 01/12/06 6 OP7 18 1 a & i 01/12/06 Meadows House Version 5.2 Page 32 7 OP7 15 (2) 8 9 OP7 OP9 17 1 b 13 (2) 10 OP9 13 (2) 11 OP12 16 n 12 OP15 OP27 18 (a) 13 OP29 19 & Schedule 2 The Registered Person must ensure that care plan assessments and evaluations are kept up to date. Restated from inspection 27/02/06 as timescale of 31/05/06 not met. Care records must be kept securely. Photos of residents must be placed on their MAR sheets. There must not be any unexplained gaps on the daily entries to the MAR sheet. Action must be taken to address the unsatisfactory clinical room temperature on Crownwood unit and to ensure the drugs fridge temperature is within safe limits. Restated Requirement as previous timescale of 30/04/06 not met. The Registered Person must ensure that the home provides residents with a greater level of meaningful activities. The Registered Person must ensure that adequate numbers of staff are employed and this is re-assessed as soon as possible and the outcome notified to the CSCI The Registered Person must ensure that current photographs are retained on staff files, and company stamps or signed compliment slips are obtained on references. 01/12/06 01/12/06 01/12/06 01/12/06 01/01/07 01/12/06 01/12/06 Meadows House DS0000067469.V299891.R01.S.doc Version 5.2 Page 33 14 OP30 17 The Registered Person must ensure that all the training / developmental requirements identified in agenda items 6 & 3, respectively of the minutes of the AP meetings held on on15/05/06 and 01/06/06 are implemented as soon as possible, now that the schedule for implementation has been produced by the Regional manager. 01/12/06 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 Refer to Standard OP12 OP30 Good Practice Recommendations The provision of a mini bus would further facilitate outings for residents. The manager should send a copy of the training matrix for staff when completed to the Inspector, CSCI. Meadows House DS0000067469.V299891.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Meadows House DS0000067469.V299891.R01.S.doc Version 5.2 Page 35 - 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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