Inspection on 19/12/05 for Meadows Sands Care Home

This inspection was carried out on 19th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 Sands Care Home 08/12/09

Meadows Sands Care Home 10/06/09

Meadows Sands Care Home 02/08/07

Meadows Sands Care Home 03/08/06

Meadows Sands Care Home 05/04/06

Meadows Sands Care Home 24/08/05

Meadows Sands Care Home 14/12/04

Meadows Sands Care Home 23/08/04

Meadows Sands Care Home 10/03/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Meadows Sands Care Home 98 South Parade Skegness Lincs PE25 3HR Lead Inspector Dawn Podmore Unannounced Inspection 19th December 2005 10:00 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 Sands Care Home DS0000002552.V273084.R01.S.doc Version 5.0 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 Sands Care Home DS0000002552.V273084.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Meadows Sands Care Home Address 98 South Parade Skegness Lincs PE25 3HR 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) 01754 762712 Accredited Care Limited Care Home 26 Category(ies) of Dementia - over 65 years of age (26), Old age, registration, with number not falling within any other category (26) of places Meadows Sands Care Home DS0000002552.V273084.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide personal care for service users of both sexes whose primary needs fall within the following categories:Old age, not falling within any other category (OP) (26) Dementia - over 65 years of age (DE[E]) (26) The maximum number of service users to be accommodated is 26. 2. Date of last inspection 24th August 2005 Brief Description of the Service: Meadow Sands Care Home is situated on the sea front at the Southern end of Skegness. There are public car parking facilities to the front of the home and three car park spaces to the rear of the home for staff. The home has no garden but seating is available at the front. The bedrooms are situated on three floors accessible by stairs or a passenger lift. There are communal lounges and dining facilities on the ground floor. There is no Registered Manager for the home but an acting manager has been in place since August 2005, an application has not yet been received by the Commission to consider the managers fitness for Registration. Meadows Sands Care Home DS0000002552.V273084.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over 5 hours with two inspectors. The main method of inspection used was called ‘case tracking’ which involved selecting three residents and tracking the care they receive through the checking of their records, discussion with them, the care staff and observation of care practices. There was focus on checking compliance of previous requirements made in the unannounced inspection report of August 2005. A tour of the building was undertaken and care and staff records were examined and feedback given to the unregistered manager at each stage. There were twelve residents living in the home at the time of this inspection. Four residents and two members of staff were formally interviewed. What the service does well: What has improved since the last inspection? What they could do better: Only two out of the eleven previous requirements made in August 2005 have been met. Taking into consideration that the manager is relatively new in post an extension to these timescales to meet the outstanding requirements has been given but these must be addressed within the specified timescales to ensure the safety of residents and staff. Meadows Sands Care Home DS0000002552.V273084.R01.S.doc Version 5.0 Page 6 All aspects of care planning need to improve. The home should not admit residents without a detailed pre assessment to ensure that the environment is suitable and safe and that staff have had the appropriate training to provide the necessary care. All residents must have a care plan, which tells staff what care the resident requires otherwise they may receive the appropriate care. Short timescales were agreed with acting manager during the inspection to ensure that all residents have a written up to date plan of care. Staff had not received a comprehensive induction, which is needed to ensure that they can meet the needs of residents. The home needs to ensure that all staff receive regular formal recorded supervision and essential training in areas such as basic food hygiene and the protection of vulnerable adults. Improvements to risk assessments relating to individual residents and the environment need to be addressed as a matter of urgency to help protect residents and staff from unnecessary harm, these are detailed in the report. Systems should be in place to ensure that residents’ views are acted upon and that choices are made available in all aspects of their daily living including activities. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Meadows Sands Care Home DS0000002552.V273084.R01.S.doc Version 5.0 Page 7 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 Sands Care Home DS0000002552.V273084.R01.S.doc Version 5.0 Page 8 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): 3 The lack of pre admission assessments could lead to residents needs not being met. EVIDENCE: Two residents recently admitted to the home did not have a recorded assessment of need undertaken by the home prior to admission; this means that the home did not know if they could meet the individual needs of each of those residents. One of these residents did not have an assessment on file from the placing authority (Social Services) but did have a letter from the Community Psychiatric Nurse, which due to the content would strongly suggest that the home would need to undertake a comprehensive assessment to decide as to whether they could offer the resident a place which would meet individuals needs. Intermediate care was not provided by the home. Meadows Sands Care Home DS0000002552.V273084.R01.S.doc Version 5.0 Page 9 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 and 10 Residents are placed at risk due to a lack of documentation to show how individual care needs and associated risks will be assessed, planned and met. Shortfalls in medication procedures and staff training in the administration of medication could put residents at risk. EVIDENCE: Two residents recently admitted to the home did not have a care plan or risk assessments in place. The remaining residents did not have updated plans of care or risk assessments, this was of concern particularly when there were residents in the home who on observation had complex care needs including dementia. Daily recordings are not specific in detail and the term ‘appears fine’ is noted to be recorded on those residents’ records whose needs were of a complex nature. Meadows Sands Care Home DS0000002552.V273084.R01.S.doc Version 5.0 Page 10 Staff did not have written instruction in the form of a plan of care to describe how they will look after each resident. Staff spoken to said that they did not have responsibility for care plans and relied on a verbal hand over at each shift change. There was no recorded evidence to show that residents had been consulted about their care needs and preferences. A new medication system has been implemented since the last inspection and staff stated that they have received related training; however, the manager confirmed that the home did not have a medication policy/ procedure, which reflected this new process. It was noted that a staff member had pre signed a medication record prior to medication being administered, this is a training issue which the manager needs to address. A resident who is self medicating did not have a risk assessment in place which would assess that medication is administered and stored safely. Improvements to residents privacy and dignity have been made because doors have been fitted to downstairs toilets. Meadows Sands Care Home DS0000002552.V273084.R01.S.doc Version 5.0 Page 11 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): 12 and 13 The home does not provide an appropriate programme of activities. EVIDENCE: There was no ongoing activity programme provided; this means that residents may not be receiving appropriate social stimulation. Individual needs, interests and preferences have not been fully identified in care plans this is particularly important for residents who have dementia. A carol service had taken place the week prior to inspection and a Christmas party in the home was planned. Residents comments regarding activities include: ‘there’s no regular entertainment in the home but I am happy as I am’ ‘I’m happy listening to music’. A member of staff said ‘residents do not interact much, some just sleep’ Meadows Sands Care Home DS0000002552.V273084.R01.S.doc Version 5.0 Page 12 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): 18 New staff employed had not received training in the protection vulnerable adults; this could put residents at risk. EVIDENCE: A staff member who has been working in the home for over a year and a newly recruited care staff member confirmed that they have not received training in adult protection and this was not part of the induction received. The manager was advised to include protection of vulnerable adults awareness as part of staff induction until formal training can be accessed. This is necessary so that staff are aware of the procedures taken which protect residents from abuse. Meadows Sands Care Home DS0000002552.V273084.R01.S.doc Version 5.0 Page 13 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): 19 and 24 Residents live in a clean, comfortable and homely environment but the stair carpet to the rear stairs is in need of replacement. The home is not providing a lockable facility in all bedrooms for residents to safely keep valuables, and where appropriate medication. There is lack of consultation and risk assessment regarding the fitting of locks to bedroom doors. EVIDENCE: Communal areas were clean, tidy and homely. During a tour of the home it was noted that the rear stair case carpet was threadbare in areas along the edge of each step, which is a potential hazard to residents and staff. Residents bedrooms were clean, comfortable and personalised. Locks are not provided on all residents bedrooms and there is no evidence that residents have been consulted about this provision therefore their wish for privacy cannot be assured. Meadows Sands Care Home DS0000002552.V273084.R01.S.doc Version 5.0 Page 14 Not all bedrooms have a lockable facility for residents to securely store personal possessions or medication for those able to self medicate. Meadows Sands Care Home DS0000002552.V273084.R01.S.doc Version 5.0 Page 15 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, 29 The home is meeting minimum staffing levels. Shortfalls in staff training could put residents and staff at risk. EVIDENCE: The manager is supernumerary to the staff rota and a senior carer is on duty throughout the day to aid the smooth running of the home. Between three to four care staff are on duty in the morning, three care staff in the afternoon and evening and two care staff at night. It was recommended that the home improve its documentation to demonstrate that there are enough staff on duty to meet the needs of residents. A selection of staff files showed that staff had not commenced work in the home without a Criminal Record Bureau (CRB) check and two satisfactory references being obtained first to safe guard residents. It was noted that not all staff had documentation on their files as proof of their identity. The induction programme for new staff is not comprehensive and does not include dementia or protection of vulnerable adults; this is needed to ensure that people are protected. Two staff interviewed enjoyed working at the home and felt supported but felt activities for service users could be improved. The cook has recently left, the post is advertised and in the interim period the part time cook will be covering the Christmas period. The manager must Meadows Sands Care Home DS0000002552.V273084.R01.S.doc Version 5.0 Page 16 ensure that all staff involved with the preparation of food for residents consumption should have training in basic food hygiene. Meadows Sands Care Home DS0000002552.V273084.R01.S.doc Version 5.0 Page 17 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): 33, 35, 36 and 38 There are no systems in place to show how residents are consulted about their care or that choices are offered in their daily lives. The system of recording monies held by the home on behalf of residents could be improved to ensure residents are protected from financial abuse. Residents could be placed at unnecessary risk because environmental risk assessments are not in place. EVIDENCE: The acting manager has been in post since August 2005 but an application to the Commission for her registration had not been received. The home does not have a system in place to gain the views of people who use the service. Residents meetings had not been held and there was no documentation to show that residents had been consulted about the day-to-day operation of the home. Meadows Sands Care Home DS0000002552.V273084.R01.S.doc Version 5.0 Page 18 The office administrator was responsible for the safe keeping of residents personal monies. Accounts sampled were found to be satisfactory however, there needs to be improvements to the current recording system to include two signatures (where possible one of which should be the resident) when transactions are made. Residents did not have access to personal monies at a weekend or evening and the manager should assess this situation and ensure that people are aware of arrangements in place. Records show that not all staff had received regular recorded supervision sessions; this is needed to provide support and development. The Registered Provider needs to visit and complete a monthly report detailing his findings at the home. There was no evidence that these visits had consistently taken place. At the time of inspection the rear fire door was locked by means of a key but the key could not be found which could put staff and residents at risk in the event of a fire. By the end of the inspection, the key had been found but the a manager was asked to reassess the key arrangement as a matter of urgency by liaising with the fire officer and documenting his recommendations in the homes fire risk assessment. There were no risk assessments in place for: unguarded radiators, the unprotected gas fires in the two lounge areas or for a freestanding electric heater, which was ‘on’ in a residents bedroom. The heater was in very close proximity to bedding and a plastic bag was left leaning against the heater. The acting manager arranged for the heater to be removed from the bedroom during the inspection. Staff who handle food had not all received basic food hygiene training; this training is to ensure that correct practices are carried out. The home had recently achieved ‘Investors in People’ this is quality award for staff training and development. Meadows Sands Care Home DS0000002552.V273084.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 2 2 x x x 2 x x x STAFFING Standard No Score 27 2 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 1 x 3 2 x 2 Meadows Sands Care Home DS0000002552.V273084.R01.S.doc Version 5.0 Page 20 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 OP3 Regulation 14 (1) Requirement Timescale for action 31/01/06 2 OP7 15(1) (2) (c) (d) 3 OP7 15(1) (2) Documented, comprehensive assessments must be undertaken prior to the admission of a service user to ensure that the home can meet their needs. The previous timescale 01/02/05 and 11/09/05 is unmet. The new timescale has been agreed at the time of inspection. 31/01/06 All service users must have a documented plan of care. The plans must provide up to date, in depth information addressing the management of identified needs, appropriate goals and be regularly reviewed and revised as required. The previous timescale 01/06/05 and 01/10/05 is unmet. The new timescale has been agreed at the time of inspection. All service users must have a 31/01/06 comprehensive risk assessment that identifies potential risks. They must provide staff with documented information regarding the management of DS0000002552.V273084.R01.S.doc Version 5.0 Meadows Sands Care Home Page 21 4 OP9 17 (2) (3) (i) these risks and what actions should be taken to minimise them. The previous timescale 01/02/05 and 11/09/05 is unmet. The new timescale has been agreed at the time of inspection. The homes policy and procedure must reflect the current medications systems in place. The acting manager must ensure that all staff responsible for administering medication follow the correct procedure Consult with service users and formulate and implement an appropriate social activities programme and record people’s involvement. To maintain service users privacy the home must provide appropriate locks to service users accommodation or evidence that these have been either offered and refused or risk assessed as not advisable. The previous timescale 01/10/05 is unmet. All service user bedrooms must have a lockable facility for the storage of personal possessions and where appropriate medications. There must be evidence of a staff members identity held within their recruitment file as described in Schedule 2. All staff must attend mandatory training and new staff must undergo a comprehensive, documented induction programme. The previous timescale 01/05/05 and 01/10/05 is unmet All staff must receive appraisal DS0000002552.V273084.R01.S.doc 31/01/06 5 OP12 16 (2) (m) 31/03/06 .6 OP24 16 (1) 12 (4) 31/03/06 7 OP24 13 (2) 30/06/06 8 OP29 19 (1) (b) (i) 18 (1) 28/02/06 9 OP30 31/03/06 10 OP36 18 (1) (a) 28/02/06 Page 22 Meadows Sands Care Home Version 5.0 2 11 OP37 26 (1) (4) (5) 12 OP38 18 (1) 16 (2) 13 OP38 13 (4) (c) and supervision as required. The previous timescale 01/03/05 and 01/11/05 is unmet Monthly visits must be made by the provider and documented in accordance with Regulation 26 The previous timescale 30/09/05 is unmet It is a requirement to provide training in food handling, hygiene and safety for all staff involved in food preparation and handling. The previous timescale 01/04/05 and 01/11/05 is unmet All areas of the home need to be assessed for health and safety issues and a risk assessment produced, these should include: gas fires to lounge and the worn stair carpet. An up to date fire risk assessment should include arrangements for doors reliant on key to be opened. 31/01/06 31/03/06 31/03/06 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 OP27 OP34 Good Practice Recommendations The manager should continually assess and record the changing needs of service users living in the home to ensure staffing levels meet their needs. Two signatures are obtained preferably one being from the resident for all transactions of personal monies held in safe keeping by the home. Arrangements should be made for service users to have access to personal monies outside office hours. Service users should then be informed of these arrangements. Meadows Sands Care Home DS0000002552.V273084.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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