Inspection on 25/02/09 for Meadowside

This inspection was carried out on 25th February 2009.

CSCI found this care home to be providing an Excellent 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

Meadowside 12/12/06

Meadowside 23/11/05

Meadowside 16/08/05

Meadowside 11/01/05

Meadowside 13/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Meadowside 35 Plymouth Road Tavistock Devon PL19 8BS     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anita Sutcliffe     Date: 0 9 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Meadowside 35 Plymouth Road Tavistock Devon PL19 8BS 01822614336 01822614336 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Roger Hine,Mrs Anne Hine care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Three named Service Users over the age of 65 years Date of last inspection Brief description of the care home Meadowside is a large extended Victorian House close to the centre of Tavistock. The home offers care to 11 people (under the age of 65) who have mental health needs. The majority of people who live at Meadowside have done so for many years, and whilst the home promotes independence the home does not offer intensive rehabilitation. The house has a lower ground floor where there is the kitchen, dining room/lounge, bedrooms and a shower room. There is a lounge, three single bedrooms on the ground floor. On the first floor there are four bedrooms and on the second floor there are two bedrooms. The home is staffed 24 hours per day, at night there are sleep in staff. There is a large garden to the rear of the property, with a decked area that is easily accessed from the lounge/dining room. We are told that the fees for Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 11 Brief description of the care home Meadowside at this time are from £350 to £450 per week. The registered manager said there are no additional charges except for a small contribution to holidays. A copy of the Service Users Guide and most recent inspection report is on the Residents notice board and Staff notice board. There is a copy of the Statement of Purpose in the Office. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Information has been collected toward this key inspection since the previous key inspection December 2006. We reviewed the service November 2007, at which time we surveyed peoples opinion. For this key inspection we surveyed the opinion of people who use the service and staff. We did two unannounced visits to the home, interviewed two staff, the manager and looked at the care of two people receiving the service. We also spoke with a visiting health and social care professional. We looked around the home, looked at some policies and procedures and records of care delivered and staff recruitment. Care Homes for Adults (18-65 years) Page 6 of 27 What the care home does well: What has improved since the last inspection? 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 set out 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. Care Homes for Adults (18-65 years) Page 7 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are fully understood and they have lots of opportunity to find out about the home prior to deciding if it will suit them. Evidence: Each of the seven people who responded to survey told us they received enough information about the home before they moved in and and each said they had received a contract. We looked at how the admission of the last person admitted to the home was handled. We met and had a conversation with them, the health care professional involved in the admission, and discussed their needs with two care staff and the registered manager. They had visited the home prior to a decision being made, met and had a meal with other people and stopped over night. There was the opportunity for more visits and more discussion about Meadowside. Care Homes for Adults (18-65 years) Page 9 of 27 Evidence: Full information was available on their relevant history, their needs and wishes, taking into account any risks. The manager was adding to and changing the information as the home got to know them better. We asked two staff if they knew what care and support the person needed and what risks there might be. They were able to describe in detail how they are providing support and meeting their needs. They were also fully informed of possible risk and how to manage them. A health care professional who was involved in the persons admission was very satisfied with how the admission was handled and how well the home were meeting her needs, describing this as excellent. She felt they were thriving in the home. Care Homes for Adults (18-65 years) Page 10 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are fully supported to direct their own lives with risks fully understood and managed in their best interest. Evidence: We looked at how peoples individual needs and choices are met. Asked if they receive the care and support they need six people told us through survey that they always do and one said they usually do. Asked if staff listen and act on what they say, all said they do. Each person has a care file including assessment of their needs and a plan as to how those needs may be met. The two files we saw were very detailed and included information relating to their history, needs, goals and any risks. With one person a risk was road safety. Staff were able to describe how this was managed in the persons best interest; to keep them safe whilst not putting unnecessary restrictions on them. The Care Manager of that person rated the promotion of her independence and handling of her needs as excellent. Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: It was clear from observation that people lead independent lives with support as required. Each person has a key worker who knows them particularly well. Care Homes for Adults (18-65 years) Page 12 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to lead fulfilled lives of value to them. Evidence: We looked at whether people are able to lead lives of value to them. Asked if there are activities arranged at the home that they can take part in six people told us through survey that there always are and one said there usually is adding: I dont like taking part in the activities. I do what I want to do. People at the home are very much in control of their day. One person wanted to go swimming and was asked if they wanted to be accompanied or not. The following day they were going to a gym. They do conservation work, cooking, attend a youth group and like shopping. One person told us how much they enjoyed a singer who came to the home and how Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: they danced. They went to a holiday camp in 2008 and are planning a trip to Scotland this year. The manager is researching additional funding for this. Personal relationships are fully supported. The manager described how she will ensure peoples privacy and safety are maintained. People are studying the computer, attending a local arts centre and active in the church. They do their own banking, look after their own medicines when able and look after their own room. The home environment itself is a comfortable place for social events with a lounge/dining area opening out on to a garden. Tavistock has a wealth of shops, cafes and places of interest. There is a swimming pool, arts centre, parks and variety of restaurants. It was confirmed that these are used regularly. Five people told us through survey that they like the food and two said they usually do. The lounge/dining room has a mini kitchen with fridge, microwave and kettle. People told us there are no restrictions on food. However, one person is being helped to control their weight as part of their planned care. People who use the service discuss what meals they want at their meetings. Staff then write a menu which is displayed for each to see and then an alternative offered if they dont like the meal available. Some people choose to cook. Each person looks after their own bedroom. People are very well supported to make decisions about their lives through the planning of their care and support from staff, especially the manager and their key worker. Care Homes for Adults (18-65 years) Page 14 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health care needs are met. Evidence: We looked at how well peoples health and well being are promoted. Each person has a detailed medical history and their medical needs are known prior to admission. Meeting health needs is part of the plan of their care and they are able to say exactly how they would like any personal care help to be provided. Records showed that health care professionals are consulted as and when necessary. This includes psychiatric support, eye and foot health, diabetic care and gender specific checks, such as breast screening. Each person is able to attend a G.P. of their choice. There are several G.P. surgeries in Tavistock. Each person has a yearly medical check up. People who use the service are supported to manage their own medicines when any risk associated with doing so is sufficiently managed. Several do so. We saw that medicine records were clear and complete and the handling of medicines is well Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: organised. However, there are three sets of keys to the medicine storage cupboard, which does not ensure a full audit of their use is possible. This adds to any risk of mistakes or mishandling. We discussed this with the manager and she is making arrangements for only one set to be in use at a time. Care Homes for Adults (18-65 years) Page 16 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to make their feelings known. They are protected from abuse but this could be further improved. Evidence: We looked at how well people are listened to and if they are protected from abuse. Asked if they know who to speak to if not happy and if they know how to make a complaint people told us they did. The homes complaints policy is clear and includes timescales and contact details for the Commission. CSCI details are also displayed on the notice board by the entrance, along side details of advocacy services. Each person also has their own copy of the service user guide which contains the same information. Throughout the inspection people came into the office to talk to the manager and staff; relationships between them appeared to be relaxed and comfortable. People told us through survey that staff listen and act on what they say. The manager tells us there have been no complaints to the home and the Commission has received no complaints about the service. We spoke with two support workers, one fairly new to the home. Both told us they had received training in how to safeguard people from abuse. They were able to describe the types of abuse and said any concern they might have would be taken to the Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: manager. However, they were not fully conversant with what steps to take if they felt the need to alert concerns outside the home. One was aware that the police could be contacted but neither mentioned the Local Authority Safeguarding team, to whom all concerns, which might be abuse, should be referred. We looked at the homes whistle blowing policy, which should inform staff how they can alert concerns. It contained the contact details for the Commission, but did not mention the Local Authority Safeguarding team or the police. However, it did describe how staff are protected should they wish to disclose concerns. There have been no concerns raised about the home. The five staff who completed surveys toward the inspection each said they knew how to respond to any concerns. Those we spoke with were very confident that the manager would act promptly to protect people. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this 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 home environment meets the needs of people who live there. Evidence: We looked at how well the home environment meets peoples needs. There is a good variety of shared space which is comfortable and homely. The main lounge/dining area has patio doors to the garden, comfortable, domestic seating and a mini kitchen with fridge, microwave, kettle and equipment. There is a second lounge near the home entrance in which people can smoke. We saw the bedrooms of two people. They were clean, fresh, nicely furnished and very individual. Both told us how much they like their room. People have a key so they can lock their door when they wish for privacy, security and ownership of the space. The laundry is small but meets the needs of people at the home. All areas of the home were clean and hygienic and people told us through survey that the home is always clean and fresh. The furniture and fittings are in places a little worn. One stair carpet needed replacing but steps were already being taken to do this. People using the service were involved Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: in choosing the style and colour of a new one. With the exception of the carpet the home was in a good state of repair. The home employs domestic staff who keep the main areas of the home clean. People clean their own bedrooms. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a staff which is properly recruited, trained and well supervised. Evidence: We looked at how effective staffing arrangements are at the home. One person who uses the service told us: I like the staff. Theyre nice to me. We saw that relationships between people and staff were relaxed. Asked if their induction training covered everything they needed to know to do the job well when they started each of the five staff who responded to survey said yes. Asked if they are being given training which is relevant to their role, helps them understand and meet peoples individual needs and helps them keep up to date with new ways of working each said yes adding: Training courses are always on offer, both internal and external courses. Mandatory training is refreshed as necessary. Most staff are NVQ trained and I am aware of training because POVA made me aware of the people I work with mental health problems. However, one staff told us: Id like more training and understanding. More courses, but I am very happy with the work I do. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: We spoke with two staff, one recently employed. They told us that they are constantly made aware of good practise and offered training all the time and supported doing it. We were also told that all new staff start National Vocational Qualifications (NVQ) in care and all health and safety training is regular and ongoing. Staff told us that there are sufficient of them to meet peoples needs and do their work properly, one adding: The rota is planned to ensure the needs of individuals are met. We are told there is very low turnover of staff. This should help provide continuity of care. We looked at whether staff recruitment was robust and protected the vulnerable people who use the service. Two recruitment records were examined and all the checks required had been undertaken. Staff are very well supervised from the onset of employment. They have goals to achieve and training for them is planned. Records of staff supervision were very structured. Staff told us: The homes reputation preceded it and Youre not afraid to come and ask anything. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is very well managed. Evidence: The registered manager, Mrs. Ann Hine is very well qualified and experienced to run the home. She is respected by people who use the service and staff and leads by example. Staff told us they are constantly made aware of good practice. The deputy manager at Meadowside has nearly completed the Registrered Managers Award and so is also achieving qualifications in home management. Mrs. Hine ensures her own working knowledge and skills by taking any training staff attend and having her work supervised and appriased from an outside source. The home uses several methods for ensuring the quality of service provided. We saw the 2008 - 2009 Business Plan for the home setting out goals to be achieved. People who use the service and staff have their opinion of the service surveyed and there are regular meetings for people and staff. In addition, the manager told us about one to one time available to people with staff or herself. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: Mrs. Hine has been proactive in ensuring new legislation on mental capacity and deprivatin of liberty will be understood and in place by 1st. April when it comes into law. She was able to describe how she supports individual needs and strives to meet peoples potential. We also saw this in practice. The standard of record keeping is high and safeguards peoples best interests. Health and safety are promoted. The only concern identified was a worn carpet about to be replaced. Staff receive all mandatory health and safety training. We confirmed that the home has a fire safety risk assessment which looks at fire safety risk within the home and how they will be reduced. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 23 All staff should be fully conversant with how to alert concerns to the necessary authority, the police or safeguarding team, should this be necessary. The whistle blowing policy should make this information clear. Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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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