CARE HOME ADULTS 18-65
Meadowside Liverpool Road Walmer, Deal Kent CT14 7NW Lead Inspector
Julie Sumner Unannounced 06/09/05 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Meadowside H56-H05 S37510 Meadowside V244996 060905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Meadowside Address Liverpool Road, Walmer, Deal, Kent CT14 7NW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01304 363445 Kent County Council Mr John Wilson Registered Care Home 20 Category(ies) of Learning Disability 16 registration, with number Physical Disability 4 of places Meadowside H56-H05 S37510 Meadowside V244996 060905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th January 2005 Brief Description of the Service: Meadowside provides respite and transitional care and support to a maximum of 16 people with learning disabilities and up to 4 people with physical disabilities. The home is set in a quiet location in Walmer within 10 minutes drive of Deal. Service users have access to minibuses and there are public transport services in the area. The building is set in attractive gardens with an adjacent day service on the grounds. Attending the day service is part of the respite service. Meadowside is set over two floors. There is pushbutton access in and out of the home for people with disabilities. The office/reception is by the entrance. There is a range of communal facilities. There is a large lounge with a drinks/kitchenette adjoined by a serving hatch. There is a quiet lounge with a table that is usually used for board games and puzzles. There is an additional kitchen and lounge near the bedrooms that are used for transitional service users. All bedrooms are single. Bedrooms registered for people with learning disabilties are quite small with basic furnishings. Four bedrooms are registered for people with physical disabilities. There are two bedrooms with adjustable beds and overhead hoists and two other ground floor rooms with space for mobile hoists. There are 5 bathrooms one with a Parker bath,flush floor shower and overhead hoist. Meals are taken at the canteen/dining room which is shared with the day centre. Service users can choose from the menu. The main kitchen adjoins the dining room and the kitchen staff serve service users.
Meadowside H56-H05 S37510 Meadowside V244996 060905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out in two parts over two days. The first day was spent with the staff and meeting service users and the second day, just the morning was spent in the home, with the registered manager. Service users spoken to said they really like the home. One service user said it was “like home from home” and “the carers are really good and nice”. The following methods of inspection and information gathering were used: One-to-one discussion and group discussion at different times with service users and staff, observing activity in the home, touring the home, having lunch, and reading and discussing policies, plans and records including individual service user plans, medication charts, some staff records including training records and duty rota. What the service does well: What has improved since the last inspection?
All the work recommended by the fire safety officer has been carried out including new fireproof glass above the doors, doors have been repainted with fire retardant paint and the gaps that were too wide have been rectified. New furniture and equipment has been purchased to assist with caring for people with physical disabilities and for their comfort. These include mobile and ceiling track hoists and new specialised beds.
Meadowside H56-H05 S37510 Meadowside V244996 060905 Stage 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Meadowside H56-H05 S37510 Meadowside V244996 060905 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR 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) Scoring of Standards Statutory Requirements Identified During the Inspection Meadowside H56-H05 S37510 Meadowside V244996 060905 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 Assessments are comprehensive and form a good basis service user plans. EVIDENCE: Assessments are completed for each individual. Where a service user visits more than once the assessment is reviewed and changes are highlighted for reference at the beginning of the support plan. Meadowside H56-H05 S37510 Meadowside V244996 060905 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 9 Service users have well written plans and can expect a consistent service during their stay and at subsequent stays. Potential risks are identified and managed well. EVIDENCE: A sample of service users plans was viewed. An initial assessment and review record sheet is included to ensure continuity of care provided and highlights any changes to the care that needs to be provided at the home from one visit to the next. There were clear guidelines for staff with regard to support needed. Risk assessments are in place for all relevant circumstances and have been designed to provide an appropriate level of staff support for care and for different activities. Meadowside H56-H05 S37510 Meadowside V244996 060905 Stage 4.doc Version 1.40 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 17 A good range of meals is provided that meets service users tastes and choices in a sociable setting. EVIDENCE: Service users attend the day centre whilst on respite at Meadowside. A range of recreational and social activities are provided there. Ten service users had gone out ten-pin bowling. Service users staying at Meadowside are supported to develop independent living skills. Meals are eaten in the canteen dining hall, which is shared with the day centre. A section of the hall is used at breakfast time and for the evening mealtime when it is only used by the people staying at Meadowside. At lunchtime it is busy and sociable. Service users said they liked this. There is a choice of menu and service users choose what they want and it is served out to them by the kitchen/dining staff. The meal was sampled. It was presented well, provided balanced nutrition and tasted good. Drinks and snacks are available in the home. There is a kitchen in the part of the home where transitional service users stay and this can also be used to develop independent living skills.
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The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20 There is a thorough medication procedure designed to ensure service users safety and accurate administration. EVIDENCE: There is a dedicated medication room with store cupboards, a medication fridge and washing facilities. There is a medication procedure that has been designed around respite with a focus on accountability with medication coming in and out of the home. Medication is also checked between shifts to minimise errors. Meadowside H56-H05 S37510 Meadowside V244996 060905 Stage 4.doc Version 1.40 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 The home has a satisfactory complaints system and service users feel that their views are listened to and acted on. EVIDENCE: There is a complaints log. There have been no complaints recently. The last complaint recorded was in 2003 and this was satisfactorily resolved. Service users spoken to said they felt that if they had a problem they would speak to staff or the manager and were confident that it would be sorted out. Meadowside H56-H05 S37510 Meadowside V244996 060905 Stage 4.doc Version 1.40 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 30 Service users can access a good range of communal space with comfortable furniture and appropriate equipment. The home is uncomfortably hot in warmer weather with insufficient ventilation. Service users are able to stay in a clean and well organised home. EVIDENCE: There are three lounges. The main lounge has a serving hatch from a kitchenette and is called the bar. One lounge is used as a quiet lounge and has a computer and dining table as well as comfortable chairs. Another lounge is in the area where transitional service users usually stay and is mainly used for them but can be used for others. There is a kitchen next to this lounge also for service users to make drinks and snacks. On site there is a small kitchen that is used for training as part of the day centre service. An occupational therapist has carried out an assessment of the building with regard to provision for people with physical disabilities. A further assessment is planned to take place with regard to some changes. Two ceiling track hoists have been installed. To new adjustable beds have been purchased. These have fitted cot sides that can be moved out of the way if they are not needed
Meadowside H56-H05 S37510 Meadowside V244996 060905 Stage 4.doc Version 1.40 Page 15 and a variety of padding that can be used. Use of the cot sides is risk assessed. One bathroom has specialist bathing equipment including a Parker bath and ceiling hoist suitable for people with physical disabilities. Comments were made about how hot the home becomes in warmer weather by staff and service users and this was actually experienced on the day of the inspection. A recommendation has been made to consider ways to resolve this and increasing the ventilation in the home. There is good storage in the home for bulky items like pads and additional items if service users come in and have forgotten something like toiletries, toothbrush or some items of clothing. There is a good sized laundry room with appropriate equipment and hand washing facilities. There is a sluice room with an additional washing machine exclusively for soiled washing. Meadowside H56-H05 S37510 Meadowside V244996 060905 Stage 4.doc Version 1.40 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 35 The arrangements for the induction of staff are good with the staff demonstrating a clear understanding of their roles. The current booking in system for service users, does not ensure sufficient staff and resources are proactively planned for. Staff are confident, know what is expected of them and there is a clear sense of accountability. EVIDENCE: There is a stable core staff team. All staff spoken to including newer staff explained their role clearly and had job descriptions. Different staff were allocated different areas of responsibility. Staff rotas were viewed. The manager has groups of care staff, domestic staff and kitchen staff to manage. Each shift has a team leader and 4/5 care staff. Shifts are modified to accommodate individuals. At the time of the inspection the home was fully booked and service users were arriving. There was some strain on staff because of all the booking in procedures required and the high number of service users being admitted. Some staff changes had to be made to accommodate all the people booked in. Additional staff had already been
Meadowside H56-H05 S37510 Meadowside V244996 060905 Stage 4.doc Version 1.40 Page 17 requested to support an individual with behaviour that sometimes challenges. A recommendation was initially made to review how places are booked. In discussion with the manager the following day of the inspection, this system had already been reviewed and a new system was planned to start in January 2006. A recommendation was made to ensure that the new system is implemented as planned. The alternative system of booking service users into the home will be based on a points system to determine the level of need and required staff support. The number of service users and staff on duty will be in response to the outcome. In a situation where a higher level of staff would be needed the manager can request additional funding in order to offer this place. Staff training has been identified through staff supervision and appraisal. The training matrix was viewed and relevant training has been organised to provide a range of skills. All new staff complete the LDAF induction and foundation training course. The workbooks were viewed. The mandatory training areas are included in these. Training is organised externally but the manager monitors training and contacts the training department. A group of staff were attending moving and handling training in the home. Two staff from the day centre have trained as moving and handling trainers and there is a rolling programme of training to ensure that all staff have up to date training. Meadowside H56-H05 S37510 Meadowside V244996 060905 Stage 4.doc Version 1.40 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, 42 The registered manager regularly reviews aspects of the home’s performance through a good programme of self review and consultations, which include the views of service users, staff and relatives. The registered manager has been proactive in developing the service to meet service users needs. EVIDENCE: There is a quality assurance system in place. Service user questionnaires have been produced in a user-friendly format with pictures and symbols. Service users are invited to give feedback at the end of their stay. A plan of action is produced if negative feedback is received and documentation related to this process was viewed. Questionnaires are also left in the entrance hall for carers, relatives and anonymous feedback. Feedback received during the inspection was positive. A health and safety manual and recruitment policies are standardised throughout the homes in KCC. The manager is extending the policies to
Meadowside H56-H05 S37510 Meadowside V244996 060905 Stage 4.doc Version 1.40 Page 19 ensure that all relevant guidelines are in place to ensure the safety and wellbeing of service users and staff. A sample of policies was viewed. The manager has ensured that necessary work needed for the premises to meet fire safety standards has been carried out. All bedroom doors have been re-painted with fire retardant intumescent paint and the glass above the doors has been replaced with fire safety glass. The gaps between all main fire compartment doors that were too wide have been rectified. All staff have received fire safety training, updated training is ongoing and allocated staff are fire wardens. Fire drills and equipment checks are carried out at required times. Moving and handling training is ongoing to ensure that all staff have up to date training. A group of staff were training during the first day of the inspection. Meadowside H56-H05 S37510 Meadowside V244996 060905 Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 x x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 x x x x 3 Standard No 31 32 33 34 35 36 Score 3 2 x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Meadowside Score x x 3 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 3 x H56-H05 S37510 Meadowside V244996 060905 Stage 4.doc Version 1.40 Page 21 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 24 24 32 Good Practice Recommendations A written maintenance plan needs to be designed to include: overall redecoration of the building, replacement of equipment, furniture and soft furnishings. Review current heating system and ventilation in the home to provide a more comfortable environment where the temperature can be adjusted. Ensure that the new booking system based on dependency and need is put into practice as planned. Meadowside H56-H05 S37510 Meadowside V244996 060905 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent, TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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