CARE HOME ADULTS 18-65
Meadowside Liverpool Road Walmer Deal Kent CT14 7NW Lead Inspector
Julie Sumner Announced Inspection 7th February 2006 09:30 Meadowside DS0000037510.V277685.R01.S.doc Version 5.1 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 Meadowside DS0000037510.V277685.R01.S.doc Version 5.1 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 Adults 18-65. 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. Meadowside DS0000037510.V277685.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Meadowside Address Liverpool Road Walmer Deal Kent CT14 7NW 01304 363445 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) Kent County Council Mr John Wilson Care Home 20 Category(ies) of Learning disability (16), Physical disability (4) registration, with number of places Meadowside DS0000037510.V277685.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users over the age of 65 to be restricted to 2 whose DOB are 05/11/1934 and 18/10/1936. 6th September 2005 Date of last inspection 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 disabilities 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 DS0000037510.V277685.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection carried out over one day in February and around 6.5 hours were spent in the home. The home was warm and welcoming. Service users spoke positively about the home. Some areas have been redecorated. There is a new booking in system for service users. Staff commented that it has given much better control to the organisation and planning for staffing, leisure activities and to make sure that individual support/care needs can be met. Service users talked about what it was like staying at Meadowside. Comments included: “like it here”, “good atmosphere”, “see my friends”, “play games – bingo, cards, watch TV, go out to places”, “nice staff, helpful”. 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, discussing the new assessment and booking in process and looking at the forms, booking in charts and staff rota, reading and discussing policies, plans and records including individual service user plans, medication charts, some staff records including recruitment and training records. What the service does well: What has improved since the last inspection?
There are newly designed assessments that are now being completed for all service users staying at Meadowside. The assessments indicate how much
Meadowside DS0000037510.V277685.R01.S.doc Version 5.1 Page 6 help each person needs whilst they are staying, how many staff they need to support them with different tasks and this then determines how many people can stay at Meadowside at any time to make sure there are always enough staff. If there is a request for someone to stay who needs a high level of support and the home has already got all the staff hours allocated then it is possible to admit them providing additional staffing has been agreed. Staff said that this system had improved the organisation of the home and they always have sufficient staff. Care plans have been developed with simplified language, pictures and symbols to increase the opportunity for service users to participate in compiling them and have a better understanding of their contents. The format and its completion can be carried out over the computer making amendments and updating much quicker and easier. There has been necessary ongoing maintenance and redecoration in the home. Three bedrooms have been redecorated. One bedroom has a new carpet and new curtains. All the beds have new mattresses and bedding. All the downstairs rooms have new net curtains. The bar has been redecorated. 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 DS0000037510.V277685.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Meadowside DS0000037510.V277685.R01.S.doc Version 5.1 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 the following standard(s): 2 Assessments have been designed to give a clear picture of identified needs and what care and support is needed whilst on respite. EVIDENCE: A new assessment format enables the staff to use a point system to identify how much support each individual needs and make sure that the home accommodates the right number of service users to match the staffing level. If a service user has a high level of need and accommodating them would mean the points overall would go over the number allocated for the home then additional staff must be allocated before the service user can be admitted. This system has vastly improved the manageability of the service and has clearly identified what staffing is required to meet individually assessed needs. Meadowside DS0000037510.V277685.R01.S.doc Version 5.1 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 the following standard(s): 6, 7 Service users have well designed plans that are more easily understandable and well written and can expect a consistent service during their stay and at subsequent stays. Staff support service users to make decisions appropriately. EVIDENCE: Viewed newly designed care planning system that is accessed and stored on the computer. The system has recently been implemented and the manager is in the process of reassessing service users and compiling new service user plans with each individual using this system. The format uses pictures and symbols and it is envisaged that the plans will be printed in colour. The new format includes the positive aspects of the previous system so that care that needs are written and updated from one visit to the next. Service users talked about their lifestyle. Meetings are held monthly to give everyone the opportunity to air their views and give suggestions for activities and improvements for the home. Usually service users stay at Meadowside for a week or two. The home also offers transitional stays whilst a suitable
Meadowside DS0000037510.V277685.R01.S.doc Version 5.1 Page 10 alternative placement is found. A service user spoke about plans for the future and was in the process of making decisions about this. Meadowside DS0000037510.V277685.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 13, 15, 16 Service users feel they have plenty to occupy them during their stay and they have a range of activities to choose from. Service users are supported to maintain contact with friends and families as they wish. Routines in the home are flexible and based on assessed needs and activities planned. EVIDENCE: A sample of service user plans were viewed with regard to leisure activity records. Planned activities and whether individuals have participated in them are recorded in service user plans. Service users had been to the cinema during the week. Staff said that the range and frequency of activities had increased since changing the booking system and having a more systematic approach to numbers of people and types of need. Contact with relatives is varied depending on the length and nature of the stay at Meadowside. Some service users live at home with their families and come into Meadowside for a break. Contact information is recorded in the service
Meadowside DS0000037510.V277685.R01.S.doc Version 5.1 Page 12 user plan. Service users spoke about keeping in touch with their friends and families whilst staying at Meadowside. The majority of service users with learning disabilities go to the day centre during the day and have always done this. Times for getting up, going to bed and how they spend their time during their stay are dependent on their assessed needs and established routines. Service uses spoken to said they were able to decide what they wanted to do and what time they got up or went out. Meadowside DS0000037510.V277685.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support
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 the following standard(s): 18, 19, 20 Service users are supported well with their personal and health care with regard to their wishes and feelings. There is a thorough medication procedure designed to ensure service users safety and accurate administration. EVIDENCE: Individual preferences are indicated in the service user plan and this has improved with the introduction of the new format of the plans where it is written from the person’s point of view. Staff get to know individuals and find out when they like to get up, go to bed, what support they need to maintain personal hygiene and personal care needs. Service users spoken to were very happy with the way they were supported with personal care and said that the routines in the home were flexible and they had a say in how they are supported. Service users said that they usually attended routine health appointments when they were at home and would only expect to go to the Drs if something unexpected happened. Information about current health conditions are in the service user plan and any support needed whilst in Meadowside is also documented. A sample of these records were viewed. One service user spoke about managing his diabetes and was happy with the support given by the staff.
Meadowside DS0000037510.V277685.R01.S.doc Version 5.1 Page 14 Staff have attended medication training. A training course is being designed especially tailored for respite care which the manager was planning to access. A sample of medication records were viewed. Meadowside DS0000037510.V277685.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 23 There are effective procedures in place to protect service users from risk of abuse. EVIDENCE: Adult protection systems within the home were discussed with the manager. Adult protection training is included in the induction training initially and there is the opportunity for additional courses and seminars to keep up to date with changing policies. Meadowside DS0000037510.V277685.R01.S.doc Version 5.1 Page 16 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 the following standard(s): 24, 30 Service users can access a good range of communal space with some comfortable furniture and appropriate equipment. Improvements to the overall appearance of the environment will enhance the service users’ quality of life. The home is clean overall. Direct access to the sluice room would improve infection control. EVIDENCE: Three bedrooms have been redecorated. All the beds have new mattresses and bedding. One bedroom has a new carpet and new curtains. The kitchenette adjoining the lounge, known as the bar, has been redecorated. All the downstairs rooms have new net curtains. The carpets in the main corridors are worn and need replacing with particular priority needed for the area where people with physical disability are accommodated where the carpet is so badly worn there is a hole in it. A requirement has been made to replace this carpet and a recommendation to include other carpets in the maintenance and renewal plan. There is a sluice room with washing machine with sluicing facility. At present the only access into this room is through the bathroom. Whilst it may be
Meadowside DS0000037510.V277685.R01.S.doc Version 5.1 Page 17 useful to use the two facilities in conjunction, it is restricting the access to the sluice room if someone is using the bathroom. Consideration needs to be given to alternative access into the sluice room that could be addition to the current access. The security and privacy of service users using the bathroom would also need to be taken into account if additional access would be provided. A recommendation has been made to consider the access to the sluice room directly in light of infection control. Urine bottles were being soaked in Milton fluid. A recommendation has been made to consider alternative methods of sterilisation. Meadowside DS0000037510.V277685.R01.S.doc Version 5.1 Page 18 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 The home has achieved the target to have at least half the workforce trained to NVQ level 2 and above. There is a robust recruitment process to employ suitable staff and protect vulnerable adults. EVIDENCE: There are 25 care staff and 16 have achieved NVQ level 2 and 3. 3 staff are studying NVQ 2 and 2 staff are studying NVQ 3. A sample of staff files were viewed with regard to recruitment checks carried out and induction training. There was evidence of CRB and POVA checks being carried out prior to employment. The LDAF induction and foundation is provided. Meadowside DS0000037510.V277685.R01.S.doc Version 5.1 Page 19 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 42 The manager has a good understanding of the areas in which the home needs to improve. Planning is in place and sets out how this improvement will be resourced and managed. Radiators in the home need to be covered in some areas to make sure more vulnerable service users are not at risk of harm. EVIDENCE: The manager has achieved NVQ level 4 in both management and care and has several years experience managing the home. Planning documentation was viewed including the home’s development plan. The manager carried out a risk assessments around all the radiators in the home. It is not possible to adjust the temperatures of individual radiators. Some radiators could pose a risk to individual safety, particularly in the part of the home accommodating people with physical disabilities. A recommendation has been made to provide covers for radiators that have been assessed as being potentially harmful to individuals if they were to lean against them or fall against them.
Meadowside DS0000037510.V277685.R01.S.doc Version 5.1 Page 20 Meadowside DS0000037510.V277685.R01.S.doc Version 5.1 Page 21 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 Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 3 ENVIRONMENT Standard No Score 24 1 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 x 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x x x LIFESTYLES Standard No Score 11 x 12 x 13 3 14 x 15 3 16 3 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x x x x 2 x Meadowside DS0000037510.V277685.R01.S.doc Version 5.1 Page 22 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 YA24 Regulation 23(2)(b) Requirement The worn carpet in the corridor needs replacing. Timescale for action 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. 3. 4. Refer to Standard YA24 YA30 YA30 YA42 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. Sluice room access through bathroom needs revising with consideration for access directly from corridor to be added. Need to consider alternative methods of sterilisation. Need to provide covers for radiators that have been assessed as being potentially harmful to individuals Meadowside DS0000037510.V277685.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Kent and Medway Area Office 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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