Inspection on 01/10/07 for Meadowside Residential Home

This inspection was carried out on 1st October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Meadowside Residential Home 02/11/09

Meadowside Residential Home 16/12/08

Meadowside Residential Home 29/08/06

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Meadowside Residential Home 60 Holden Road Finchley London N12 7DY Lead Inspector Jane Ray Key Unannounced Inspection 1st October 2007 9:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadowside Residential Home Address 60 Holden Road Finchley London N12 7DY Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8492 6500 020 8492 6603 admin.meadowside@fremantletrust.org Manager.ladyelizabeth@fremantletrust.org The Fremantle Trust Miss Hepsie McKenzie Care Home 68 Category(ies) of Dementia - over 65 years of age (22), Old age, registration, with number not falling within any other category (46) of places Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th August 2006 Brief Description of the Service: Meadowside is a large purpose built care home for sixty-eight men and women over the age of sixty-five. Twenty-two of the places are for people with dementia. The home was opened on 15th May 2006 as a result of two care homes Chandos Lodge and Lonsdale, closing. The home is owned by Catalyst Housing Association and is one of fifty-five homes managed by The Fremantle Trust. The home is designed over four levels with six separate units. Access to all floors is via the stairs or two lifts. Two units are dedicated dementia units and the other four are mainstream units. Each bedroom has its own en-suite facilities. The ground floor contains offices, a garden lounge, a laundry room, hairdressers, treatment room, kitchen and a reception area. To the front of the home is a car parking area. To the rear and side of the home is a well maintained landscaped garden and an enclosed patio area. There is also a separately managed day centre at Meadowside run by Fremantle Trust, which is open seven days a week. The home is located in a residential area of North Finchley, near Woodside Park underground station and bus routes to various parts of London. The fee for residents living in the home is £544.74 per week. The provider must make information available about the service, including inspection reports, to service users and other stakeholders. Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 1 and 2 October 2007 and was unannounced. The inspection took 10 hours to complete. The inspector did a tour of the entire service accompanied by the manager. The inspector then spent the majority of the inspection focusing on three of the six units. One of the units was for people with dementia and the other two units were for mainstream older people. In each unit the inspector spoke at length to at least one or two of the residents and visitors. The inspector also interviewed one member of the care staff in each unit as well as speaking to other care staff who were working at the time. The inspector also looked at six care plans and the medication systems in each of the units. The inspector was also joined by an “expert by experience”, who spoke at length to service users in the other three units. Following the inspection the expert prepared a report and her comments are incorporated into this inspection report. The inspector also looked at all the relevant records including service user finance records, staff files and health and safety information. The home also prepared a self–assessment (AQAA) and this was submitted to the Commission for Social Care Inspection prior to the inspection. The inspector also received 18 completed surveys, 9 from relatives and friends, 6 from service users and 3 from care professionals. The inspection is the annual key inspection and the aim is to look at how well the service is meeting the key National Minimum Standards for Older People. The inspector would like to thank the service users and staff for their assistance with the inspection process. What the service does well: The people living in the home were very positive about the service they receive and one person told the inspector “they look after me very well”. Visitors are made very welcome when they come to the home. There was a very warm and friendly atmosphere in the home and it was observed that the staff related very positively to the residents. Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 6 The inspector could observe that the staff were very positive about their work and had a good knowledge of the individual needs of each of the people living in the home. The manager is very “hands on” and two relatives said they found her very helpful and approachable. She is a positive role model and is supportive and enabling with the staff team. The physical environment throughout the home was clean and comfortable and the bedrooms are very spacious, personalized and homely. The gardens were well maintained and a source of pleasure for the residents. Many of the people said how much they enjoyed the food provided in the home and felt able to ask for an alternative if they did not want what was on the menu. The care plans and risk assessments for each person were person centred and reflected the needs of each individual. These showed that the home works closely with other healthcare professionals when this is needed. What has improved since the last inspection? What they could do better: There are a few areas for improvement identified at this inspection. The service needs to ensure there are adequate staff available to meet the needs of the residents at all times including assisting with appointments where needed. There also needs to be the provision of a range of activities linked to the interests of the people in the home that can also meet the needs of the people with dementia. Guidelines need to be place for PRN medication and medication profiles need to be accurate to ensure medication is administered correctly. Clean tablecloths need to be available at all times in the units. Care plans should be kept up to date to ensure the staff know how to support the residents. Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 7 Staff records need to include the persons photo ID and copies of visa’s need to be available as required to complete the recruitment checks. Training records need to be accurate to ensure there is a clear record of who needs training. Health and safety needs to be maintained through up to date gas and portable electrical appliance checks. It is also recommended that where processed food is used that it is of a good quality. Bedrooms must have adequate storage space to ensure items can be put away as required. 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. The summary of this inspection report can be made available in other formats on request. Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2,3,4 and 5 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People moving to the home can be assured that they will be assessed, given information about the home and be able to visit the service to decide if they want to move there. The staff team have great deal of skill and experience in caring for older people and people with dementia. EVIDENCE: I read the homes statement of purpose and service user guide. They provide information to people thinking of moving to the service, relatives or other care professionals. The statement of purpose explains what the service provides to meet the needs of people with dementia. Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 10 I looked at the assessments completed for four people living in the home. They all had a detailed assessment prepared by social services or the local NHS service at the time of their admission. Once they had arrived at the home an assessment was completed covering all their individual needs. This also included information such as their preferred routine and their life story. I discussed the process of moving to the home with the residents and care staff. They explained that the people who live in the home normally are able to visit often with their relatives and some may come for a day visit. The first four weeks are treated as a trial period to see if the person likes the home. One person told me that she was unable to visit as she had been in hospital but her daughter had looked around for her. The surveys completed by the service users showed that they all felt they had received enough information about the home before their arrival and that two of the surveys had been completed by people who had received respite care at the home prior to being admitted as a permanent resident. I looked at the contracts between the home and the residents for six people living in the home. All these documents had been completed with the room number and most had been signed but it is recommended that the block contract fee is included. I discussed respite care with the manager. The home provides two respite beds and these were filled at the time of the inspection. This home does not offer rehabilitation and therefore is not an intermediate care service. I spoke to the staff about the needs of the people living in the home and then looked at the training they had been offered. Two of the units in the home are designated as specialist dementia services. The staff training records showed that most of the permanent residential staff had attended internal courses on how to support people who have dementia, which they said they had found very useful. A senior manager who has been trained to be a trainer by the Alzheimer’s Society delivers this training. Two senior carers in the home have also been trained as a “dementia champion” and provide new staff with training using a specially prepared induction pack. The six surveys completed by residents showed that four people said they always receive the care and support they need and two said they usually receive the care and support. Most of the relatives and friends said that the home always or usually met the needs of their relative for example one person said that, “mum feels very comfortable here and misses her carers when she is away”. Another person said, “My father is very well looked after here, the carers we have met are all so wonderful”. The expert by experience felt that the residents seemed happy with the home. Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The health and wellbeing of the people living in the home is well maintained. Risks are assessed and residents are treated with respect and their privacy protected. Guidelines for the administration of PRN medications need to be in place. EVIDENCE: I looked in detail at two care plans in each of the three units. Each care plan is very person centred. The care plans are holistic and not only covered the persons healthcare and support needs but also looked at their emotional needs including significant relationships. Where possible the care plans are signed by the resident. The care plans had been reviewed on a monthly basis, although one care plan had not been updated following a recent hospital admission. Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 12 Each care plan included an individual risk assessment that always included a moving and handling assessment. Other areas of risk were also covered such as smoking. The home operates a key-working system and the staff who were interviewed showed a good understanding of their key-working role and the residents all knew the name of their key-worker and found this person very helpful. The residents had each had a review meeting in the previous year and this had included relatives and friends where possible. All of the care plans included a “life story”, which was very useful for staff in building a good understanding of each person. I looked at the healthcare records for each person whose care plan was inspected. Each person has a record of the healthcare appointments they attend. The records indicated that the people living in the home see the GP, district nurse and optician on a regular basis. They are also supported to see appropriate specialists where required, for example one person had attended a specialist clinic in relation to her leg ulcers. None of the residents had a record of having a dental check. The deputy manager explained that all the residents had been asked if they wanted to see the dentist and referrals had been made where this had been requested. I was able to see copies of the referrals. The home is now waiting for appointment dates to be sent to the residents. Nearly all of the completed service user surveys said that the people always received the medical support they needed. One resident told the expert by experience how her mobility had improved since coming to the home. Each person had a nutritional assessment and had been supported to have their weight checked on a monthly basis or more regularly if necessary. At the time of the inspection, the manager explained that none of the people living in the home had a pressure sore. I did however look at the care plan for a person who had been treated for leg ulcers and now had preventative measures in place. Her care plan addressing these healthcare needs was comprehensive. The medication and the administration records were inspected in three of the units. The home uses the Boots blister pack administration system. Each unit has their own trolley and the trolleys are stored an air-conditioned room on each floor of the home. Staff were observed administering the medication appropriately during the inspection. The staff who were administering medication confirmed they had received training that had consisted of a training course and a practical assessment. I looked at the medication records. These showed that the medication administration records were being completed and signed appropriately. The individual medication profiles for each person were mainly up to date, although a few minor amendments were needed to a few profiles. All medication received and returned is recorded on the administration records and so there is a clear audit trail available of the medication. The only concern was that one person had PRN medication for a particular healthcare need and there was no written protocol in place for when it should be administered. The correct procedures were in place for the Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 13 administration of controlled drugs including secure separate storage and double signatures. The people living in the home and a visitor spoken to during the inspection were full of praise for the staff. One resident said “I think the staff are very caring”. Most of the surveys completed by residents said that the staff always listen and act on what they say and one said the staff are very “compassionate”. I observed that all the personal care was given in a manner that preserved the privacy and dignity of the people living in the home and this was assisted by all the bedrooms have en-suite facilities. The staff always knock before entering the residents bedrooms. Everyone was appropriately dressed and were able to access the hairdresser who visits the home three times a week. The staff were observed to be friendly and able to share a joke, whilst treating people in a respectful manner. Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home find that the service can meet their cultural and religious needs, support them to maintain contact with their relatives and offer them a healthy diet. Residents are supported to contribute their ideas at meetings. The absence of an activity co-ordinator in the home means that activities are not taking place as regularly as the residents might wish. EVIDENCE: It was observed during the inspection that people living in the home were able to follow their own routine, getting up more slowly if they wished to do so and spending time in their bedrooms if they preferred. One resident told me how she liked to stay up late and watch television in the evenings and another said she likes to stay in bed till 10am. At the time of the inspection there was no activity co-ordinator in post. The manager explained that the post has been advertised. The manager had Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 15 arranged for an existing member of staff to be released from her duties to do activities for an hour and a half in the morning and for staff in the units to do some activities in the afternoon. On the first day of the inspection the morning activities took place and the inspector could see these were enjoyed by a number of the residents. On the second day the member of staff could not be released to do the activities and some residents expressed their disappointment. I could see the staff on the units doing some activities in the afternoon but this is very dependent on them having the time. Only one of the six questionnaires completed by service users said there were usually activities available. Two said “the staff have not got enough time”, two said they were “not aware of activities” and one said that all their activities were “provided by their family”. Four of the relatives commented in their questionnaires that they would like to see more activities in the home and opportunities to go out. The expert by experience noted that there is no library service for the home. It was also observed that whilst residents are invited to social events at a local church most would need help from staff to attend. The residents have chosen to have a dog in the home and she visits the units and gives everyone a lot of pleasure. The home strives to meet peoples’ religious and cultural needs in line with their individual wishes. The deputy manager explained that a catholic church service takes place once a week at the home and that a Church of England service takes place every four or five weeks. One resident who is Muslim is supported by her relatives to visit the mosque. The cook explained that different food can be provided according to peoples religious or cultural needs. At the time of the inspection one of the residents spoke Farsi, and none of the staff spoke the same language. The family had provided a few key words and phases the staff can use. The home also link with the relatives when they need to discuss particular issues. The feedback from relatives and friends in the survey said that the service always or usually meets the different needs of people in terms of their age, race, ethnicity, disability, gender, faith and sexual orientation. Visitors were observed coming to the home during the inspection and were able to spend time with people in the lounge or their bedrooms. I was able to speak to one visitor who said she always felt welcome in the home and was offered a cup of tea. From discussions with the staff and residents I could see that most people had contact with relatives and friends and that the staff supported these relationships. One resident told me how he likes to meet up with friends and go to the pub each week. It was observed that some of the rooms were personalised and that people had brought with their possessions into the home if they wanted to do so. The inspector observed that the people living in the home were able to talk to the staff and express their wishes about their daily lives. The staff were observed encouraging the residents to make choices in their lives such as Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 16 choosing drinks or where they wanted to sit. One resident told the expert by experience how she likes to sit in her room and listen to the radio. The home also has a residents meetings that take place in each unit. The minutes of these meetings were inspected on three units and they showed that these meetings take place with varying frequency, but provide a useful means of communication when they happen. The home follows a four-week rolling menu. Three meals are provided each day and regular hot drinks in between. The people living in the home were very positive about the food and said alternatives are always available if they want something different. One resident has chosen a completely alternative menu that the home is preparing for him. Fresh fruit and salads are available as part of the menu. The cook explained that where people need their food pureed, each food is prepared separately. As part of the inspection I was able to observe lunch on the first day and could see that this took place in a relaxed and sociable manner. Staff support was given in a helpful and discreet manner. The tables have condiments available and the vegetables are in a serving dish so residents can help themselves. The expert by experience ate lunch with a group of residents in another unit. She enjoyed parts of the meal but found the mashed potato rather flavourless. One person said the “sausages here are horrible” and she also felt the quality could be improved. Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16,17 and 18 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home have access to an effective complaints procedure. They are also protected by most of the staff having completed training on the protection of vulnerable adults. EVIDENCE: I looked at the complaints procedure, which forms part of the Fremantle feedback process. This process is clearly explained and is given to every person in the home as part of the service user guide. I also looked at the record of complaints and in the last year there have been four complaints of which all have been partly or fully substantiated. I felt that it was positive that the complaints were both written and verbal and were being appropriately acknowledged and addressed. The outcomes of the complaints were clearly recorded. The residents spoken to said that if they had any concerns they would speak to their key-worker or the manager. The surveys showed that all the residents apart from one said they would know who to speak to if they had a complaint and the other person said that as there had been some “staff changes” they would not know who to approach. All the relatives also said that they knew how to make a complaint and that where they have raised issues Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 18 the service has responded appropriately although one relative said that they have needed to raise the concern “again and again”. The home has an appropriate policy and procedure in place for the protection of vulnerable adults. The staff spoken to, demonstrated a good understanding of how to recognise abuse and what action they would need to take. The staff training records showed that most staff had completed training on safeguarding vulnerable adults and that further training was planned. The manager provides this training. I also looked at the systems in place to support the residents to manage and safeguard their personal monies. Relatives assist most of the residents but some are supported by Fremantle in this area. Each person has a record as part of their care plan explaining how his or her personal finances are managed. I looked at the monies for three residents with the support of the administrator. People have a separate account for their cash expenses and their savings. Where people have a large level of savings they are supported by Fremantle to put their monies into an interest bearing account. There is a receipt available for each item of expenditure. Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,20,21,22,23,24,25 and 26 were inspected. Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Meadowside is a purpose built service and provides a comfortable and safe environment for the people who live in the home. EVIDENCE: Meadowside is a purpose built home with accommodation available on the four floors. The building is divided into six units and also has a day centre. Each unit consists of a lounge / dining area and small kitchen, a second small lounge as well as all the bedrooms. Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 20 Whilst the building is large the design helps people to find their way around. In addition the units for people with dementia have a different colour scheme that helps people to orientate themselves. Whilst the home is not designed to be a secure unit the flats and the front door do have number pads or exit buttons that need to be pressed in order to open the doors and this safeguards people with dementia who may be at risk of wandering. Meadowside is designed with an attractive garden including a safe area for people with dementia. A communal lounge area is available on the ground floor and this area is used for meetings and activities. All the bedrooms in the home are single and very spacious with en-suite shower and toilet facilities. The bedrooms are all appropriately equipped. Each flat also has a bathroom with a bath that is accessible for people with limited mobility. The people living in the home are able to personalize their bedrooms. The expert by experience spoke to one person who had brought her bureau with her into the home. I could see that additional aids and adaptations including hoists are provided according to the individual needs of the people living in the home. It was however noted that there can be a lack of storage space particularly for continence products which are sometimes visible in the room. The heating and lighting throughout the home was appropriate in all the areas. The premises were clean and tidy throughout and there were no unpleasant odours. The only comment was that some of the tablecloths in the units were soiled and had not been replaced between meals. The laundry was appropriately equipped and suitable arrangements were in place for the washing of foul laundry. Two relatives had mentioned in their surveys about personal clothing being lost. I could see that there was a system available to handle laundry where labels have fallen off and residents, relatives and staff can come and find any missing laundry. Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are supported by a stable and experienced staff team, but the staffing establishment makes it hard to ensure that there are staff available for additional tasks such as taking people to outpatient appointments. The staffs training records have not been kept up to date and this makes it hard to accurately plan who needs to attend training courses. EVIDENCE: The staffing structure for the service consists of the manager, deputy manager, six unit leaders and a team of care staff. There is a separate team of ancillary staff including cooks, domestics and laundry staff. I looked at the staff rota’s, spent time in three units, spoke to staff and visitors and had feedback from the surveys in order to inspect staffing levels. The manager explained that at the time of the inspection there were 56 vacant care staff hours mainly at the weekend and the home has not used agency staff for the past three months. Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 22 The staff are allocated to the units but work across a floor. Units 1 and 2 are for people with dementia and they each have two care staff working during the day and one care staff in each unit at night. Units 3 and 4 are for older people and during the day they have one carer in each unit and another carer who floats between the two units. Since the last inspection additional hours have been introduced to ensure there are two staff working in these units from 7.30am – 11am and from 5.30pm –11pm. Units 5 and 6 are for older people and during the day they have one carer in each unit and another carer who floats between the two units. The units for older people share one waking night staff between two units at night. During the day there is one senior member of staff who is floating to address any problems but they also have to work on the units if a staff member is not available for work and a replacement cannot be found as happened on the first day of the inspection. Three of the surveys completed by relatives and friends said they would like to see more staff. One said that the staff don’t have enough time to “sit and talk” to the residents. A fourth relative said she was disappointed that staff could not accompany his mother when she went to hospital for an outpatient clinic. Two care professionals and two residents also comment on the home being understaffed. Staff spoken to also commented that staffing levels can be difficult at times when they are working with only one member of staff on a unit and when people need to go for appointments. The manager felt that the needs of people in units 5 and 6 were increasing and staffing levels may have to be reviewed on this floor. A complaint received in the home also reflected the problems experienced in providing staff to go with residents to hospital appointments. The manager explained that at the time of the inspection 32 care staff have either completed or are working towards the NVQ in care. This means that over 50 of the staff have completed or are studying for an NVQ in care, most of whom are being supported by the Fremantle NVQ assessment centre. The home also benefits from two staff who are qualified NVQ assessors and a third person is also working towards this qualification. I looked at the recruitment checks for four members of staff. They all had an application form, two written references and a CRB check. Three of the staff did not have any copy of their photographic ID that would also include evidence of a visa where this was needed. All the staff had completed and signed contracts of employment. I looked at the training records for four members of staff and at the staff, training matrix for the whole staff team. The staff all have a record of a completed induction. The company induction lasts five days and is very thorough and includes training on how to promote each resident’s rights, choice, privacy, individuality, dignity and respect. It also promotes the concept of person centred care. I spoke to a member of staff who is just completing her induction. She said this process was very thorough with two weeks of Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 23 shadowing and the completion of an internal induction checklist. She is now attending the companies five day training programme. The staff team, training matrix was not up to date and this made it hard to accurately tell who still needed training in certain mandatory areas. The company does have an ongoing programme of training but the manager explained that some training takes place in Aylesbury, which is difficult for staff in North London to access. Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,32,33,35,36 and 38 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in this home benefit from the service being well managed. They also have an opportunity to contribute their point of view through the quality assurance process. Maintenance checks to the gas system and portable electrical appliances need to take place to safeguard the residents from health and safety risks. EVIDENCE: The registered manager has extensive skills and experience. She has started the studying towards her NVQ level 4. Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 25 The manager during the inspection demonstrated an excellent knowledge of all aspects of the service she manages and was observed to have an open and inclusive style of management with the staff team in the home. The residents spoke very positively of the manager and said she was very helpful. There is a clear management structure within the home. Monthly staff team meetings take place and discuss a range of operational issues. I looked at the quality assurance exercise that had just been completed. This consisted of a detailed quality audit completed by Fremantle senior managers looking at all aspects of the operation of the home, and questionnaires that went to residents, relatives, staff and care professionals. The results and comments received had been collated into an action plan. I looked at the supervision records for four members of staff. These show that supervision sessions were taking place regularly, although one was of a poor quality and this reflects a staff training need. The health and safety records were inspected. In terms of fire safety the fire alarm, emergency lighting and fire extinguishers had all been serviced. The emergency plan is in place and the fire alarm is being checked on a weekly basis. The service has a fire safety risk assessment and monthly fire drills have taken place. The training matrix showed that permanent staff had completed fire safety training. The maintenance certificates for the electrical installations, lifts, hoists and water system check for legionnaires were all in place. The gas system and portable electrical appliances needed an annual check and no date was available for this to take place. The staff training records for health and safety were inspected. The training matrix was not sufficiently up to date to get a clear picture of who still needed to receive training, although there was evidence of ongoing training taking place. Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 26 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 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 x 2 Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 27 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 OP9 Regulation 13(2) Requirement The registered person must ensure medication profiles are up to date and PRN medication guidelines are in place where needed. The Registered Persons must ensure that all the residents have access to activities in line with their individual interests and activities for service users with dementia are developed. The registered person must ensure clean tablecloths are provided. The registered persons must ensure that the staffing levels throughout the home are adequate to meet the needs of the residents including all the support that is required. This requirement is amended and restated from the last inspection. Previous timescale of 27/10/06 not fully met. The registered person must ensure that all the staff records include passport ID and a copy of a visa where needed. DS0000067043.V346415.R01.S.doc Timescale for action 31/10/07 2. OP12 16(2) 30/11/07 3. 4. OP26 OP27 16(2)(j) 18(1)(a) 31/10/07 30/11/07 5. OP29 19(1)-(5) 30/11/07 Meadowside Residential Home Version 5.2 Page 28 6. OP30 18(1)(c) 7. OP38 13(4) The registered persons must ensure that the training records are kept up to date in order to ensure that all staff working in the home receive mandatory training. This requirement is amended and restated from the last inspection. Previous timescale of 22/12/06 not fully met. The registered person must ensure that the annual gas and portable electrical appliance service checks are completed. 30/11/07 31/12/07 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 OP2 OP7 OP15 OP23 Good Practice Recommendations The registered person should ensure all the contracts between the home and the service user are fully completed including the fee payable by the local authority. The registered person should ensure the care plans are updated when there are changes in a persons individual needs. The registered person should ensure that where processed food is used that it is of a good quality. The registered person should provide adequate storage to ensure that continence products can be put away. Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Meadowside Residential Home DS0000067043.V346415.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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