Inspection on 08/05/08 for Meadowside Residential Home

This inspection was carried out on 8th May 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Meadowside Residential Home 26/04/06

Meadowside Residential Home 12/01/06

Meadowside Residential Home 26/07/05

Meadowside Residential Home 22/01/05

Meadowside Residential Home 15/06/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Meadowside Residential Home 41 Highweek Road Newton Abbot Devon TQ12 1TR Lead Inspector Wendy Baines Unannounced Inspection 8th May 2008 10:00 Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 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 DS0000003753.V363340.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 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 Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadowside Residential Home Address 41 Highweek Road Newton Abbot Devon TQ12 1TR 01626 363243 01626 363243 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) Newton Abbot & District Society for Mentally Handicapped Children & Adults Mrs Heather June Lamble Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care- Code PC To service users of either gender whose primary care needs on admission to the home are within the following categories: 2. Learning disability- Code LD The maximum number of service users who can be accommodated is 10. Last Key- 26th April 2006. Last Annual service review- 14.04.08. Date of last inspection Brief Description of the Service: Meadowside cares for up to 10 adults with learning disabilities. It is owned by a registered charity. The Home is a large detached house with gardens and a day resource in the grounds, close to the centre of Newton Abbott with all its amenities and transport links. Meadowside is currently set out on a ground and first floor, with all the bedrooms on the first floor with bathroom and toilet facilities and a staff sleep-in room. On the ground floor are the kitchen, offices, laundry, a hobbies room, dining room, lounge and a staff sleep-in room. There is an unfinished extension to the rear of the property, which will add additional bedrooms, a sitting area and bathroom facilities when completed. The Owners intentions are not to increase the number of residents cared for at Meadowside but given all residents a single bedroom and more space. Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 2 Star: This means the people who use the service experience Good quality outcomes. This report is a summary of a cycle of Inspection activity at Meadowland since the last inspection visit. To help CSCI make decisions about the home the Provider gave us information in writing about how the home is run; any documents submitted since the last inspection were examined along with the records of what was found at the last visit; A site visit took place over one full day with no prior notice being given to the home as to the date and timing; discussions were held with the Registered manager and staff on duty; various records were sampled, such as care plans and risk assessments; questionnaires were sent to the people who use the service and their families; a tour was made of the home and garden, time was spent with people using the service and the inspector was able to talk with, and observe the staff on duty. The care of all people living in the home was looked at in detail and their experience of care was tracked through records and discussions with staff and management from the early days of their admission to the current date, looking at how well the home understands their needs and the opportunities and lifestyles they experience. Where possible time was then spent with these people, and feedback was sought from their care managers and other specialist services. This inspection approach hopes to gather as much information about what the experience of living at the home is really like, and to make sure that their views of the home forms the basis of this report. All the required core standards were assessed during the key Inspection process. The fees for the home currently range from between £340-£450, although these may vary dependent on the assessed needs of the person using the service. Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Since the last inspection there has been an extension to the property. This has provided two new bedrooms, a bathroom with hoist, additional toilet and space for a hobbies room. Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 7 The number of residents has remained the same, however the extension has meant that two residents have had new bedrooms and two others now have a single room, which they would previously have shared. A stair lift has been fitted to assist one resident who had been discharged from hospital following a fall. It was felt that due to the age of residents in the home this facility would benefit other people in the future. Facilities and staffing levels in the home have been reviewed to ensure the safety of all people using the service. Additional funding had been requested to recruit a waking night staff, which has met the specific needs of one person during the night whilst ensuring the safety and well being of others. A call bell system and alarm pad had been fitted to resident’s bedrooms and the main door. It was felt that this facility would support everyone in the home as they become older and their needs increase and would also ensure the safety of people with Dementia. Residents spoken to said that they felt safer now that they can contact a staff member if they need help. One resident commented on the positive changes in the home, ‘ There have been lots of changes and most of them positive, people are able to make more choices, now that we have cars and not a mini-bus we don’t have to go out in groups’. Feedback from relatives included, ‘ There is recently a more relaxed and less tense atmosphere in the home’. What they could do better: There must be a consistent process for reviewing care plans. Any changes must be agreed, signed and dated by all concerned. Any changes must be clearly documented to ensure that they can be read, understood and consistently followed by those providing care. The content of the care plan must be sufficient in detail to reflect when a persons’ support needs have increased. This will ensure that everyone can understand the changes and meet the individuals’ needs sufficiently. People could be further supported to make choices and take control over their lives by developing a more ‘ Person Centred’ system of planning care. This should include; involving the individual in their care plan, describing who and what is important to them and their goals and aspirations for the future. People should have the opportunity to access independent advocacy services whenever possible. Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 8 All staff should be sufficiently skilled and trained to meet the needs of the people they care for. Training should be updated and relevant to the changing needs of people using the service. Staff should be able to adequately support the changing needs of people due to age/or illness such as Dementia. 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 DS0000003753.V363340.R01.S.doc Version 5.2 Page 9 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 Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. 1,2,3,4. This judgement has been made using available evidence including a visit to this service. The homes admission process is thorough and allows people to make an informed choice about where they want to live. The home in liaison with other agencies regularly reviews the needs of people who use the service to ensure that their needs are being adequately met. EVIDENCE: There had been no new people admitted to the home since the last inspection. There was a detailed document called the homes ‘ Statement of purpose’ which provides people with information about the home and the services available. There was also a ‘ Service user guide’, which contained more specific information for people who choose to move into the home. This information was available in pictures, symbols and Braille for people who may not be able to read or understand the written word. Both these documents and a copy of the homes last inspection report were available in the main reception area of the home. Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 11 The home had a written admissions procedure, and this described how the service gathers information about any new residents before they move in and arrangements for visits so that people can make an informed choice about whether or not they wish to live there. Residents spoken to during the inspection were able to recall the time they moved into the home and said that they had been able to come for tea, meet the staff other residents and see their bedroom. Most of the people currently living at Meadowside have lived there since the home opened and have a wide range of care needs. Records confirmed that the home regularly reviews the needs of all residents to ensure that the appropriate support and care is being provided. Copies of residents’ contracts were available, these had been signed by the individual and/or their representative. Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. 6,7,8,9. This judgement has been made using available evidence including a visit to this service. Care plans contain information about peoples daily support needs. However, the current system does not ensure that care plans are updated to reflect changing needs, which could result in needs not being sufficiently met. Residents are given opportunities to partake in decisions about the day- today running if the home. This could be further improved by the involvement of independent advocacy services and a more person centred way of planning care. EVIDENCE: A sample group of three people were selected and their experience of care was tracked by looking at records and discussions with staff and management from the early days of their admission to the current date, looking at how well the home understands their needs and the opportunities and lifestyle they experience. As part of this process the inspector was able to spend time with Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 13 these people, observe the care being provided and in some cases speak to other agencies and people involved in their care. The care plans and risk assessments were very detailed and included information about daily support needs and how to keep the individual safe. Although care plans contained information about the individuals current skills and daily support needs they did not show how the home explores what is important to the individual and any goals and aspirations for the future. One of the care plans had several changes made and the original information had been crossed off and new information written in pencil. Through discussion with the manager it was evident that the individuals needs had changed significantly due to a recent deterioration in health and the care and support required on a daily basis had increased. The way the information had been changed did not clarify who had agreed the changes or when they had been made. There were many examples of residents being involved in decision making about their lives, and the day-to- day running of the home. One resident said that there had been lots of changes during the time they had lived there and that most of these had been for the better ‘ People are able to make more choices, now that we don’t have a mini- bus people are able to choose whether they go out or not’ Residents said they know who to speak to and are able to make suggestions about improving the home or care they receive. Examples were given about how residents have been involved in making decisions about changes to the dining area and new furnishings. Another resident said that they had been supported by the staff to be as independent as possible ‘ I visit my friends and they are welcome to visit me at the home’. The manager said that she makes a point of being available in the home each day and spends time talking to each resident to make sure that any concerns can be dealt with. All the residents spoken to said that they could speak to the manager or their key-worker if they had a problem. Several of the residents are elderly and would not have family members to assist them when considering any issues to do with the home or future needs. The manager said that although the home has not accessed support from independent advocacy services in the past this would be something they would begin to explore. Throughout the inspection staff were observed using their knowledge and skills to encourage and support service users to make choices and have control over their lifestyle. Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 14 Discussion confirmed that people living in the home have a range of skills and support needs relating to the management of their finances. This information was not documented within the individual care plan. All residents had their own bank account and where possible were being encouraged to look after their money and participate in purchasing their own personal items. A clear record was available of all expenditure, and money kept in the home was safely stored. Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. 12,13,14,15,16,17. This judgement has been made using available evidence including a visit to this service. Residents are supported and encouraged to lead a full and active lifestyle. They are valued within the local community and are supported to maintain positive links with family and friends. Residents are able to enjoy good quality meals within a comfortable and relaxed environment. EVIDENCE: The atmosphere in the home was warm and welcoming. Several service users were getting ready to go out and others were either attending to morning chores or enjoying a leisurely breakfast. Daily records and discussion with residents confirmed that people are supported to attend a range of activities inside and outside the home. Due to Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 16 the age of some residents these activities are now at a gentler pace and may just involve local walks and trips out for lunch and to meet friends. Others attend local college courses and get involved in activities such as cooking, sport and craft. Information about each individuals plan for the week was documented and available in the file and on the homes notice board. Service users were happy to meet with the inspector and were keen to share information about their daily routines, plans for the day and other opportunities and holidays they had enjoyed since the last inspection visit. One family member said that their relative enjoyed hobbies, holidays and outings. All the residents comment cards stated that they could do whatever they wanted to do, including visiting and staying with relatives, and going into town unsupported if able. One resident said that they visit their friends and that they can have friends visit the home to listen to music in their room. The staff had supported one resident to buy flowers for a relative who had been unwell. Another resident said that the staff support him to attend church and make the necessary travel arrangements. The layout and size of the home allows for people to mix with other residents or sit quietly away from the TV and others if they choose. There is also a large attractive garden for people to enjoy during the summer months. One resident was feeling unwell and was able to sit quietly in one of the bright and relaxing communal sitting rooms. Staff were attentive and caring and asked the resident if they would like to go for a walk during the afternoon. Throughout the inspection staff were observed treating people in a dignified and respectful way. The inspector was able to observe the lunchtime and evening meal routine and spoke with residents about the quality of the food provided. Meals were served within a very comfortable and attractive dining area. The food served was of a high standard and was well presented. All the residents spoken to said they had no complaints about the food and were able to choose something different if they didn’t like what was on the menu. A menu sheet was also available and the staff said that much thought was given to ensuring that meals are varied and meet each individual’s needs and personal preferences. Drinks were served to residents throughout the day and plenty of snacks and fresh fruit were available. The manager said that residents had recently been involved in choosing new table- cloths and were giving consideration to purchasing new dining tables and chairs. Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 17 Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. 18,19,20,21. This judgement has been made using available evidence including a visit to this service. The health needs of residents are well met with evidence of multi-disciplinary work take place when required. Residents who require minimal assistance with their daily personal care needs are well supported, however the information available to staff for residents who have more complex daily needs is not always sufficient in detail to ensure that care is delivered in a consistent manner. EVIDENCE: Information about peoples healthcare needs was clearly documented within individual files and daily records. A record was kept of all appointments and residents said that they are supported to have regular checks at the opticians and dentist. On the day of the inspection staff were making an appointment for one resident who had been unwell and the key-worker gave reassurance that she would be available to give support during this visit. Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 19 The care plans that were looked at during the inspection contained information for staff about how the resident needs and chooses to be supported with their daily personal care needs. Staff spoken to were familiar with these arrangements and said that most of the support involved encouragement and prompts rather than actual ‘ hands on’ support. The needs of one resident had recently changed and the manager said that although they had been able to attend to personal care tasks independently in the past they now needed total support. This change was not reflected in the care plan and the information available to staff was not sufficient to ensure that care is provided in a consistent manner. Staff spoken to said that they were aware of the changes and did feel that a lack of consistency when providing support had resulted in the resident displaying some changes in mood and behaviour. Referrals had been made to external agencies to review residents who were showing possible signs of early Dementia. Reviews had taken place for these residents and the Specialist Learning Disability service had plans to provide support to review care arrangements and support staff and other residents with issues relating to Dementia care. Some of the staff had received Dementia training and the manager said that this would now be part of the homes on-going training programme. Information was available within files about the current medication prescribed for each resident with a brief description of reasons for taking and possible side affects. None of the residents administer their own medication although one person did like to have some involvement and this was being positively supported by the home. One resident required insulin injection, and staff had received training in relation to safe administration and storage. A separate fridge had been provided. Most of the residents who live at Meadowside have lived there for many years. Some are now elderly and are having to deal with and experience a range of changes relating to the aging process. The staff were able to talk about these changes and appreciate that some of the residents want to slow down and enjoy a slower pace of life whilst some may also be experiencing the loss of their relatives and changes in health. Records confirmed that some of the staff had attended recent training such as Dementia, although two of the staff spoken to on the day of inspection said that they had attended the mandatory health and safety training but had not received any other training relating to residents needs for at least two years. Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. 22,23. This judgement has been made using available evidence including a visit to this service. The systems and procedures in the home ensure that all residents are listened to and their concerns are addressed promptly. Every effort is made to ensure that people are protected from abusive situations. EVIDENCE: The complaints procedure for the home was discussed with staff and residents. All residents spoken to said that they knew who to speak to if they had a problem and felt that the staff would do something about it. One resident said that they were able to support other residents who would not be able to voice their concerns and views verbally and that the manager and staff welcomed this contribution. Every resident stated in their comment card that they knew who to speak to if they were unhappy. The manager said that she is often in the home during the day and makes a point of chatting with their residents either in the privacy of their rooms or in a group as a way of giving everyone the opportunity to raise any issues. The home had a written complaints procedure, which was also available in a picture format and displayed in the home. One resident had the complaints procedure provided in Braille. Residents were also clear that they could contact the inspector if necessary and details of the Commission were available on the homes notice board. Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 21 Staff and residents said that their had been a ‘ general improvement’ in the home during the last 12 months and one relative said ‘ the atmosphere has improved and is less tense’. The staff spoken to were clear about the procedure should they be concerned about an abusive situation, and all staff had received or were due to attend ‘ Safeguarding’ training. The staff spoken to said that all the homes policies and procedures were accessible should they need to refer to them. The general feeling in the home throughout the inspection was one of openness and inclusion. Residents were encouraged to speak with the inspector and the staff were keen to be involved and participate in the inspection process. Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. 24,25,26,27,28,29,30. This judgement has been made using available evidence including a visit to this service. The environment is clean, homely and well maintained. The size, facilities and layout of the home are suitable for the needs of people who currently live in the home. However, consideration will need to be given to all aspects of the environment as peoples needs change or new people move into the home. EVIDENCE: A tour of the premises took place, which included all communal areas and a sample of residents’ bedrooms. Since the last inspection the home has completed an extension to the property, which has provided two new rooms, and a bathroom. This has also created more space for a hobbies room and additional toilet. Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 23 The number of people living in the home has remained the same, however the extension has meant that two residents can have improved bedroom facilities and two others now have single bedrooms, which they would previously have shared. The manager said that the plan to extend the property resulted from a review of the changing needs of residents as some have become frail due to age and/or illness. The new bedrooms are on the ground floor and the bathroom has a hoist for residents who may require this facility in the future. All the bedrooms seen were clean and tidy. A cleaner is employed on a regular basis, and residents are supported to partake in daily chores if they choose to do so. One resident was keen to show the inspector their room and all their special and treasured belongings. Two of the bedrooms seen were smaller than the required size as stated in the standards. One of these bedrooms had very poor natural lighting although both were well decorated and the manager said that both residents had lived in the home for many years and were very happy with their rooms. The property is large and there is sufficient communal and private space. During the visit one resident was feeling unwell and was able to sit quietly in one of the lounges whilst others sat watching the TV in a different part of the house. A stair lift had been fitted to support the needs of one resident when they had been discharged from hospital following a fall. Each resident has a call bell system and an alarm pad has been fitted to the door to support one resident who is likely to wander. It was evident through discussion that the manager continues to think of ways of improving the facilities available to people who live in the home. She also recognises that there is likely to be other areas to consider within the environment if the service continues to support people with Dementia and other care needs relating to illness and old age. Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. 31,32,33,34,35,36. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from a staff team that is consistent and sufficient in numbers to meet the current needs of people living in the home. The homes robust recruitment process protects residents’. Although staff have a good knowledge of residents due to the length of time they have known them their knowledge and understanding of changing needs due to age and/or illness is limited and should be supported by a regular and relevant training opportunities. EVIDENCE: On the day of the visit there were two care staff on duty, the deputy and Registered manager plus cleaning staff. The manager said that this would be usual during a normal shift although staffing arrangements can alter to meet specific needs or any particular activities planned in the home. The general feeling was that this was sufficient numbers for the amount and needs of Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 25 residents and this was reflected in the discussions with staff and residents during the visit. There had previously been two sleeping night staff, however the manager had recently undertaken a review of residents needs and requested additional funding to recruit one waking night worker. This change had meant that a resident could have their needs met during the night whilst not restricting other people who live in the home. Another resident said there would now be staff to support him when he had been out during the evening. Lots of interaction between staff and residents was observed during the visit, with everyone comfortable in each other’s company. Most of the staff team had worked in the home since it opened and had a good knowledge of the daily needs of residents. Those spoken to were aware that the needs of two residents had changed significantly due to the onset of Dementia, however those spoken to had not received any recent training specific to this area of care. Training records confirmed that all staff had attended regular health and safety training such as Fire training and food hygiene although this was not the case for other more specialised training relating to the needs of residents. Four staff files were looked at in detail. Correct recruitment checks had been carried out including the completion of a full application form with employment history, written references and Criminal records checks. Since the last visit the manager is also ensuring that POVA (Protection of vulnerable adults) first checks are carried out before a new member of staff starts working in the home. Equality and diversity was discussed, and there were examples of how residents are enabled to be valued members of society, follow a chosen faith, efforts are made to assist people with aids and adaptations and barriers to access in the community have been contested by the manager and staff. Staff spoken to said that despite changes in management during the last 12 months they feel well supported. Daily communication books and handover meetings ensure that staff are kept informed about events in the home and issues relating to residents. Staff said that care plans and policies/procedures are accessible and written in a way that can be understood. The manager is available during the day for staff to speak to although formal staff supervision and staff meetings were not taking place. Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. 37,38,42. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from an open, inclusive and positive style of management. The manager has a good understanding of the areas in which the home needs to improve and regularly seeks feedback from staff and residents regarding issues concerning the home and the services provided. EVIDENCE: Since the last Inspection the previous Registered Manager has left the home and a new manager has now registered with the Commission. It was evident that the new manager has worked hard to review all policies and procedures in the home since she started in May 2007. Along with the deputy manager she has been reviewing all records relating to residents and Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 27 has applied for additional funding to recruit waking night staff due to the changing needs of one resident. During this change there has also been the completion of a large extension to the home, which has given the current residents improved facilities and two residents new bedrooms. The manager is aware of other areas where the home needs to improve and said that she was particularly looking to prioritise staff training, supervision and appraisals. All the staff spoken to said that they felt well supported and could speak to the manager at any time. One resident said that there had been changes in the home and that they were for the better. One of the comment cards from a relative said ‘ the staff are excellent at keeping me informed of any issues concerning my relative’ Staff had received all the necessary health and safety training. The information provided to the Commission prior to the inspection confirmed that all the required maintenance and servicing checks are carried out. The manager said that risk assessments had been completed for all windows and window restrictors had been put in place where a risk had been identified. The accident and injury book was seen and discussion took place with the manager about how they had addressed the situation when a resident had fallen on a number of occasions. Records confirmed that advice had been sought and preventative measures taken to protect the resident concerned. Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 28 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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 4 14 3 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 2 3 3 X X X 3 X Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 29 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 YA6 Regulation 15 ((b,c,d) Requirement All people using the service must have their care plan reviewed at least every six months or when their needs change. When changes are made to a care plan this should be signed and dated and written in a way that can be understood by those providing the care. Care plans must have up to date and clear information about peoples’ daily personal care and health needs. This plan must be sufficient in detail to ensure that that support is provided in consistent manner. This information must be regularly reviewed and updated to reflect any changes in an individuals support needs. This must be addressed as a matter of priority for the person identified during the inspection. Timescale for action 23/07/08 2 YA18 15 (1) (b) 23/08/08 Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 30 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. Refer to Standard YA7 Good Practice Recommendations People using the service should have the opportunity to access independent advocacy service to assist them when considering issues relating to the home, their care and lifestyle. The homes training programme should be developed to ensure that all staff have the necessary skills to understand and respond to the changing needs of people with Dementia. The home should ensure that all staff working in the home have regular and updated training specific to the needs of the people for whom the service is intended. Support for staff should be developed to include regular, 1:1 staff supervision and opportunities for staff to meet as a team. These meetings should be documented and include discussion about specific job roles, individual residents and training needs. The home should develop a more ‘ Person Centred’ approach to planning care. This should involve the resident being fully involved in their care plan, including where possible other people who are important in their lives. The plan should detail what and who is important to the individual and an action plan to look at how the individual can be supported to achieve their goals and aspirations. 2. YA21 3. YA32 4. YA36 5 YA6 Meadowside Residential Home DS0000003753.V363340.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 DS0000003753.V363340.R01.S.doc Version 5.2 Page 32 - 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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