Inspection on 14/06/05 for Meadowsweet

This inspection was carried out on 14th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Meadowsweet 30/04/08

Meadowsweet 30/10/07

Meadowsweet 22/06/07

Meadowsweet 22/05/06

Meadowsweet 20/10/05

Meadowsweet 02/12/04

Meadowsweet 07/06/04

Meadowsweet 19/01/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Meadowsweet, 14 14 Meadowsweet Close Raynes Park London SW20 9PB Lead Inspector Emma Dove Unannounced 14 June 10:30am and 15 June 09:30 am 2005 th th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Meadowsweet, 14 G54-G04 S34132 Meadowsweet V233612 140605 Stage 04.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Meadowsweet, 14 Address 14 Meadowsweet Close Raynes Park London SW20 9PB 020 8544 9830 020 8544 9830 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) London Borough of Merton CRH Care Home 6 Category(ies) of LD Learning Disability (6) registration, with number of places Meadowsweet, 14 G54-G04 S34132 Meadowsweet V233612 140605 Stage 04.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: For the manager and staff to receive training on Care Standard Act Legislation, Regulations and Standards and the Protection of Vulnerable Adults. Date of last inspection 02/12/04 Brief Description of the Service: 14, Meadowsweet Close is a registered care home for up to six adults with learning disabilities. Six adults are currently residing at the home. The home is owned by a Housing Association and staffed by the London Borough of Merton. The home is situated in a residential area of Raynes Park close to local shops, bus services and leisure facilities. Accommodation is provided over two floors. One bedroom, bathroom, lounge/dining room, kitchen, laundry room and office are available on the ground floor. Five bedrooms, one bathroom with toilet and a staff room are available on the first floor. A lift services both floors. The home is staffed twenty-four hours a day. Three meals a day are provided and service users are able to prepare drinks and snacks in between meals. Meadowsweet, 14 G54-G04 S34132 Meadowsweet V233612 140605 Stage 04.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over the course of seven and a half hours by one regulation inspector. The inspection consisted of examination of records, inspection of communal areas of the home, talking to residents, the manager and staff. The inspector spoke with three residents and two members of staff. What the service does well: What has improved since the last inspection? What they could do better: The Statement of Purpose should be dated for reference. A Service Users Guide to the home must be produced to comply with The Care Homes Regulations 2001. The contract of residence should include the room to be occupied to comply with the Care Homes Regulations 2001. A Person Centred Plan should be developed for all residents to ensure all their needs are recorded and met. An activities programme should be developed for one resident, to ensure their social and leisure needs are met. Meadowsweet, 14 G54-G04 S34132 Meadowsweet V233612 140605 Stage 04.doc Version 1.30 Page 6 Records must be maintained of medication received at the home and returned to the pharmacist to enable a clear audit trail of medications in stock, used and returned. The Medication Administration Record Sheets must include the correct name and dose of medication to be administered, to ensure residents receive the appropriate medications. Clear guidelines must be in place for the administration of ‘as required’ medication to ensure residents receive the correct dose in the right circumstances and to prevent care staff making medical decisions. A stock rotation or audit should be in place to ensure medications are used in order of receipt. Residents wishes regarding terminal care and death should be recorded so they can be respected. Policies require updating to reflect the CSCI. The quality assurance system should be more structured to ensure residents, their relatives and other interested parties views are sought regarding the services provided at the home. A fire call point is required in the lounge following recommendation from a fire risk assessment completed by the London Borough of Merton. An individual fire risk assessment must be completed for one resident to ensure the residents and staff members safety. For safety reasons and to comply with the Care Homes Regulations, the fire alarm must be tested weekly, the fire alarm must be serviced, the electrical supply must be checked and the portable electrical appliances must be checked. 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. Meadowsweet, 14 G54-G04 S34132 Meadowsweet V233612 140605 Stage 04.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Meadowsweet, 14 G54-G04 S34132 Meadowsweet V233612 140605 Stage 04.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 & 5 Prospective residents have access to a Statement of Purpose which provides them with information required to make a decision regarding moving into the home. A Service Users Guide to the home has not been produced, this does not assist prospective residents in making an informed choice. An assessment would be completed prior to a new resident moving into the home, ensuring that the home is appropriate and that the individuals needs can be met. Residents do not have clear information about the room to be occupied and the fees charged. EVIDENCE: The Statement of Purpose includes details of the location of the home, the facilities available, whom the service is intended, referral information and activities available at the home. This requires the date being added to identify when it was produced and reviewed. Assessments are completed prior to new residents admission to the home, ensuring the home can meet the individuals needs. The contract of residence includes details of health and safety requirements, expectations and respect and what staff will do for residents. The contract requires updating to include the room to be occupied and the fees to be charged to be in line with the Care Homes Regulations 2001, to ensure residents rights are not undermined. Meadowsweet, 14 G54-G04 S34132 Meadowsweet V233612 140605 Stage 04.doc Version 1.30 Page 9 Meadowsweet, 14 G54-G04 S34132 Meadowsweet V233612 140605 Stage 04.doc Version 1.30 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 & 8 No progress has been made with developing and updating care plans and person centred plans. This does not ensure residents current needs are met. Residents make decisions and are involved in the day-to-day running of the home. EVIDENCE: Care plans are in place which require updating to ensure they include residents current needs. Evidence is not available confirming residents participation in the care planning process. Annual reviews of care are held with records maintained. Records maintained of residents general information must be dated to ensure it is up to date. A new record of participation has been developed which identifies the activities, domestic tasks and contact with family members and friends. This gives residents, key workers and the manager a quick reference guide which focuses on residents activities and communication. Residents are involved in day-to-day decisions regarding meals, activities, holidays and decoration within the home. House meetings are held every month, the minutes for one meeting were not signed and for one meeting rough notes like an agenda were available. Meeting minutes should be Meadowsweet, 14 G54-G04 S34132 Meadowsweet V233612 140605 Stage 04.doc Version 1.30 Page 11 maintained which are accessible to residents and should be signed by the staff member who wrote them. Residents are encouraged and supported in managing their finances, maintaining their independence. Meadowsweet, 14 G54-G04 S34132 Meadowsweet V233612 140605 Stage 04.doc Version 1.30 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 13 Residents social and educational needs are met through accessing a variety of day centres during the week and activities and clubs during the evenings. One residents needs are not met due to not having a day activities programme, this should be developed. EVIDENCE: Residents attend day centres, clubs and groups depending on their needs and interests. One resident does not attend a day centre or any clubs or groups, a programme of activities within the home and in the community must be developed with this resident. Residents are able to pursue their religious observance. A new folder has been introduced which includes leaflets and information on local activities and leisure facilities. This is a positive development enabling residents to access more local community based activities. Meadowsweet, 14 G54-G04 S34132 Meadowsweet V233612 140605 Stage 04.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20 & 21 Residents health and welfare is protected by appropriate medication policies and practises in place at the home, however issues were observed regarding recording practises of medications. EVIDENCE: The medication policy has been updated to include changes in the storage arrangement for medications. Medication is securely stored at the home. Records are maintained of medications received and disposed, these sheets were not completed in full and one did not have a date. This does not allow for an audit trail of medication at the home. Medication profiles are in place, one profile includes the previous name for a medication and the dose in milligrams when the dose is in micrograms. These issues must be addressed to ensure residents health and welfare is protected. One resident has one ‘as required’ medication which does not include clear written guidelines for when it should be administered. Clear guidelines must be developed to ensure residents receive ‘as required’ medication at the appropriate time. A large quantity of creams, shampoos and lotions was found in the medication cabinet, all of which were received in April and May 2005. Clear stock rotation and audits should be in place to ensure prescription items are used in the order they are received. Meadowsweet, 14 G54-G04 S34132 Meadowsweet V233612 140605 Stage 04.doc Version 1.30 Page 14 Case files do not contain details of residents wishes regarding terminal illness and death, this does not ensure that residents needs are fully recorded and can be respected. Meadowsweet, 14 G54-G04 S34132 Meadowsweet V233612 140605 Stage 04.doc Version 1.30 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 Residents are protected by the complaints procedure. No residents raised concerns, which was confirmed by the records maintained at the home. EVIDENCE: The organisations complaints procedure is included in the Statement of Purpose, this does not include details of the CSCI. The complaints leaflets displayed on the notice board in the entrance hall of the home includes details of the CSCI. One resident was aware of how to make a complaint and another resident had no problems at the home. No complaints have been received by the CSCI. Meadowsweet, 14 G54-G04 S34132 Meadowsweet V233612 140605 Stage 04.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 28 Residents live in a homely and comfortable environment. EVIDENCE: The home is purpose built and meets the needs of current residents. The home is in keeping with neighbouring houses and is not easily identifiable as a care home. The temporary ramp to the front door has been replaced with a permanent fixture. This improves the appearance at the entrance of the home and ensures residents safety on entering the home. The home is close to local shops and public transport systems. Residents can access communal areas of the home which include a lounge dining room with doors to the garden. Garden furniture is available for residents to use when the weather permits. Meadowsweet, 14 G54-G04 S34132 Meadowsweet V233612 140605 Stage 04.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 34 &35 Residents needs are met by a mixture of longstanding and newly appointed staff who demonstrated a commitment to meeting residents needs. Staff have access to a training programme ensuring residents needs are met by appropriately trained staff. Staff recruitment practices at the home promotes residents welfare. EVIDENCE: Two members of staff are on duty during the day with one member of staff asleep but on call at the home at night. One day a week an additional member of staff is on duty during the day enabling residents to go out on specific chosen activities or outings. These staffing levels were observed to be sufficient to meet residents needs during the inspection. Residents have experienced a number of changes to staff in the last year with a new manager being appointed and one member of staff going on secondment away from the home. Regular agency staff and bank staff cover staff absences which ensures consistency of care for residents. A handover is completed by staff at the end of every shift. This ensures staff coming on duty at the home are aware of issues, progress and tasks to be completed with residents and up to date with residents care needs. Staff meetings are held every month, again ensuring staff are up to date with residents care needs and information regarding the home and the organisation. Meadowsweet, 14 G54-G04 S34132 Meadowsweet V233612 140605 Stage 04.doc Version 1.30 Page 18 Staff recruitment policies and practices support and protect residents who live at the home, references and Criminal Record Bureau checks are completed prior to new staff being appointed. Residents were recently involved in the recruitment process for the new manager. The organisation has a training and development programme for staff which ensures residents receive support and assistance from competent staff. Staff have completed training in person centred planning which will enable them to develop plans with individual residents. Meadowsweet, 14 G54-G04 S34132 Meadowsweet V233612 140605 Stage 04.doc Version 1.30 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39, 40 & 42 Residents views are sought regarding the services provided at the home, this could be developed further to include all areas of the homes operation. Residents health and safety is compromised by the lack of checks in place for the fire alarm, the electrical supply and the portable electrical appliances. EVIDENCE: The new manager has been at the home for four months and has previous experience in a similar setting. The manager should register with the CSCI. The manager demonstrated a commitment to improving the individual services provided at the home. Issues raised at residents meetings are taken to staff meetings and staff can raise issues at residents meetings, ensuring residents views are taken into account. The quality assurance systems in the home could be developed further to ensure that residents views and opinions are behind all decisions made at the home. The registered person completes a visit to the home every month and addresses issues relating to the care residents receive at the home, writes a Meadowsweet, 14 G54-G04 S34132 Meadowsweet V233612 140605 Stage 04.doc Version 1.30 Page 20 report which is available at the home with a copy sent to the CSCI. This complies with the Care Homes Regulations 2001. Polices and procedures are in place to promote residents welfare and ensure residents and staffs health and safety. The in-house polices and procedures require updating to include details of the CSCI. Residents health and safety is promoted by polices, procedures and practices within the home with the exception of the weekly test of the fire alarm system, the routine servicing of the fire alarm system, the electrical supply check and the portable electrical appliance tests which have not been completed. These must be carried out at the required frequency for safety reasons. A fire risk assessment must be completed for one resident including actions staff should take when the fire alarm sounds to ensure both the individual resident, staff and other residents safety at the home. Meadowsweet, 14 G54-G04 S34132 Meadowsweet V233612 140605 Stage 04.doc Version 1.30 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x x 2 Standard No 22 23 ENVIRONMENT Score 2 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x 3 x x Standard No 11 12 13 14 15 16 17 x 2 3 x x x x Standard No 31 32 33 34 35 36 Score 2 x 3 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Meadowsweet, 14 Score x x 2 2 Standard No 37 38 39 40 41 42 43 Score 2 x 2 2 x 2 x G54-G04 S34132 Meadowsweet V233612 140605 Stage 04.doc Version 1.30 Page 22 YES 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 1 Regulation 4 Requirement The registered person must ensure that the Statement of Purpose is updated to include details of the new manager. (timescale of 13/08/04 not met) The registered person must ensure that a Service Users Guide to the home is developed. (timescale of 13/08/04 not met) The registered person must ensure that the contract of residence includes the room to be occupied and the fees charged. (timescale of 28/02/05 not met) The registered person must ensure that a person centred plan is developed for all residents. The registered person must ensure that an activities programme is developed for one resident. The registered person must ensure that clear written guidance is in place for the use of as required medication. (timescale of 28/02/05 not met) The registered person must ensure that records are maintained of medication Timescale for action 05/08/05 2. 1 5 05/08/05 3. 5 5 (1) b and (3) 05/08/05 4. 6 15 (1) 05/08/05 5. 12 16 (2) m &n 13 (2) 05/08/05 6. 20 05/08/05 7. 20 13 (2) 05/08/05 Meadowsweet, 14 G54-G04 S34132 Meadowsweet V233612 140605 Stage 04.doc Version 1.30 Page 23 8. 21 15 (2) c 9. 22 22 (7) 10. 39 24 11. 40 17 (2) Schedule 4 (15 & 16) 13 (4) 12. 42 13. 42 23 (4)c (iv) 13 (4) c 14. 42 received at the home and returned to the pharmacist. The registered person must ensure that all residents wishes regarding terminal care and death are recorded. (timescale of 13/08/04 not met) The registered person must ensure that the complaints procedure available includes details of the CSCI. The registered person must ensure that the quality assurance system is developed to include seeking residents, their relatives and placing social workers opinions of the services provided at the home. The registered person must ensure that the in-house policies and procedures are updated to include details of the CSCI. (timescale of 28/02/05 not met) The registered person must ensure that the electrical supply and portable electrical appliances are tested at the required intervals with evidence confirming this available at the home. (timescale of 13/08/04 not met) The registered person must ensure that the fire alarm system is tested weekly and serviced regularly. The registered person must ensure that a risk assessment is completed for one resident to include actions staff should take when the fire alarm sounds. 05/08/05 05/08/05 05/08/05 05/08/05 05/08/05 05/08/05 05/08/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Meadowsweet, 14 G54-G04 S34132 Meadowsweet V233612 140605 Stage 04.doc Version 1.30 Page 24 No. 1. 2. Refer to Standard 8 20 Good Practice Recommendations The reigstered person should ensure that information on policies and procedures is produced in a format accessible to all residents. The registered person should give consideration to an audit of medication stored at the home and a stock rotation process for large quantities of medication is in place. Meadowsweet, 14 G54-G04 S34132 Meadowsweet V233612 140605 Stage 04.doc Version 1.30 Page 25 Commission for Social Care Inspection Ground Floor - CSCI 41-47 Hartfield Road Wimbledon SW19 3RG National Enquiry Line: 0845 015 0120 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 Meadowsweet, 14 G54-G04 S34132 Meadowsweet V233612 140605 Stage 04.doc Version 1.30 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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