Inspection on 17/01/08 for Meadway Court

This inspection was carried out on 17th January 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Meadway Court 27/01/09

Meadway Court 04/07/06

Meadway Court 08/03/06

Meadway Court 12/05/05

Meadway Court 08/12/04

Meadway Court 24/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Meadway Court Meadway Bramhall Stockport Cheshire SK7 1JZ Lead Inspector Mrs Fiona Bryan Unannounced Inspection 17th January 2008 09:20 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 Meadway Court DS0000008567.V357728.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. Meadway Court DS0000008567.V357728.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadway Court Address Meadway Bramhall Stockport Cheshire SK7 1JZ 0161-440 8150 0161 439 5629 meadwaycourt@boroughcare.org.uk 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) Borough Care Limited Care Home 42 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (42) of places Meadway Court DS0000008567.V357728.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 42 OP and up to 5 DE(E). Date of last inspection 4th July 2006 Brief Description of the Service: Meadway Court provides permanent residential care for up to 36 older people and offers intermediate care facilities for up to six residents. Intermediate care is for people who have been assessed, by health and social care professionals, as being suitable for a short-term placement of rehabilitative care. The length of stay is time limited between one to six weeks. During their stay residents are seen by Physiotherapists, Occupational therapists, Social Workers and district nurses. Meadway Court also offers day care facilities for up to four service users over seven days per week. The home is one of 12 care homes owned by Borough Care Limited, a ‘not-forprofit’ company. The home consists of 40 single bedrooms and one shared bedroom. Bedrooms are situated on the ground and first floor areas of the home, 24 of the rooms have en-suite facilities, which comprises of a washhand basin and toilet. There are several communal areas situated throughout the home, including a large conservatory to the rear of the building, which opens onto a large patio area with garden furniture. The gardens are pleasantly landscaped with flowers and shrubs. A lounge is available for residents wishing to smoke. A full passenger lift is in place. The home is situated at the end of a cul-de-sac in the Bramhall area of Stockport. Bramhall village is approximately ten minutes walk away. The village has a wide variety of shops, restaurants, churches and banks. Access to motorway networks, public transport and train station are within a reasonable distance of the home. Fees range from £322 to £418. The service user guide is displayed in the reception area of the home and is given to prospective residents or their relatives when they visit the home. Meadway Court DS0000008567.V357728.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 1 star. This means the people who use this service experience adequate quality outcomes. This key unannounced inspection, which included a site visit, took place on Thursday, 17th January 2008. The home was not told beforehand of the inspection visit. All key inspection standards were assessed at the site visit and information was taken from various sources, which included observing care practices and talking with people who live at the home, the person in charge and other members of the staff team. Three people were looked at in detail, looking at their experience of the home from their admission to the present day. A tour of the building was conducted and a selection of staff and care records was examined, including medication records, employment and training records and staff duty rotas. Before the inspection, we asked for comment cards to be sent out to residents and relatives asking what they thought about the care at the home. Two relatives and seven residents returned their comments cards. We also sent some questionnaires to GP’s who visit the home and two replied. Comments from these questionnaires are included in the report. The home does not have a registered manager. A manager has been appointed but she is currently on maternity leave and therefore has not yet completed the process for registration. In the meantime, a manager from another home within Borough Care has been visiting the home daily to offer support and help to the deputy manager. At the time of the site visit the deputy manager was off but the manager from the other home was present and acting as the person-in-charge. Before the site visit we sent a form called an Annual Quality Assurance Assessment (AQAA), which asks what they think they do well, what they have improved upon and what they need to do better. The manager from the other home completed it and although it was late being returned she had identified within it many of the areas for improvement that we found at this inspection. Meadway Court DS0000008567.V357728.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The procedures for the management of medicines within the home had improved and were satisfactory at this inspection. The company has increased the length of induction training for new staff to 4.5 days. The training covers health and safety topics, as well as issues such as resident confidentiality and respecting privacy and dignity. Some other areas within the home were not as good as they were at the last inspection. Meadway Court DS0000008567.V357728.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Meadway Court DS0000008567.V357728.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 Meadway Court DS0000008567.V357728.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): 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Detailed assessments are undertaken before people come into to the home so they can feel confident that their needs can be met. EVIDENCE: A statement of purpose and a service user guide are available in the home and copies are given to all new and prospective residents. These documents need updating with the details of the new manager once she is registered. Four residents were case tracked. Pre-admission assessments, contracts, financial details and archived records were kept in the manager’s office, whilst risk assessments and care plans were kept in each person’s own room, so that staff could use them every day as working documents. Meadway Court DS0000008567.V357728.R01.S.doc Version 5.2 Page 10 An assessment had been undertaken for each person before they came into the home. Staff use a “trigger” system to assess potential concerns about a resident’s nutritional or pressure areas and if there are concerns the resident is referred to the district nurses. Staff undertake their own assessments regarding the risk of falls and moving and handling. Staff were knowledgeable about the people they were caring for and said that changes to the residents’ needs or information about new residents was provided to them at staff handovers at the beginning of every shift. Meadway Court provides six intermediate care beds. Service users who accessed these beds were assessed prior to their admission under the Department of Health ‘Single Needs Assessment Process’ (SAP) and were admitted directly from hospital or from home. Physiotherapy, occupational therapy and district nursing input were available for intermediate care service users Monday to Friday. Meadway Court DS0000008567.V357728.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): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Staff need to develop residents’ care plans so they address their care needs in a more person-centred way. This will ensure that staff have the information to deliver and monitor care effectively. EVIDENCE: Four people were case tracked. Each person had a care file in their room that contained care plans and risk assessments. Each person had three standard care plans that detailed their personal and hygiene needs, dietary needs and requirements for care during the night. Additional care plans were then written for other issues specific to the individual resident. Care plans were quite generic and information was fairly basic, for example, stating that the resident needed assistance or supervision but without detailing what the resident could do for themselves or how the care to be delivered would be monitored to evaluate its effectiveness. Meadway Court DS0000008567.V357728.R01.S.doc Version 5.2 Page 12 Risk assessments were undertaken but where risks were identified there was not always a corresponding care plan, for example, one resident was identified as at risk of pressure ulcers and the risk assessment summary stated that a pressure mattress was in situ. There were no further details about this and there was no care plan to inform staff how often they were to assist the resident to change position, etc. Staff need this information so they can check that any equipment is set correctly and working properly and so they can work to a plan to reduce the risk to the resident of developing pressure ulcers. Care plans were in place for most personal and physical care needs but did not always address residents’ mental health needs, for example, one resident was quite agitated but had no care plan to assist staff to monitor this and identify triggers that may cause agitation and the best means of reassuring the resident. Care plans and risk assessments were generally reviewed monthly. It was noted that nutritional risk assessments were not carried out routinely. It is recommended that all residents are screened on admission to assess their nutritional status in accordance with Department of Health guidance (Improving nutritional care, published October 2007). Residents had generally been weighed regularly. Actions stated as being required in care plans were not always carried out in practice and this was discussed with the person in charge. One resident was clearly very uncomfortable and wanted to move from the wheelchair they were in. Their care plan said that they should be transferred to a comfortable chair as soon as possible but the resident was left in the wheelchair for at least an hour. This is discussed further in the section about “complaints and protection” later in this report. Records showed that health care services, such as the GP, chiropodist, optician and dentist, had been accessed for people living at the home and arrangements were made for people to attend outpatient appointments at the hospital. It was reported that the GP visits residents admitted for intermediate care at least once a week. One person had been admitted to the home two days previously. Although care plans had been written, a daily record of the resident’s progress had yet to be started. A statement as to the condition of each resident should be written at least once in every 24 hours. Examination of a number of residents’ medicine administration records indicated that medicines were stored, administered and disposed of satisfactorily. One resident managed his own medicines. A risk assessment had been undertaken to ensure that this would be safe. Meadway Court DS0000008567.V357728.R01.S.doc Version 5.2 Page 13 Before the site visit the CSCI sent surveys to residents and relatives asking about their views of the home. Two relatives and seven residents responded. Comments included “Care depends on staff availability – sometimes agency staff don’t appear to be properly briefed or motivated”, “Regular long serving staff are the most helpful”, “medical support is summoned when asked for”, “Mum does report that some staff are not as gentle as others”, “the majority of staff are caring and kind” and “some queries are not always followed up without prompting”. One resident said that the attitude of one or two of the carers was unhelpful but most of the staff were kind. Surveys were also received from two health care professionals that regularly visit the home. Both of these showed that they were mainly satisfied with the care offered to the people they visited. In terms of planning to meet people’s diverse needs, it was noted that the two male carers on duty on the day of the site visit were both working on the first floor, whilst the three female carers were all working on the ground floor. In order to ensure that residents can be attended by a carer of their choice of gender, if this is important to them, it may be beneficial to plan for a mix of staff on each floor, where possible. Meadway Court DS0000008567.V357728.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): 12, 13, 14 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Lack of person-centred planning in respect of social care needs means that some people’s social, cultural and recreational expectations may not be met. EVIDENCE: Four people were case tracked and a number of other residents were spoken to about their views of the home’s arrangements for social activities and stimulation and the food provided by the home. There is no designated activities organiser employed at the home and residents said there were few activities or social events. Since the last inspection the large communal room on the ground floor that was used as a lounge/dining room has been altered so it is now used solely as a dining room, and most of the residents on the first floor are expected to come down to the ground floor and dine in this room. Meadway Court DS0000008567.V357728.R01.S.doc Version 5.2 Page 15 Most of the residents spoken to did not like this arrangement and it was reported that many of the residents do not use any of the smaller lounges and now stay in their rooms for the majority of the day, which is potentially isolating. It was further reported that since this room was no longer used in part as a lounge, activities such as bingo and outside entertainers had become less frequent. Some residents were able to carry on with interests such as reading, crosswords and puzzles and listened to music or watched television in their own rooms, but there were few signs of social interaction in the communal areas. Residents said the routines of the home were fairly flexible, in that, they were able to get up and go to bed when they wanted. One resident had a kettle in his room and was able to make himself a hot drink when he wanted to. However, because of the new dining arrangements staff spent a lot of time assisting residents to get to the dining room, whilst other residents were sat waiting for their meal to be served, so the routines of the home had the potential to infringe on how the residents spent their time. Whilst looking round the home we saw a resident still in bed at 10:15am – the carer who was showing us round had not been aware that the resident was still in bed and they had not had any breakfast or a drink. Few care staff were seen in the 45 minutes it took us to walk round the home and although we were aware that staff would be in residents’ rooms, helping them to get washed and dressed, it seemed that staff were very busy. Staffing levels are discussed further in the “staffing” section of this report. Comments from the residents spoken to about activities included “there are no activities, I get visitors but there is nothing else. All the residents have stopped going in the lounges”, “there are not a lot of activities organised by the home”, “there is occasional bingo or a quiz and an evening entertainer occasionally”, “we went on a canal trip – I enjoyed that” and “I get a bit bored”. Comments from surveys received from residents and relatives included “I preferred the dining seating as it was before – we used to eat all our meals upstairs but now it varies – I think this is due to staff issues”, “We chose the home for the small lounges/dining rooms and were disappointed when they made dining all downstairs – this task means people spend a lot of time travelling up and down stairs and sitting around in the dining room waiting for others to join them”, “there are not enough activities because of staff levels” and “Entertainment is good”. Meadway Court DS0000008567.V357728.R01.S.doc Version 5.2 Page 16 Residents spoken to said that, in the main, they liked the food provided by the home and were given a choice at each mealtime. Examination of the menus showed that a variety of food was provided. Some residents said they were not always offered a drink between meals as it depended if there were enough staff. Some residents said their meals were cold by the time they were served. At lunchtime on the day of the site visit people were offered a choice of either a selection of sandwiches and tomato soup or fish fingers, peas and bread and butter. This was the lighter meal of the day. The evening meal was either gammon or vegetable quiche. Portions were a good size. Tables were nicely set in both the dining rooms, with cloths, cutlery, crockery, jugs of juice, candles and serviettes. In the ground floor dining room, three carers served 28 residents plus a few residents who remained in their rooms. Carers did seem under pressure to serve the meals and did not have a lot of time to supervise and encourage residents to eat. Lunch was served at about 12.45pm. Residents said lunchtime was really set for 12.30pm but had been getting later recently. One resident said this meant that there was a shorter gap between lunch and tea and she wasn’t always ready to eat by teatime as she had eaten a later lunch. A questionnaire had recently been distributed to residents seeking their views on the food provided by the home. The questionnaire did not ask for any feedback about the dining arrangements and it is recommended that further consultation is held with residents about this issue to determine the majority opinion. Meadway Court DS0000008567.V357728.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): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Residents are not always certain their views are listened to and more rigour is needed to ensure that decisions regarding restraint are appropriately recorded and can evidence that the resident’s rights have been considered. EVIDENCE: The home’s complaints procedure is displayed in the home and is available in the service user guide and also provided in the terms and conditions of residency. A record of complaints received had been maintained, which showed how each complaint had been investigated and resolved. All the residents who returned surveys said they were aware of how to complain and 86 felt that staff listened to and acted on what they said. However, some residents spoken to were not sure who they would complain to and were uncertain as to whether their concerns would be addressed. We felt that this was due to the changes in management and the temporary arrangements in place, which whilst acceptable do not give residents the ability to build up a relationship with the manager. Meadway Court DS0000008567.V357728.R01.S.doc Version 5.2 Page 18 Since the last inspection the CSCI has received one complaint from an exmember of staff, mainly concerning staffing levels and the dining arrangements. We passed this complaint to the provider to investigate and received a response that indicated that the issues raised had been resolved but we did not find this to be the case during our site visit, as identified in other sections. Staff said they had attended training in safeguarding adults and were able to describe the steps they would take if they suspected abuse. It was observed during the site visit that one resident was restrained in a wheelchair by the use of a lap belt. The resident was clearly agitated and uncomfortable and although staff did from time to time try to engage her in activities to distract her, she was clear in her request to get out of the wheelchair. When she was eventually released from the chair, she became much calmer and more content. She was later seen walking with a frame. Examination of this resident’s care file showed that no care plan or risk assessment was in place to indicate why restraint was being used. However, a letter kept on file in the office showed that her GP had been involved in discussions about her management as she was at risk of falling, and her advocate had been informed. A person-centred care plan is needed for this resident to reduce the risks and demonstrate continuing involvement of the multi-professional team. Furthermore, a risk assessment to provide governance to the actions taken should be in place and a wider range of person-centred activities should be available to increase stimulation. Staff need to be proactive in assessing and predicting triggers for behaviours that may result in restraint and a record should be kept of when restraint was used and this should be regularly evaluated to ensure it is still appropriate. The manager may wish to consider the issues raised in the CSCI publication “Rights, Risks and Restraints” (November 2007). Meadway Court DS0000008567.V357728.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): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home is clean, tidy and generally free from odours, but further consultation should be held with residents as to the function of the communal areas. EVIDENCE: A tour of the home was conducted. The home was clean, tidy and free from any unpleasant odours. The premises were well maintained, both internally and externally. Residents spoken to said they were generally satisfied with the cleaning and laundry services. Five of the seven residents who returned surveys said the home was always clean and fresh, two said it usually was. Meadway Court DS0000008567.V357728.R01.S.doc Version 5.2 Page 20 A number of service users’ rooms were seen, which were furnished and equipped to a comfortable standard. The majority had been personalised by the occupants, with pictures, ornaments and small items of furniture. It was reported that one of the bathrooms was being converted to a shower room the following week, and two baths were being fitted with hoists. This will be very beneficial to residents, as staff said that at the present time very few residents are able to use these baths. Since the last inspection a barbecue area has been provided in the garden. The home has several small lounges, including a room designated for residents wishing to smoke, and a conservatory. Very few residents were seen spending time in these rooms and the changes to the function of the large communal room on the ground floor need reviewing with residents to ensure they satisfy the majority of residents’ needs and wishes. Meadway Court DS0000008567.V357728.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): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The staffing levels and deployment of staff does not provide for the service meeting residents’ needs. EVIDENCE: On the day of the site visit three carers were on duty to care for 17 residents on the ground floor and two carers were on duty looking after 25 residents on the first floor. In addition, there was a care supervisor and one of the managers from another home within the company who was providing managerial support. Of residents that returned surveys, 43 said that staff were always available when they needed them, 14 said they usually were and 29 said they only sometimes were. Residents and relatives spoken to mainly said that they felt the home was short-staffed on a fairly regular basis. Comments included “there have been staff shortages which have meant inadequate staffing levels and long delays in answering the buzzers”, “Staffing levels are getting better but there are not always enough staff”, “the availability of staff varies greatly at each visit”, “staff are very, very busy – more staff are needed”, “they are short staffed and have no time to chat” and “Staff are busy and don’t keep their promises”. Meadway Court DS0000008567.V357728.R01.S.doc Version 5.2 Page 22 One visitor said the person they visited had told them they had waited for up to an hour for staff to answer the buzzer. Two complaints recorded in the complaints record were related to staff not answering buzzers within an appropriate time. Staff felt that staffing levels were sufficient but did say that they spent a lot of time transporting residents around the home at meal times, which added to their workload. We described an incident that we witnessed in the sections about “health and personal care” and “complaints and protection” where a resident was restrained by a lap belt in a wheelchair for a significant period of time. It is our opinion that the resident in question was left for longer than they were happy or comfortable with, because there were insufficient staff at that time to supervise them; therefore staff left the resident in the chair in an attempt to ensure their safety. The acting manager acknowledged that staffing levels had been an issue over recent months but did feel that the situation was improving as more staff have been recruited. At the last key inspection on 4th July 2006 it was found that not all of the required records were available at the time of the inspection, for example, references and a CRB certificate and a requirement was made that all documents and information be in place before any new employee commenced working at the home. A random inspection was carried out on 26th October 2006 to monitor this requirement and it was found that for the two staff whose files were examined, full employment histories and references were not available. During this site visit two staff personnel files were examined. The first reference for one staff member provided contradictory dates to the person’s employment history, as to when they had been employed and the second was not clear as to whom the person was who was providing the reference. Information on the second file was satisfactory. Information supplied in the AQAA reported that 69 of the care staff at the home had successfully completed NVQ training to level 2 or above. Staff personnel files and a staff training record provided details of supervision and training in topics such as moving and handling, fire safety, safeguarding adults, food safety, infection control, health and safety, first aid, communication, dementia care, falls prevention and pressure area care. It was reported that the induction training had been extended since the last inspection to 4.5 days. Staff confirmed that they had received training in various topics. Meadway Court DS0000008567.V357728.R01.S.doc Version 5.2 Page 23 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): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The organisation must continue to put strategies in place to ensure that people receive a consistent, well-managed and well-planned service. EVIDENCE: Since the last inspection a new manager has been appointed who is not yet registered with the CSCI and is currently on maternity leave. In her absence, a manager from another home within the group is supporting the deputy manager and is available at the home for some part of most days. Meadway Court DS0000008567.V357728.R01.S.doc Version 5.2 Page 24 Residents all said that residents’ meetings were held regularly, although not all were certain about how much their views were considered. Borough Care undertakes quality assurance and produces an annual report but the results were quite difficult to understand and did not give a clear idea about the views of residents or other stakeholders on how the home was performing. Some residents did feel that there were some problems at the home, saying there was “poor organisation” and “there is no-one in charge”. However, staff said they felt supported and one resident said they could not think of anything the home could do better. Residents said they were satisfied with the arrangements at the home for keeping their money safe. These records were not examined at this visit. The acting manager said the company finance director does audit them annually. Regular checks had been made of the premises and equipment to ensure that everything was in good working order and well maintained. Staff said they were provided with enough resources and equipment to do their job safely. It was observed that the store cupboard containing cleaning products was left unlocked on the day of the site visit. COSHH products should be stored safely to prevent risk to residents or staff. The AQAA was returned late and we had to ask several times for it to be completed and returned. This was in part because of the temporary absence of the manager; the acting manager was not aware it had been sent. The acting manager had tried hard to provide accurate information within the limits of her knowledge of the home. In discussion with her and on reading the AQAA it was apparent that many of the issues identified at this inspection had also been recognised by her. Although the acting manager is “caretaking” the home until the return of the manager, she said that she would take steps to start looking at some of the areas for improvement. Meadway Court DS0000008567.V357728.R01.S.doc Version 5.2 Page 25 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 2 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Meadway Court DS0000008567.V357728.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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 OP18 Regulation 13(7) Requirement Where restraint is considered any action must be taken following risk assessment and as part of a multi-disciplinary team approach. Incidents of restraint must be clearly recorded and the need for restraint evaluated to ensure it remains appropriate and any infringement on an individual’s human rights are kept to a minimum. Staffing levels and the deployment of staff must be reviewed to make sure they meet the needs of the residents. References and employment checks must be thoroughly scrutinised to ensure they are accurate and can be verified. Timescale for action 15/02/08 2 OP27 18 15/02/08 3 OP29 Schedule 2 15/02/08 Meadway Court DS0000008567.V357728.R01.S.doc Version 5.2 Page 27 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 OP7 Good Practice Recommendations Care plans should be made more person-centred and include information on the resident’s capabilities as well as what care staff need to provide. Staff should deliver care as it is stated in care plans. Where risk assessments identify a risk to the resident a corresponding care plan should be developed. A statement as to the condition and progress of each resident should be written at least once in every 24-hour period. Nutritional screening should be undertaken for all residents on admission in accordance with Department of Health guidelines. Consideration should be given to employing an activities organiser. Further consultation should be held with residents to seek their views about the dining and social arrangements. 2 3 4 5 6 OP7 OP7 OP8 OP12 OP33 Meadway Court DS0000008567.V357728.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Manchester Local Office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 Meadway Court DS0000008567.V357728.R01.S.doc Version 5.2 Page 29 - 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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