Inspection on 20/08/07 for Meavy View

This inspection was carried out on 20th August 2007.

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

Meavy View 27/09/06

Meavy View 14/02/06

Meavy View 10/10/05

Meavy View 15/03/05

Meavy View 10/08/04

Meavy View 26/02/04

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 Meavy View 146 Milkstone Road Rochdale Lancashire OL11 1NX Lead Inspector Jenny Andrew Unannounced Inspection 20th August 2007 08:10 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 Meavy View DS0000025484.V346966.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. Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meavy View Address 146 Milkstone Road Rochdale Lancashire OL11 1NX 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) 01706 861876 01706 642639 Mr David Fitton Mrs Anna Christina Fitton Charlotte Zoe Adshead Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home only: Code PC, to people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category: Code OP The maximum number of people who can be accommodated is: 32. 27th September 2006 Date of last inspection Brief Description of the Service: Meavy View is a care home providing personal care and accommodation for 32 people aged 65 years and over. The three-storey building is purpose built and a passenger lift is provided to all floors. Twenty-eight single and two double bedrooms are provided. One single and one double room have en-suite facilities. The home is located approximately one mile from Rochdale town centre, close to a small shopping precinct and Post Office. A regular bus service to Rochdale passes the home. A patio area is provided to the rear of the home that is used by service users in the summer months. Ramped access is available to the front of the home. Parking for approximately five cars is available at the front of the home, with some additional on-street parking at the side of the house. At the time of this inspection weekly fees were from £349.90 to £369.90 per week; a top-up charge being made of between £10 and £20 for larger rooms. Additional charges were for hairdressing, private chiropody, newspapers, dry cleaning and taxis. A copy of the Commission for Social Care Inspection’s latest report was displayed in the entrance hall. Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The staff at the home did not know this visit was going to take place. The visit lasted nine hours with the inspector arriving at 08:10 and leaving at 17:15 hours. The inspector looked around parts of the building, checked the records kept on service users to make sure staff were looking after them properly, as well as looking at how the medication was given out. The files of three members of staff were also checked to make sure the home was doing all the right checks before they let the staff start work. An “expert by experience” was also used at this inspection. This is a person who, because of their shared experience of using services and/or ways of communicating, visit a service with an inspector to help them get a picture of what it is like to live in and use a service. The “expert” stayed three hours and her part of the inspection was to speak to the residents living at the home and get their views about what it was like to live there. Her observations and feedback have been included throughout the report. In order to obtain as much information as possible about how well the home looks after the residents, the manager, 11 residents, two carers on an individual basis and three in a group, the cook, domestic, one relative and two district nurses were spoken with. Before the inspection, comment cards were sent out to residents and relatives/carers asking what they thought about the care at the home. Five residents and one relative filled the cards in and returned them to the Commission for Social Care Inspection (CSCI) and this information has also been used in the report. Before the inspection, we also asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what the management of the home feel they do well, and what they need to do better. This helps us to determine if the management of the home see the service they provide the same way that we see the service. We felt this form was completed honestly and that a lot of time and effort had been given to completing it accurately and in great detail. The Commission for Social Care Inspection (CSCI) has not undertaken any complaint investigations at the home since the last key inspection, although one complaint received by the CSCI was forwarded to the manager to investigate. This was done thoroughly and speedily. Since the last inspection, a new manager has been recruited for the home who has been approved and registered by the CSCI in May 2007. Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The owner had appointed a permanent manager who was trained and experienced and she had been approved and registered by the Commission for Social Care Inspection. Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 7 The care plans were written in plain English and were detailed and easy to understand by the staff team. Where medical problems were identified, the care plans showed exactly what care the staff needed to give to the person. Where residents were having regular falls, the manager was making sure that the advice of health care professionals was taken and put into practice. The manager had acted on all the requirements and recommendations made by the CSCI pharmacist so that medication was now being safely given. Staff were having regular one to one meetings with the manager so that she could check out whether they had any problems, talk about their role and see if they needed to do any further training. The owner had bought new digital sitting scales so that the frail residents could be regularly weighed. This ensured that if people were losing weight something could be done quickly about this. The social activities in the home had increased and residents had more to keep them occupied. However, further improvements were still needed for the people who were mentally frail. The manager had arranged weekly church services to be held in the home and also for a representative of the Catholic faith to call regularly. The residents really appreciated this. Staff were not starting work until references had been received so that the manager could make sure staff were suitable to work safely with the residents. Staffing levels during the evening and at night had been reviewed and the rota showed that more staff were now employed on these shifts so they would be able to give the residents the care they needed. Two male carers were now employed which meant that the male residents could choose to have someone of the same gender to assist them with their personal care needs. What they could do better: When new residents come into the home, the manager needed to undertake an assessment of their dietary needs so that the staff would know what kind of food they needed to offer in order to keep them healthy. An assessment tool called The Malnutrition Universal Screening Tool (MUST) could be used to do this. Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 8 Some areas of the home had an unpleasant odour and the manager needed to take action to address this so the home was a pleasant place for the residents to live. Flooring in two areas needed to be made safe so that the residents would not be at risk of tripping. Whilst new staff were doing training when they first started work called “Skills for Care”, they were not completing it within the first 12 weeks of employment. The manager needed to make sure they did moving/handling, fire, abuse, infection control and food hygiene, within this period so they would be able to work safely with the people they cared for. 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. Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 9 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 Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 10 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): 3 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents were assessed before admission to the home to ensure their needs could be fully met. Standard 6 was not assessed, as the home did not provide intermediate care. EVIDENCE: The manager undertook pre-admission assessments, irrespective of whether the potential resident was privately funding or funded by the Local Authority. The manager had recently reviewed the pre-admission assessment document to include a wider range of needs. Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 11 Pre-admission assessments for four people were checked, one for someone who had lived at the home for just ten days, two for people who had been admitted since April 2007 and one for a resident who had lived at the home since March 2006. Fully completed assessments were in place for all four people, as well as Local Authority Level 3 assessment documents. The manager said that she would go out to visit people in their own homes or hospital and encouraged the person’s relatives to be present also. One care assistant said a resident had recently come to look around the home with a care manager and had shown an interest in coming to live there. His assessment had been done during the visit. It was clear that admissions would only take place if the manager was confident that the staff had the skills to meet the needs of the prospective resident. In emergency situations, when a resident needed to move into the home quickly, the manager said she requested the care manager to fax through as many details as possible so that she would have a general overview of their initial needs. She would then undertake her own detailed assessment within the first two days of admission. Where residents had identified nursing needs, the district nurses were contacted and arrangements made for the individuals to be visited at the home. Feedback from one of the visiting district nurses indicated they were contacted as soon as any problems were identified and that the staff followed her instructions with regard to the residents’ care. The majority of the staff had recently undertaken Mental Capacity Act training so they would be more aware of the needs and rights of those people who were mentally frail. At the last inspection, three staff had done dementia care training, as some of the residents currently living at the home were mentally frail. The manager said she would book more staff on dementia care courses over the next 12 months. Whilst the standard relating to contractual arrangements was not inspected, it was identified at the last inspection that some residents did not have a contract. The manager said all new residents who had been admitted since she had been appointed had been given a contract but she was unclear as to whether this included all residents. She was to check this with the owner and said she would ensure contracts were issued as needed. Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 12 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 & 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents’ health and personal care needs were being met by staff who respected their privacy/dignity needs. EVIDENCE: The manager was in the process of changing the format of the care plans to one that was more easily understandable by the care staff. All the care staff spoken to felt the new care plans were simpler and clearer than those previously in place. From checking three plans, it was identified that all problem related needs had been addressed. Discussion did, however, take place with the manager about care plans looking at all areas of a person’s life, including their emotional and social needs. A social history sheet was part of the care planning process but key workers had not yet all spent time with their residents and/or their relatives to obtain relevant information. The manager said she would address these shortfalls and review the care plan format accordingly. As part of the admission process, residents’ religious and cultural needs were recorded. Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 13 Significant improvements were noted since the last inspection, in respect of the recording of specific medical problems. These were done on a short term care plan and two of the plans seen recorded how staff should care for people with pressure sores and in respect of catheter care. Another improvement was in respect of the monitoring of falls. Where residents were noted to be at risk of falling, a risk assessment had been undertaken and action needed to reduce the risk was included as part of the care plan. One resident with a history of falls had been referred to a physiotherapist and, as a result of their assessment, the resident had moved to a larger room so that the bed could be better positioned. Furniture had been moved around and a handrail fitted so that getting out of bed would be easier. As a result, this person had had no further falls. Visits by all health care professionals, together with the outcome of their visits were recorded on the care plan files. A senior was seen completing one such record during the visit. It was noted on one file that a resident who had very recently been admitted to the home had not yet received a bath. The care staff checked on this and said it was because her name had not been added to the list. This was done during the visit and a bath was arranged. Whilst residents said they were satisfied with the bathing arrangements in place, staff were not always being vigilant in recording when they had assisted with this task and, in some instances, records showed that weekly baths had not always been given. The manager said she would reinforce the importance of keeping accurate care records. Up to date risk assessments were in place for moving/handling, skin (Waterlows), falls and any specific medical conditions. Where the risk was seen to be high or medium, detailed care plans had been formulated to show how the risk was to be managed. Whilst some staff in the home had previously been trained in the use of the Malnutrition Universal Screening Tool (MUST), which was an assessment document that alerted staff to take action if a resident was assessed as being at risk of malnutrition, it had not been implemented. The new manager said this was new to her and she had already spoken to the dietician and had booked both herself and the deputy on a course in October so that she would then have the knowledge to pass down to the care staff. Although the assessment tool was not in place, one file highlighted that an underweight person had been prescribed build-up drinks and a letter was on file showing that the community dietician had been involved. Since the last inspection, new digital sitting scales had been bought so that all residents, including those who were physically frail, could be regularly weighed. Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 14 Feedback from the visiting district nurses was very positive. One said that following the appointment of the new manager, a joint meeting with the practice had been held, resulting in improved relationships and co-operation. They felt the residents were well cared for and that the staff were co-operative and always followed their instructions. Relative feedback was also positive. One questionnaire recorded “care staff spend time with my mum, she is kept clean and dry and is well fed. She is very happy in her room and whenever I ask for an aspect of care to be changed the staff make the change”. Resident feedback indicated satisfaction with the way their health and personal care needs were being met. One person commented, “my clothes are always clean”, another said “if you need a Doctor, one is requested immediately”. Suitable equipment was in use for both recovery from and prevention of pressure sores. When residents were identified at risk, charts in respect of fluid/food intake and pressure relief were put in place. Recordings on care plans showed that residents received regular visits from chiropodists and opticians. One feedback comment card said, “I need new false teeth but can’t get out, I understand nobody does home visits any more”. The manager said she was not aware of this problem but would check out with all residents whether they had any dental problems and arrange a domiciliary visit. One person said she could no longer see to read and this was reported to the manager who said she would arrange for an optician to visit her. Medication policies/procedures were in place and minutes of a recent staff meeting showed the acting manager had been reinforcing correct procedures with them. Additional medication training had been arranged in March 2007, for those responsible for dispensing medication. The arrangements in place for the storage and disposal of drugs were satisfactory and controlled drugs were also being stored and administered safely. Controlled drugs for two residents were checked and found to be in order. The Boots pharmacist had last visited on 5 June 2007 and their report showed that the system was being correctly used. The requirements and recommendations made in the last inspection report in connection with medication had been implemented. At the time of the inspection, there were no residents who were holding their own medication but should this be requested, a risk assessment would be undertaken and an action plan formulated. Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 15 The aims and objectives of the home reinforced the importance of treating residents with respect and dignity. The residents spoken to were complimentary about how the staff cared for them. They said they were treated with dignity in relation to the manner in which staff assisted them with bathing, dressing, continence, etc., and that staff respected their individual daily routines and wishes. Many of the staff had recently done continence training to raise their awareness of this aspect of care. Since the last inspection, another male care assistant had been appointed. This meant there were now two male carers on the staff team, which enabled the male residents to choose to receive assistance with personal care tasks with someone of the same gender. One of the male carers was spoken to. He demonstrated sensitivity in respect of gender issues and said he always asked any new female residents if they had a preference for a male or female to assist with personal care tasks. Staff interviewed gave good examples of how they respected people’s privacy and dignity. Examples included: closing bathroom and toilet doors, locking doors when bathing, closing curtains, keeping people covered when assisting with dressing and undressing and knocking on doors before entering. The expert by experience noted, when speaking to residents in their bedrooms, that the doors were left open and staff passing by kept a watchful eye on them without invading their privacy. Observations also showed that staff were quietly courteous in all their dealings with the residents. Approximately half of the staff had completed their NVQ level 2 training which included privacy and dignity. Residents were encouraged to remain as independent as possible and this was observed during the inspection. Residents who were becoming less mobile were being encouraged to continue to walk with the aid of their zimmer frames or walking sticks. The home was adequately equipped with necessary aids and adaptations, which promoted people’s independence. Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 16 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents were able to follow their preferred routines and make daily choices in respect of lifestyle preferences. EVIDENCE: A requirement was made at the last key inspection for an activity programme to be written and implemented. A programme had been formulated and was displayed within the home. From speaking to residents and staff, it was identified that the daily activity recorded did not always take place. Varying reasons were given for this, including the carer’s lack of time and residents’ reluctance or lack of motivation. Reminiscence packs from the local library were continuing to be delivered but staff did not always utilise them. Whilst dominoes and table games were scheduled to take place on the day of the visit, this activity did not take place. The care staff said this was because they had been kept busy giving assistance to the residents who were having baths. The carers did however, feel the manager had made improvements in this area and activities had increased. Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 17 A volunteer was visiting the home with a “pat” dog and feedback indicated this session had been very much enjoyed. This visit will be done on a regular basis in the future. The manager was also waiting for Criminal Record Bureau and other reference checks being returned for a volunteer who would be starting to visit. Staff said they spent what free time they had on a one to one basis, chatting with people. Whilst activity log sheets formed part of the care plan file, the sheets were not being kept updated so it was unclear what activities individuals had been involved in. The manager was to look at other ways in which this could be recorded. The more independent residents spoken with confirmed they were satisfied with what was being offered or said they declined to take part, preferring to read newspapers, do puzzle books or watch the television. Some people said they were enjoying the bingo sessions which were now being organised. Entertainers visited on a monthly basis, with Active Minds and a musical entertainer coming into the home. It was felt that more stimulation for the more mentally frail would be beneficial and the manager said she would discuss this with the staff team. The expert by experience commented on the absence of photographs around the home, which she felt would have assisted residents in remembering what previous activities and outings they had enjoyed. Such a display could also be used to promote further discussions about what future outings they might enjoy. Arrangements were currently being made for a trip to Hollingworth Lake with a meal in a café. This had been put forward by a resident at one of the meetings which were being held. In addition, many of the residents were to visit a local community centre exhibition at the weekend following the visit. Improvements were noted in respect of meeting people’s religious needs. Following a meeting the manager had organised with some of the residents, it had been requested that regular religious services be held at the home. This had been done and a minister was holding a regular Friday service which was being enjoyed by several residents. A nun was also visiting regularly which was meeting the needs of those people of the Catholic faith. Details of people’s religious needs were identified as part of the pre-admission assessment and had been recorded on the care plans seen. All the residents spoken to felt the staff respected their preferred routines and lifestyles and evidence of this was seen during the inspection. They could get up when they wanted, choose to eat where they were sitting or at the dining tables, chose what to wear and which lounge to sit in. A recent addition to care plan files was a resident choice sheet and these were in the process of being completed for each person. This sheet also contained details of people’s individual likes and dislikes. Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 18 Only one relative feedback questionnaire was returned and one relative spoken to during the visit. Both confirmed they were made welcome and that they could visit whenever they chose. One person felt the carers supported people to live the life they chose. Whilst residents may handle their own finances, at the time of the inspection, the relatives were tending to have control in this area. The menus were varied and nutritious and choices were offered at each meal. The main meal was at lunch time, with a lighter meal being offered at tea. Breakfast was observed and it was evident that whatever time people chose to get up, they could have anything they wanted for their breakfast. Requests were made for, “a fried egg sandwich”, “scrambled eggs”, “bacon and egg”, “grapefruit”, “porridge” and varying cereals. Feedback from residents spoken to was positive about the food. Four-weekly rotating menus were in place and residents were asked at meetings if they were satisfied with the food and whether they wished for any changes to take place. The minutes of one meeting had recorded more chips to be offered and this had been done. Mealtimes were unhurried and the tables were appropriately set. Several residents chose to eat where they were sitting in the lounge or in their bedrooms and this was not a problem. The special dietary needs of the residents were being met and, to assist with independence, one person had a plateguard. Staff checked out whether people had had sufficient to eat and also asked if they wanted more to drink. Residents said they were given supper drinks and could have biscuits or toast. Some of the staff did, however, identify a problem that after a certain time the kitchen and pantry were locked up. They said that on one or two occasions, someone had had to go to the “sister home”, Meavy House, to borrow items. The manager said she had instructed the cook to ensure that tea, coffee, milk, bread, biscuits and packet soup were kept at the serving counter in the residents’ dining room so that any residents wanting something to eat or drink later could be accommodated. This was checked out during the visit and all the identified items were in place. As one resident was said to occasionally like a more substantial supper, the manager said she would make sure that cheese or tinned paste was kept in the fridge so that staff could make her a sandwich. The choice of meal on the inspection day was sausages, vegetables, mashed potato and onion gravy or quiche, with peaches and carnation cream to follow. The meals were sampled and were hot and tasty. The expert by experience had a ham salad which she enjoyed. The teatime choices were soup, assorted sandwiches and sausage rolls. The soup was offered to all residents followed by whatever else they chose. Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 19 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. An effective complaints system was in place which residents and relatives were familiar with and staff training and good recruitment practices ensured that, as far as possible, residents were protected from abuse. EVIDENCE: The complaints procedure was included in the service user guide and statement of purpose. The manager said each resident had been given a copy of the service user guide and the documents were seen in some of the bedrooms. The manager said she also checked out at resident meetings whether anyone had any complaints. A complaints file was in place and the anonymous complaint that the CSCI had forwarded to the home for the manager to look into, was contained in the file, together with the outcome of the manager’s investigation. The manager said she took any complaints or grumbles seriously and had logged three other complaints in the book, all of which had been thoroughly investigated with the outcome recorded. The CSCI had not been involved in any complaint or protection of vulnerable adult investigations over the past year. Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 20 Feedback, both from residents and from returned comment cards, indicated that the residents knew how to make a complaint and could speak to any of the staff if they had a problem. This happened on the day of the visit and the manager made time to spend with the resident. A copy of the Rochdale inter-agency protection procedure was in place, together with a whistle blowing procedure. The manager had recently forwarded a notification to the CSCI in respect of bad practice. She had handled the problem appropriately with the residents’ interests being prioritised. Staff files showed that Criminal Record Bureau checks were being undertaken and that if staff started work before these had been obtained, that Pova first checks were being done, with staff working under supervision until full checks were received. The home had a DVD on abuse and nine of the staff had recently received training. In order to demonstrate their understanding, short questionnaires were completed but from checking one or two, some were in need of expansion. The owner was responsible for validating the questionnaires and he should ensure that questionnaires are completed as fully as possible. The manager was mindful that the remaining staff needed to do abuse training. Discussion took place about the importance of such training in order to ensure that all staff were aware of what to do if they should suspect abuse was taking place. The manager said she would telephone the Social Services Department training section to request training dates for future courses. Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 21 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 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. A clean and comfortable environment was provided for residents but more attention needed to be paid to malodours within the home and to health and safety issues. EVIDENCE: Since the last inspection, new bedroom furniture had been purchased for the majority of the bedrooms. This consisted of matching lockable cabinets, drawers, wardrobes and over-bed tables. The owner had also recently applied for a government grant for new lounge carpeting and to improve bathing facilities. A new bathroom with walk-in shower was being planned when the grant was received. Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 22 From walking around the building, it was apparent that some areas were malodorous. A faint odour was detected on the ground floor, with a stronger odour apparent on one of the upper floor corridors and two bedrooms. The manager said continence was a problem but that carpets were regularly cleaned. If cleaning carpets does not address the problem, new carpets should be purchased or alternative flooring considered in bedrooms. Clearly, replacement flooring should only be fitted, following full consultation with the residents and/or their family. Outside the lift on the first floor, the corridor carpet was rucked and needed stretching to prevent it from being unsafe. In addition, the flooring in the dining room, in front of the doorway, was beginning to rise which could result in a resident tripping. Both areas must be made safe. The home had previously employed a handyman but he had left and the owner was now responsible for keeping the home maintained. The maintenance book was checked and it was noted that recordings had been made that buzzers were faulty in three of the bedrooms. All three buzzers were tested during the visit and one was still found to be faulty. The manager said she would ensure this was repaired as quickly as possible and, in the absence of the owner, would get an electrician in that week. In the interim, she would advise the night staff of the need to check this resident on a much more frequent basis. Another recording in the book said that an overhead light was faulty and the person did not like sleeping in the dark. During the visit, a bedside lamp was supplied until the overhead light could be repaired. The home had had a fire inspection on 5 July 2007 and the report, which was seen during the visit, confirmed that everything was satisfactory. All bedrooms, toilets and bathrooms were clean and the décor in the bedrooms and communal areas was satisfactory. The expert by experience identified some of the bedrooms were not particularly personalised, although others were. Key workers should check with their residents to see if they are satisfied with their rooms and support them to make changes if this is what they want. The home was non-smoking and this was set out in their Statement of Purpose and Service User Guide. Only one resident smoked and she did so with the staff, outside the building. Infection control policies and procedures were in place and the manager had also obtained a booklet on good infection control practice from the North West Health Protection Unit. The staff had been instructed to read the booklet and sign to say they had done so. The home had a DVD in respect of infection control which many of the staff had seen. Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 23 During the inspection, good practice was observed in respect of staff using white disposable aprons for assisting with personal care and blue ones for assisting with meals. The domestic and laundry assistant also confirmed they had access to protective clothing and gloves. It was identified that, on occasions, the domestic ran out of cleaning materials and waste bags. The owner should make sure these products are ordered in sufficient time to ensure there is always a plentiful supply. On the top floor of the home, there was no liquid soap in the toilets and bathroom. This was rectified during the inspection. The laundry was situated in the basement and the washing machines had sluice programmes. The laundry was clean and tidy and individual baskets were supplied for each person. Feedback from residents spoken to confirmed that laundry was being returned to the rightful owner. One returned comment card from a resident commented that they had experienced problems when the wrong clothing had been given to them. Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 24 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Sufficient trained staff were on duty throughout the day and night to ensure the needs of the residents were able to be met. EVIDENCE: From checking the staff rotas and speaking to care staff and residents, it was clear that sufficient staff were working on each shift. Since the last key inspection, when it was identified staffing problems were being experienced in respect of shortage of staff and staff providing cover at the owner’s other home across the road, Meavy House, the manager had taken appropriate steps to ensure this was no longer a problem. Additional staff were now working on the evening and night-time shifts and staff were no longer authorised to provide cover at Meavy House. There were currently two staff vacancies, one for a senior and one for a night care assistant. Information recorded on the Annual Quality Assurance Assessment form indicated that ten staff had left the home over the past 12 months. Whilst this turnover is considered quite high, several of the staff had worked at the home for many years, which meant there was a core group of staff whom the residents had got to know and trust. Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 25 Feedback from the residents was very positive about both the manager and the staff team and everyone felt safe and secure living in the home. Six of the current residents living at Meavy View were male and there were two male carers who could assist with their personal care tasks if they wanted someone of the same gender. The ethnic makeup of the team was predominantly white British, which reflected the current all white resident group and the age range of the staff was varied. According to information provided on the AQAA, policies and procedures were in place for the recruitment and selection of staff and these were being implemented. Three staff files were checked, two of which were for recently recruited care staff. The files were in good order as the manager had recently re-formatted them. Staff were not starting work until the necessary references and Criminal Record Bureau/Pova first checks had been done. She was also asking for three references, which is good recruitment practice. As part of the induction process, new staff were given a copy of the General Social Care Council’s “Code of Practice” to refer to. Of the 20 care staff currently employed, ten had already completed their NVQ level 2 or above, equating to a ratio of 50 trained staff. Five staff were currently undertaking their NVQ level 2 training and a further three had enrolled to do their NVQ level 3. It was clear the manager and provider were committed to ensuring the staff received the right training to equip them to do their jobs well. All new staff were undertaking the Skills for Care induction training, which the manager was overseeing. The two files for the most recently recruited staff were seen. Both contained completed Skills for Care training records. However, on closer inspection, it was seen that one of the care staff had not completed any of the mandatory training courses, even though she had started work in May 2007. The other person who had started in April had done the DVD training in respect of abuse, infection control and had attended training in continence management. All new staff must complete all the required mandatory training, whenever possible within the first 12 weeks of employment. The third file contained evidence of induction training having taken place in the old format, as this person had been employed at the home since 2002. Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 26 As there was no up to date training matrix in place, it was difficult to establish, without going through every staff file, whether all the staff had undertaken the necessary health and safety training courses (e.g., food hygiene, infection control, fire, moving/handling and first aid). Those interviewed confirmed they had all undertaken their mandatory training. The AQAA stated that 13 staff had done in-house infection control training and 15 had done food hygiene. At the last inspection 19 staff had attended fire training and 15 been on moving/ handling training. However, as ten staff had left since the last inspection, these were no longer accurate figures. It is strongly recommended that the manager implements a training matrix which is kept up to date so that she can, at a glance, check who needs to undertake training and who needs refresher training. Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 27 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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The managers experience and qualifications ensured that current practices within the home promoted and safeguarded the health, safety and welfare of the people using the service. EVIDENCE: The manager had only worked at the home for approximately five months and was approved and registered by the Commission for Social Care Inspection in early May 2007. She had previously worked in a large home, in a deputy manager capacity, and was well qualified for the post, having already completed her NVQ level 4 in care and the Registered Manager’s Award. She was also an NVQ assessor and a moving/handing facilitator. Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 28 It was evident she kept herself updated by continuing to attend training courses, the most recent one being on The Mental Capacity Act. She utilised the Commission for Social Care Inspection’s website so that she was aware of any changes but this had to be done at her own home as there was no internet facility provided at the home. The provider should give serious consideration to providing broadband Internet access at the home. Feedback from staff indicated she provided clear leadership and guidance. The following comments were made about her by the staff: “approachable”, “willing to listen”, “spends time with the residents every day”, “is always contactable out of hours”, “will always give advice” and “very supportive”. Whilst she had only been in post for five months, she had made improvements in the way the home was run. These were identified by the staff who were spoken to and included the following: more detailed and easily understandable care plans, more activities being organised, better training opportunities, increased staffing levels on evening and night shifts, regular staff supervision and staff no longer covering shifts at Meavy House. The residents also seemed to know her well. She was having regular one to one supervision with the staff and recordings showed she was identifying their future training needs. She was currently in the process of reviewing the home’s policies and procedures and had recently set up a quality assurance system. Since her appointment she had held two resident meetings and also held staff meetings. The residents who were spoken to could not recall attending a meeting but the minutes of the meetings showed that several people had in fact done so. A quality assurance file was in place, which showed she was doing regular audits in respect of complaints, equipment and maintenance, Criminal Record Bureau checks, fire, health and safety and medication. She was in the process of formulating new satisfaction questionnaires, which were to be circulated to residents and their relatives and she was also considering sending them to health care professionals. She confirmed she liked to walk around the home on a daily basis, in order to check out that staff were working safely and to speak to the residents to ensure they were being cared for properly. The system in place for the management of the residents’ money was satisfactory. Since the last inspection the administrator had left and the manager said one of the owners was now undertaking this side of the business. Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 29 The residents’ families generally undertook the management of their finances but the manager said they were willing to hold money safely on behalf of the residents, if they so chose. This was currently only happening for one person. She was aware of the value of advocacy services and said a solicitor was responsible for the finances of one or two residents. Individual computer records were made of all transactions and balances and, on a monthly basis, invoices were sent out to the resident or their relatives. Receipts were held for any purchases made. The finances of three residents were checked and found to be in order. The returned AQAA form showed that all maintenance records were in order and up to date. Random sampling was undertaken of certificates for the passenger lift and hoists, gas and fire appliances and they were found to be up to date, the lift and hoist having been last serviced on 22 May 2007. It was, however, noted that the maintenance file showed that the previous date for the checking of hoists was in May 2006 and servicing of hoists and passenger lifts must be done at least twice a year. The manager said the owner might have these documents in his office and as the owner had always been vigilant in this area, the explanation was accepted. As stated in the staffing section above, it was difficult to confirm whether all the staff had done all mandatory training but the manager said she was checking through the files so she could update herself with who still needed to undertake courses. Discussion with staff and personnel files showed that, in the main, all necessary training had been completed except for the most recently appointed staff. Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 30 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 31 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 OP8 Regulation 15 Requirement Upon admission residents must be assessed in respect of their nutritional needs and an action plan written showing what needs to be done to ensure they receive the right diet. The identified flooring hazards must be made safe so that residents will not be at risk of falling. All new staff must undertake all mandatory training within the first 12 weeks of their employment to make sure they know how to care safely for the people they are looking after. Timescale for action 28/09/07 2 OP19 13(4)(a) 28/09/07 3 OP30 18(1)(c) (i) 28/09/07 Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 32 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 include people’s social and emotional needs, as well as social history details so that staff have information about what people liked doing before coming into residential care. The social activity programme should be reviewed to take into account the needs of people with mental frailty. The manager also needs to make sure the programme is put into place on a daily basis. All staff should receive abuse training so they are aware of what to do if abuse is suspected. Action should be taken to remove the malodour in certain areas of the home so that it will be a more pleasing environment for residents to live in. So that training can be monitored easily, a training matrix should be formulated showing dates when staff have undertaken training courses. 2 OP12 3 4 5 OP18 OP19 OP30 Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Manchester Local Office 11th Floor, West Point 501 Chester Road Old Trafford Manchester M16 9HU 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 Meavy View DS0000025484.V346966.R01.S.doc Version 5.2 Page 34 - 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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