Inspection on 27/09/06 for Meavy View

This inspection was carried out on 27th September 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Meavy View 20/08/07

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 Key Unannounced Inspection 27th September 2006 08.00 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.V307132.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.V307132.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 Mrs Susan Huntington Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Meavy View DS0000025484.V307132.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 32 service users to include:up to 32 service users in the category of OP (older people over 65years of age). The service should employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection. 14th February 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 5 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 £328.41 to £338.41 per week. Additional charges were for hairdressing, private chiropody, newspapers and taxis. A copy of the Commission for Social Care Inspection’s latest report was displayed in the entrance hall. Meavy View DS0000025484.V307132.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit took place over 7.5 hours with one Inspector. The inspector looked around parts of the building, checked the records kept on residents to make sure staff were looking after them properly (care plans) and other records the home needed to keep, to run its business. The inspector also spent time watching how staff cared for and spoke to the residents. The newly appointed acting manager was at the home during the inspection. In order to obtain as much information as possible about how well the home looked after the residents, the acting manager, 7 residents, 5 care staff the cook, 3 relatives, District Nurse and Speech Therapist were spoken with. In addition comment cards were sent out before the inspection to relatives, residents and professional visitors to the home. Of these 7 G.P, 5 relative, 1 social worker and 3 resident questionnaires were returned. Other information, which had been received about the service, over the last few months, has also been used as evidence in the report. What the service does well: Residents spoken to and feedback from returned questionnaires indicated they liked the staff team and comments received about staff included: “very pleasant”, “caring”, “very good”, “can have a laugh with them”, “nice” and “really good”. The home only cared for those people whose needs the staff could meet and staff were encouraged to attend specific training courses in how to care for people with confusion, those who were very ill and those with diabetes. The health care needs of the residents were well taken care of. The residents spoken with said they were very satisfied with how staff made appointments for them with the optician, chiropodist or doctor when they needed to be seen. Doctors and district nurses who visited the home also said how well the staff cared for the residents. A varied menu was provided with choices offered daily to residents. Those people who needed special diets were well catered for. The cook made sure that each resident had what they liked at breakfast time and bacon and eggs, scrambled eggs, sandwiches, cereals, porridge and toast were provided. Staff were getting training so they could care for residents safely and were also having regular one to one meetings with the manager or deputy manager to share ideas and discuss the care of the residents. Meavy View DS0000025484.V307132.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The home had not acted on all the recommendations made from the Pharmacist’s inspection, which had been done earlier this year and in order to make sure the medication system is safe, the acting manager needed to act on the advice given. Although the last 2 inspections had shown that social activities needed improving, the home had not made any progress in this area. Many residents said they would like more things organising on a daily basis so they would not be bored. There were some shifts when not enough staff were on duty which had resulted in staff not having enough time to spend with each resident and one of the reasons why they had no time to organise social activities. New staff were not all doing the right training when they first started, to make sure they were able to do their jobs properly. Meavy View DS0000025484.V307132.R01.S.doc Version 5.2 Page 7 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. Meavy View DS0000025484.V307132.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 Meavy View DS0000025484.V307132.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Unless admitted on an emergency basis, all residents were assessed before admission, in order to ensure the home could meet their identified needs. EVIDENCE: Three files were inspected, 2 for residents who had been admitted on an emergency basis and one for a permanent resident. All three contained initial assessment documents done by a member of the staff team. For the two people who had been admitted as emergencies, their assessments were said to have been completed the day of admission. However as the assessments were undated, it was not possible to confirm this was so and in future, all documentation should be dated and signed. The permanent resident had been assessed before coming into the home. Where care managers were involved in the admission, they had also provided detailed needs assessment and this was seen in one of the files. Feedback from residents and relatives indicated they were appropriately involved in the assessment process and considered the home was able to meet their needs. Two respite stay residents were spoken to Meavy View DS0000025484.V307132.R01.S.doc Version 5.2 Page 10 during the inspection and both felt their placements were benefiting them. Information from the assessment documents had, where relevant, been included in the residents care plans. Where residents had identified nursing needs, the district nurses were contacted and arrangements made for the individuals to be visited at the home. A district nurse was visiting at the time of the inspection. She confirmed that the staff contacted the service as soon as any problems were identified and that they followed her instructions with regard to the residents’ care. As the home had several mentally frail residents living there, 3 carers had already undertaken dementia care training and a further 21 were booked on training courses from October to March 2007. This training will ensure the staff understand more fully how to meet these peoples needs. In addition, in February of this year, 5 staff had done a palliative care training course and 3 had done a course related to diabetes. Whilst the standard relating to contractual arrangements was not inspected, it was identified from talking to residents and relatives that they were unaware of such a document. The acting manager said she had already identified this shortfall and the owner was addressing it. Contracts were to be discussed and signed as part of the review meetings, which were in the process of being arranged with relatives. Meavy View DS0000025484.V307132.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Residents’ health and personal care needs were being well met by staff who respected the privacy/dignity needs of the residents. All documentation was in the process of being reviewed and updated, with the involvement of residents and their relatives. EVIDENCE: At the time of the inspection, the newly appointed acting manager was in the process of reviewing and updating care plans for each resident. As part of this process, she was arranging review meetings with relatives and residents in order they could be fully involved in the process and could sign and agree the updated care plans. One of the relatives spoken to said he thought this was long overdue and was pleased to have been requested to visit on a formal basis to discuss his mother’s care. Care plans were in place for all residents currently living at the home, including those on respite stays. Three care plans were randomly checked and all contained detailed relevant information, which would enable staff to meet their Meavy View DS0000025484.V307132.R01.S.doc Version 5.2 Page 12 identified needs. In one instance however, a care plan did not contain sufficient information with regard to catheter care. The care plan should record the care needed for the catheter site and how such care is to be achieved and fluid intake should be recorded dependent upon the resident’s condition, i.e. they may be reluctant to take fluids. Record of district nurse visits were however, recorded. The acting manager said she would amend the plan. Cultural and religious needs of the individuals had been identified. Up to date risk assessments were in place for self-medication, moving/handling, skin (Waterlows), nutrition, 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 of the staff had received training in how to implement the new Malnutrition Universal Screening Tool (MUST), the manager had delayed implementing this until the staff felt they thoroughly understood it. She had therefore requested the dietician to visit the home again and the tool was due to be implemented the week following the inspection. This tool was an assessment document that alerted staff to take action if a resident was assessed as being at risk of malnutrition. The acting manager had requested new sitting scales be purchased as she felt the scales presently being used were not showing true readings. All files did however, show that residents were being regularly weighed. Feedback from the visiting district nurse was very positive. She said she had only been visiting the home for 4 weeks, but during that time had been impressed by the well cared for appearance of the residents and the fact the staff really seemed to care for them. Information received from the 7 G.P.’s questionnaires indicated they were all very satisfied with the overall care provided to their patients and that staff demonstrated a clear understanding of their care needs. One commented “the home is extremely good” and another said “I have been very satisfied with the care of my patients at Meavy View”. Relative feedback was also positive. One questionnaire recorded “I have never had to bring health or care issues to the staff’s notice e.g. pressure mattresses, cushions, doctors visits; they have all been organised and we are always informed of any problems immediately”. Resident feedback was also positive although two residents spoken to made negative comments. One said they had to wait a long time in a morning for the staff to assist her with personal care needs and another resident said he had not had a bath for over a week. The acting manager spoke to the resident about her concerns in a morning and said she would address it with the staff. From checking bath records of the other resident and from speaking to his key worker, it was identified that the key worker had been on holiday and the resident liked to be assisted by a male carer. As there was only one male carer he had declined a bath until his return. Meavy View DS0000025484.V307132.R01.S.doc Version 5.2 Page 13 Suitable equipment was in use for both recovery from and prevention of pressure sores. Residents identified at risk, had care plans in place in relation to fluid/food intake and pressure relief. Charts were used which were completed by both day and night staff. Recordings on care plans showed that residents received regular visits from chiropodists and opticians. A speech therapist was visiting on the day of the inspection and she confirmed that staff implemented any instructions given. She was seen contributing to the care plan and in another instance, recordings from a visiting physiotherapist were also noted. Where the physiotherapist had requested staff follow certain exercises with the staff, cardex recordings did not show when these were being done or indeed, when the resident was refusing to do them. This should be addressed. The home were currently experiencing problems in getting a dentist to undertake domiciliary visits but the acting manager was liaising with the local health centre and visits were being arranged for those people who needed them. Medication policies/procedures were in place and minutes of a recent staff meeting showed the acting manager had been reinforcing correct procedures with them. She had also checked on when residents’ medication had last been reviewed and as a result was in the process of contacting G.P.s to make the necessary arrangements. Where problems were identified with individual residents e.g. repeated refusal of medication, G.P.’s were consulted. Notes were seen on 1 residents file where a meeting with the G.P., resident, relative and acting manager had taken place, in order to try and resolve identified problems. This good practice is commended. 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. A pharmacy inspection had been done early 2006 but not all the requirements and recommendations made in the report had been implemented. The morning and lunchtime medication rounds were observed and the staff followed the correct procedures. It was however, noted from checking previous records that on one or two occasions the Medication Administration Record sheets (MAR) had not always been signed by the person giving out medication. This must be addressed. It was also noted that records were not consistently made when nutritional supplements were administered and handwritten MAR were not being countersigned. It had previously been identified that Lactulose and Movicol were not always administered from residents’ own supplies. This practice was continuing as the acting manager said so many residents were taking this medication that the drugs trolley was not large enough to accommodate them all. As a result, the manager had requested the owner to purchase a larger trolley and this had been ordered. Meavy View DS0000025484.V307132.R01.S.doc Version 5.2 Page 14 Arrangements for the storage and disposal of drugs was satisfactory, and controlled drugs were also being stored and administered safely. Controlled drugs for 3 residents were checked and all found to be in order. The Boots pharmacist had last visited on 23 July 2006 and the home had implemented the recommendations made. All staff, responsible for giving out medication had received appropriate medication training. The aims and objectives of the home reinforced the importance of treating residents with respect and dignity. The residents spoken to were very 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. One male resident said he liked to be assisted with a bath by the male carer and that this was usually arranged. The care plan for a female resident recorded that she preferred to be bathed by a female carer. Many of the residents currently living at the home valued being able to stay in their rooms all day, including having meals there. Returned questionnaires from visiting professionals all recorded that when they visited the home, their patients were seen in their own bedrooms. This was observed during the inspection when the district nurse visited. 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.V307132.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Staff promoted and encouraged residents to exercise choice regarding routines, food, personal affairs and lifestyle, in the context of an agreed notion of acceptable risk, but insufficient social stimulation was provided, resulting in residents becoming bored and feeling unfulfilled. EVIDENCE: At previous inspections, the lack of daily activities and social stimulation had been identified and little progress had been made to address this shortfall. Feedback questionnaires from relatives and residents highlighted this as an area for improvement as did the home’s own recent survey done with the residents. Comments made by some of the residents interviewed included “we entertain ourselves”, “there’s never anything going on for us”, “tend to sleep mostly as there’s nothing else to do”, “staff don’t have time to spend chatting with me” and, “the days sometimes are long as there’s nothing arranged”. The acting manager said that following on from the survey she had recently conducted, she had already arranged for a singer to entertain the residents on 3 October and on 31 October, a Halloween party was being arranged to which relatives had been invited. Posters were displayed in the home, advertising Meavy View DS0000025484.V307132.R01.S.doc Version 5.2 Page 16 these functions and two residents spoken to said they were really looking forward to the events. Also a trip to the illuminations at Blackpool was being arranged. Whilst an activity programme was displayed in the home, it was not being implemented. Staff spoken to said the dependency level of the residents was quite high and they had to prioritise their personal care needs. This left them very little time to do activities and even when they had planned to do so, something would usually come up which would prevent them from doing the activity. The home had recently had delivery of a reminiscence box from the library, containing photographs and information about the royal family but this had not yet been utilised. It was identified that whilst bingo had been requested at a residents meeting held in January 2006, nothing had been done about this request. If residents are asked what they would like to see organised and their suggestions are ignored, it will make them feel their contribution at meetings is not valued and may cause them to cease making future suggestions. Two recommendations were made at the last inspection which had not been implemented: to designate a staff member to be responsible for making sure the programme was followed and for a daily record to be re-introduced showing which residents had taken part in the planned activities. In order to address the lack of social stimulation, the acting manager must now ensure that an activity programme, which takes into account the needs of individuals, groups and people of differing abilities, is implemented. If the existing staff provision is insufficient to enable them to undertake activities, then an activities worker must be employed. The only regular activity was fortnightly visits by an external entertainer who would organise, games, quizzes and hold discussions with the residents. These visits were very much enjoyed by the residents. Residents’ religious needs were recorded as part of the admission process and this was noted on the care plans inspected. At the time of the inspection, staff said several church visitors came to the home to see individual residents. Visitors spoken with and feedback from the relatives/visitors comment cards, indicated staff made them feel welcome. This was also observed during the inspection, when visitors were asked if they would like a drink. Visitors may call at any time and may see residents in the privacy of their rooms. Observation and discussion with residents and staff showed that residents were able to make day to day decisions regarding rising/retiring times, what clothing to wear, where to sit and what to eat. A number of residents chose to stay in their rooms during the day; staff were observed supporting them to do Meavy View DS0000025484.V307132.R01.S.doc Version 5.2 Page 17 so. They also made sure that they were provided with sufficient drinks and their needs were not neglected. Residents’ wishes regarding involvement in their financial affairs were established on admission and the majority had asked relatives/friends or advocates to be responsible for finances. The returned resident questionnaires aid that staff always listened to and acted upon what they said. On the whole residents gave positive feedback about the food – the majority said they enjoyed it but two returned comment cards said they sometimes did. One commented they felt the food needed more seasoning due to diminishing taste buds. Comments from those spoken with included “excellent”; “I get enough”; “choices are offered”; “I’m satisfied”, “always good” and ‘can’t grumble”. Two residents particularly said they enjoyed breakfast and they could have anything they wanted. This was evidenced during the inspection. The cook catered for individual residents and bacon and egg, scrambled egg, boiled egg sandwiches, porridge, cereal and toast were enjoyed. Four weekly menus were in place and they were varied and nutritious. Where alterations had been made, the menus had been amended. The inspector sampled the lunch, which was roast turkey, stuffing, mashed potatoes, sprouts and swede. The good practice of asking residents if they wanted stuffing was noted and it was not pre-plated. The food was tasty and hot when served. As a result of residents’ requests, two roast dinners were now provided weekly and on those days a menu’d choice was not available. If a resident did not want the roast dinner, other options would be offered. The dessert was lemon sponge and custard or icecream. The menu was displayed in the dining room. At teatime, soup was always offered and the majority of residents were said to enjoy it. After the soup course, a choice of sandwiches or a hot snack were available followed by home baked cakes. The cook was knowledgeable about the needs of the residents with diabetes and had recently attended a diabetes training course held by the Health Care Trust. She said she had learnt a lot from attending the course. The special dietary needs of other residents were being met and soft diets were provided as needed. The cook was also aware of the likes and dislikes of each of the residents. Those residents wishing to eat in their bedrooms were efficiently served and nicely set out trays were taken by the staff to their rooms. Food was appropriately covered. As the lift was proving to be unreliable, more residents than normal were having their meals in their bedrooms. Drinks were offered throughout the day and the residents spoken to said they could have a choice of tea, coffee or cold drinks. Those who stayed in their rooms confirmed that they were never forgotten. A resident who was being spoken with in her bedroom requested Horlicks for her afternoon drink. She said she often liked a milky drink in an afternoon and this never presented a problem to the staff. Supper drinks and biscuits were generally provided Meavy View DS0000025484.V307132.R01.S.doc Version 5.2 Page 18 around 7.00 p.m. with a more substantial supper provided by the night staff after 9.00 p.m. One resident said they often enjoyed toast and sometimes had a sandwich. Milky drinks were also available. Meavy View DS0000025484.V307132.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. An effective complaints system was in place which residents were familiar with and staff training and good recruitment practices ensured that residents were protected from abuse. EVIDENCE: The complaints procedure was included in the service user guide and statement of purpose. The acting manager had noted that information packs containing these documents were not in all of the bedrooms and new packs had been prepared. During the inspection, the care manager was seen to put the packs in each of the bedrooms. A complaints log book was in place but only 1 minor complaint had been logged in February 2006. The outcome to address the complaint had only been partly completed by the registered manager who was presently absent due to sickness. The acting manager said she had investigated two concerns since coming into post, which had been logged on the individual residents files. The good practice of holding a meeting with the relative and G.P. was noted with minutes being taken. Appropriate action had been taken to address the concerns raised. In future it is recommended that concerns are briefly recorded in the complaint book, and action taken be cross referenced to the appropriate file. The Commission for Social Care Inspection had not had cause to investigate any complaints over the last 12 months. One concern had however, been raised by telephone to the CSCI and this was investigated Meavy View DS0000025484.V307132.R01.S.doc Version 5.2 Page 20 during the inspection. The concern was in relation to lack of night staff and more details relating to this may be seen in the staffing section below. The residents spoken with all felt they could speak to any staff about problems and that they would be listened to. A copy of Rochdale’s Inter-agency protection procedure was in place and the home’s policies and procedures included one on whistle blowing as well as a more detailed one on abuse. Protection of Vulnerable Adults (POVA) was also addressed in the home’s induction training. Staff spoken with understood the importance of reporting malpractice and many had already done or were in the process of completing their NVQ level 2 training that included units on abuse. As a result of the acting manager reviewing staff training, she had booked 25 places on the Protection of Vulnerable Adult (POVA) training provided by Rochdale Social Services Department, between October 2006 and November 2007. Evidence of this was seen on inspection. Feedback from residents indicated they felt safe living at Meavy View. The home had not been involved in any Protection of Vulnerable Adult investigations over the past 12 months. 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 done and staff were not working unsupervised. Meavy View DS0000025484.V307132.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. A clean, safe, well maintained and comfortable environment was provided for residents and infection control practices were satisfactory. EVIDENCE: Information from the pre-inspection questionnaire showed that since the last inspection the entrance hall and ground floor corridors had been re-decorated and one of the empty bedrooms was in the process of being re-decorated. The owner had also recently bought 4 new beds and new carpets had 6 chairs, which were being put either in the lounges or residents bedrooms. All the residents spoken with were satisfied with their bedrooms and felt the home was kept clean and well maintained. There was evidence of them bringing in a number of personal possessions to make their rooms more homely. Feedback from questionnaires indicated the home was always fresh Meavy View DS0000025484.V307132.R01.S.doc Version 5.2 Page 22 and clean. Two people commented, “the home is kept clean” and “the home never has an unpleasant odour”. The home had implemented a food safety manual and hygiene folder, issued by the Environmental Health Officer to ensure good hygienic practices were ongoing. The Greater Manchester fire officer had not visited for some time but the fire system and appliances had been fully maintained. From walking around the home, it was seen to be clean and odour free except for one bedroom which smelled strongly of urine. Whilst the carpet had been regularly cleaned, the smell could not be eradicated and the owner should take prompt action to replace the carpet. On the day of the inspection, there were no cleaners present due to personal reasons. The staff were undertaking basic tasks to ensure cleanliness standards were maintained. Level access was provided throughout the home along with a passenger lift and handrails in corridors. In order to promote residents’ independence, grab rails, raised toilet seats and Scandia frames were provided in bathrooms and toilets. During the inspection, the lift became faulty and was taken out of use, but the lift engineers responded quickly and arrived at the home by lunchtime when it was repaired. To ensure residents safety, throughout this period those residents using their first/second floor rooms were asked to remain there and their lunch was served on trays. No one was unduly worried about this. The pre-inspection questionnaire indicated that infection control policies/procedures were in place. The manager and 12 staff had undertaken infection control training within the last 12 months and the remaining staff had done it previously. In order to try and prevent the spread of infection, liquid soap and paper towels were supplied in all bathrooms, toilets, bedrooms and laundry. There was a plentiful supply of disposable gloves and blue/white aprons. Staff were seen to wear the white aprons when assisting with personal care and blue ones at mealtimes. The staff spoken with were aware of how to minimise the risk of spreading infections and gave examples of how they did this e.g. washing of hands after assisting each resident with personal care tasks, carrying soiled items to the laundry in plastic bags. The laundry was situated in the basement and the washing machines had sluice programmes. Individual baskets were supplied for each residents clothes. One returned relative questionnaire commented “the laundry and cleaning are done regularly. Care is taken to ensure that laundry is returned to its owner”. Meavy View DS0000025484.V307132.R01.S.doc Version 5.2 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. There was a good match of trained staff who were recruited in line with the home’s policies/procedures but shortfalls were identified in providing sufficient staff on every shift to meet the needs of the individual residents. EVIDENCE: The ethnic mix of the staff team was good and the home had an equal opportunity policy in place that was adhered to when recruiting staff. The home had one male carer who was responsible for assisting the male residents with their baths. Prior to the inspection visit, the Commission for Social Care Inspection (CSCI) had received information that the home had been short staffed on occasions, as a result of a number of staff leaving, being unreliable and working at the other home situated across the road from Meavy View. This was checked out during the inspection and the concerns were substantiated. The rota for the week of the inspection, together with rotas for weeks commencing 28th August and 4th September were checked. Given the size of the home, the manager had always worked on a supernumerary basis and this was continuing. A care manager had been appointed to assist the acting manager and half of her hours were taken as “hands-on” hours as it was clear from the rota that for some of the time she was office based. The rota for the Meavy View DS0000025484.V307132.R01.S.doc Version 5.2 Page 24 week of the inspection showed a shortfall of 15 hours but the week commencing 4th September there were sufficient staff on duty. However, a significant shortfall of 60 hours was identified on the rota for week commencing 28th August 2006. The rota showed that on several occasions, staff who should have been working at the home had been working at Meavy House, the owners other home. In addition 3 day staff and 2 night staff were on holiday and some sickness was also recorded. On one night during this period, only 1 night care assistant had been on duty for 27 residents although a night staff from the sister home had been across to assist for a period of time. This was established from checking the staff pay roll. The home was considered to be operating at unsafe levels during this period and the owner must ensure that where staff shortages are identified, agency staff be provided. Feedback from residents spoken with and from returned questionnaires, confirmed that on occasions, the home were under staffed. One resident said “I sometimes have to wait a long time in the morning for the staff to come and attend to me”, another person said, “When you ring your buzzer staff don’t come quickly” and one person said “you sometimes have to wait for attention because they’re very understaffed”. The staff interviewed said that many of the residents presently living at the home had high dependency needs, with the majority needing assistance by two staff. A few residents needed the assistance of 3 staff. The acting manager and the owner must now review the staff rotas to ensure that residents needs, including their social and emotional needs, are fully met on both day and night shifts. Feedback from residents and relatives about the staff was generally positive and all felt they were well cared for except for sometimes having to wait for attention. The staff were also conscious of the fact they sometimes had to ask residents to wait for attention, due to having other more dependent people to care for and felt uncomfortable about this. The home had a training schedule and staff training matrix in place for 2006/7, and the acting manager had already identified which staff needed to renew or undertake mandatory training courses. Eight staff had done basic first aid in September, 12 had done infection control, 19 had done fire training and 15 attended moving/handling courses. Food hygiene training had been booked for 22 staff from October to January 2007. It was clear that the home were committed to providing the required training for the staff team. Copy certificates were in place in each of the files checked. Of the 21 care staff employed, 6 had successfully completed NVQ level 2 training and the care manager had done her NVQ level 3. In addition 8 care staff had almost completed their NVQ level 2 training with only approximately 4 weeks left of their course. When these staff have completed, the ratio of trained staff will be over the minimum 50 . Meavy View DS0000025484.V307132.R01.S.doc Version 5.2 Page 25 From checking staff files for the newer staff, it was seen that Skills for Care Induction training had not yet been introduced although one file contained a part completed induction course (TOPSS) and another contained the home’s own induction training record sheet. One of the more recently recruited staff was spoken with and she confirmed that whilst she had not commenced her Skills for Care training, she had almost completed her NVQ level 2 training. All staff are required to undertake the Skills for Care training although where staff have completed their NVQ training, induction records can be cross referenced accordingly. All staff should undertake the sections relating to the home’s policies/procedures, aims/objectives and care practices. The acting manager said she would address this in future induction training. The Skills for Care training should be completed within 12 weeks rather than the present 6 months. Policies and procedures were in place for the recruitment and selection of staff. Three staff files were inspected, for the three most recently recruited staff. Two files contained 2 written references and 1 contained a written reference and a verbal one which had been recorded. The administrator said they had repeatedly asked for a written reference but it had not been forthcoming. In future, an alternative second reference should be requested from the employee. In addition application and health declaration forms, Criminal Record Bureau checks and/or Pova First checks were in place. Copies of the General Social Care Council “Code of Practice” were given to new staff as part of their induction process. Contracts were issued within the required timescale and staff confirmed they had received them. Meavy View DS0000025484.V307132.R01.S.doc Version 5.2 Page 26 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The staff received good guidance and direction, thus ensuring residents received safe and consistent care but systems in place for measuring the quality of the service were in need of improvement. EVIDENCE: Since the last inspection, the registered manager had, for personal reasons, had to take a significant amount of time off work and as a result, there had been some slippages in certain areas. It had been established that she would not be returning to work in the near future, so the owner had recruited an acting manager to take over the running of the home until such time as the registered manager had either returned or given notice. The acting manager had previous management experience, had successfully completed her NVQ level 4 in care and had almost completed the Registered Managers Award. Meavy View DS0000025484.V307132.R01.S.doc Version 5.2 Page 27 She had only been employed at the home for approximately 4 weeks but had already identified management issues that needed addressing. Care plans and risk assessments had been reviewed and updated, resident reviews had been arranged with relatives, staff meetings had re-commenced and a resident/relative meeting had been arranged. In addition, many of the staff had received supervision, staff appraisals were being done, training courses had been booked and staff were getting good support. Due to the registered manager’s absences from the home, quality assurance systems had deteriorated. However Quality assurance questionnaires had recently been circulated to residents, relatives and professional visitors to the home and a copy of the outcome of the survey had been sent to the CSCI. Team meetings, supervisions and appraisals had recommenced and a resident meeting had been arranged. If the acting manager continues with these endeavours, the home will have a good quality assurance and monitoring system in place. Staff feedback was very positive about the acting manager. Staff said she was supportive, that you could go to her with any problems and that she had made the care plans and risk assessments much clearer. They felt she gave them good guidance and promoted good care practice. Policies/procedures were in place in respect of the handling of residents’ finances. There was a part-time administrator employed, who worked for both homes owned by the provider. The home did not act as appointee for any residents. In the main relatives or solicitors assisted residents in the management of their finances. Some relatives chose to leave small amounts of money in the home’s safekeeping and there was an effective system in place whereby income and outgoings were recorded and receipts for purchases retained. The money and records for 3 residents was checked and found to be in order. Secure facilities were provided for the safekeeping of money and valuables on behalf of residents. Information recorded on the pre-inspection questionnaire showed that all required maintenance and health and safety checks were up to date and that health and safety policies/procedures were in place. The Inspector random sampled three maintenance records for the lifts and hoists, the gas installation and the testing of small electrical appliances. The first two were in order but documentation relating to the testing of small appliances could not be found. The manager said she would check this with the owner on his return from holiday and arrange for the documentation to be faxed to the CSCI office. All except the most recently appointed staff had received their mandatory health and safety training and those who had not had been booked on relevant training courses. Meavy View DS0000025484.V307132.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Meavy View DS0000025484.V307132.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 Requirement Timescale for action 01/10/06 2. OP12 16 Medication administration sheets must be signed or the code letter inserted if medication is not given, nutritional supplements must be recorded when given, handwritten MAR must be countersigned and Lactulose and Movicol must be administered from residents’ own supplies. The activity programme must be 31/10/06 implemented and address the needs of groups and individuals of differing abilities. (Previous timescales of 30/11/05 & 10/03/06 not met). Staffing levels within the home must be reviewed and increased to ensure that residents’ needs are fully met. Two written references must be obtained before a worker commences work. All new staff must undertake Skills for Care induction training within the first 12 weeks of employment. (Timescale of 31/12/05 not met). DS0000025484.V307132.R01.S.doc 3. OP27 18 31/10/06 4. 4. OP29 OP30 19 18 31/10/06 31/10/06 Meavy View Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP3 OP7 OP7 OP12 Good Practice Recommendations Pre-admission assessments should be dated and signed. Care plans should contain specific details in relation to catheter care. Cardex recordings should show when residents have refused to carry out exercises prescribed by the physiotherapist. In order to ensure that stimulating activities are offered daily, a staff member should be designated who will be responsible for making sure the programme is followed. A diary or daily record should be re-introduced showing which residents have taken part in the planned activity and where residents have identified an activity they would like to do e.g. bingo, it should be implemented. All concerns should be logged in the complaints book. The bedroom carpet, identified during the inspection should be replaced due to the malodour in the room. Documentation relating to the small electrical appliances should be faxed to the CSCI office. 5. OP12 4. 5. 5. OP16 OP19 OP38 Meavy View DS0000025484.V307132.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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