CARE HOMES FOR OLDER PEOPLE
Meresworth Dell Wood Field Way Rickmansworth Hertfordshire WD3 7EJ Lead Inspector
Patricia Rogan Unannounced Inspection 20th September 2006 10:30 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 Meresworth DS0000019465.V312933.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. Meresworth DS0000019465.V312933.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Meresworth Address Dell Wood Field Way Rickmansworth Hertfordshire WD3 7EJ 01923 714300 02923 714351 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) www.quantumcare.co.uk Quantum Care Limited Mrs Teresa Ann Giddings Care Home 51 Category(ies) of Dementia - over 65 years of age (51), Old age, registration, with number not falling within any other category (51), of places Physical disability over 65 years of age (51) Meresworth DS0000019465.V312933.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 24th November 2005 Brief Description of the Service: Purpose built in 1998, Meresworth is a modern design, two-storey building with a ground floor and first floor wing either side of the main entrance. Accommodation is offered in four units, providing for 51 elderly people requiring long stay residential care. All rooms are single with en-suite facility. Each unit has a lounge and a dining area; these are located in the centre of each unit off a large lobby area. There is also a fully fitted kitchenette and medication storage station in this central location on each unit. Other facilities available to service users include a ground floor sunroom, first floor hairdressing salon and activities room. Each unit has an assisted bathroom and assisted shower room. The home has a fully stainless steel equipped kitchen with appropriate storage rooms, cold storage equipment and a well-equipped laundry. The reception desk and administration office is by the main entrance. The gardens extend around all sides of the home except for the front of the building and are screened from the road and other residences by mature trees. There are pleasant patio areas where service users can sit out. Meresworth DS0000019465.V312933.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Two inspectors were present for the unannounced inspection of the home and this allowed opportunity to speak with many of the residents, staff and visitors to the home. Time was spent observing the care provision and inspecting care plans and other records. A random selection of families, friends and professionals who are involved with the residents in Meresworth were also contacted and asked for their views. Some relatives preferred to give verbal feedback and a meeting took place 4th October which then concluded the inspection. This was an inspection of the all the key standards and the overall quality of this service is good. What the service does well: What has improved since the last inspection?
The manager has responded to the requirements made at the previous inspection report and she and her senior team have worked hard with all staff to resolve issues raised. Care plan recording has been improved and dementia care mapping is being used to try to ensure every residents plan is as individual as possible, although further work is needed. There were no complaints about the food and a choice is offered, the food is sampled each day by a member of staff to ensure it is tasty and at a suitable temperature. The manager has addressed the requirement that all staff have a CRB clearance before commencing employment and she is liasing with the head office to monitor work permits to ensure they are in date. At the start of the inspection, a tour was made of the premises and all call bells were within reach of those residents who were in their rooms and no door wedges were being used. Staff take responsibility for ensuring a resident is wearing appropriate
Meresworth DS0000019465.V312933.R01.S.doc Version 5.2 Page 6 footwear and if a resident has a fall, this is recorded and events immediately prior to the fall, including the sort of footwear which is being worn is noted to discover whether there is a contributing factor. There is a varied activities programme and the manager is developing a more individualised programme of stimulation for those residents with memory impairment. The fire service have been involved in ensuring the homes fire safety action plan meets regulation. On the day of the inspection, no equipment was seen to obstruct access for residents and staff. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Meresworth DS0000019465.V312933.R01.S.doc Version 5.2 Page 7 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 Meresworth DS0000019465.V312933.R01.S.doc Version 5.2 Page 8 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 (Standard 6 is not applicable to this service) Assessments are carried out prior to a resident moving into the home and the resident, family members and other professionals are consulted to ensure needs can be met. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The pre-admission assessments for the last four residents who were admitted to Meresworth were inspected and the residents were asked about their experience of the admission and assessment process. Feedback was positive and the assessment forms showed that there had been consultation between the assessor, the prospective resident and the family members. Three of the residents had viewed the home prior to moving in. One resident had a marked memory impairment and the decision had been made that the family would view the home on behalf of the resident, to avoid needless distress and this shows that sensitivity was used by all concerned. Meresworth DS0000019465.V312933.R01.S.doc Version 5.2 Page 9 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 and 10. Care plans identified how individual needs will be met. Individualised risk assessments were in place. Health records were up to date. Medication recording was adequate but medication disposal needs monitoring. Dignity, respect and privacy is taken seriously. The quality outcome for this area is adequate. This judgement has been made using all available evidence including a visit to this service. EVIDENCE: There has been a marked improvement in the way that care plans are completed and include health, mobility, and what the resident needs assistance with. Each resident has a moving and handling assessment and a risk assessment. The manager has implemented in depth audit of all falls which has proved to be effective in trying to reduce the number of falls. Medication administration was observed and was correct, however refrigerated eyedrops were out of date but had not been disposed of. The manager was advised of this and she has arranged to speak with the staff who administered the last prescribed dose and therefore a requirement will not be made. Meresworth DS0000019465.V312933.R01.S.doc Version 5.2 Page 10 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 and 15. The majority of the residents expressed satisfaction with their life in Meresworth and most enjoyed the activities which were available. There is dementia care training to enhance the experience of those residents with dementia Family contact and community involvement is encouraged. The menu is varied and well balanced and the temperature of served food is checked every meal. The vacuum cleaner was being used by the dining room while the meal was being eaten and this can be distracting for residents. The quality in this outcome group is adequate. This judgement has been made using all available evidence including a visit to this service. EVIDENCE: Some residents were sitting together with an activities co-ordinator and were clearly enjoying the various hobbies that they were pursuing. In the TV lounge, one or two residents who expressed less satisfaction had their interests written in the care plan. However, there did not appear to be a programme to ensure staff incorporated these interests into daily life for the resident. Feedback from visitors to the home was positive and the friendly atmosphere was remarked upon.The dining rooms were pleasant, clean and bright. The tables were set very early for lunch and the door was closed to the residents. This was against the advice of the manager who wants residents to be free to walk around or sit at the dining table as they might in their own home. Small bowls of snacks are available all day.
Meresworth DS0000019465.V312933.R01.S.doc Version 5.2 Page 11 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 and 18 There is a complaints procedure and residents and relatives are assured that their complaints will be investigated. Residents legal rights are protected. There is a comprehensive policy in place to protect residents from abuse and this includes a whistleblowing policy. The quality in this outcome group is good. This judgement has been made using all available evidence including a visit to this service. EVIDENCE: Several residents said they felt confident about making a complaint. The family of a resident with dementia said they once had cause to complain and felt the investigation was thorough and promptly dealt with. Recording is transparent and relevant information is forwarded to those concerned. Residents or their representatives manage their own legal affairs and for those residents who are unable to do this, the local authority or an advocacy service is made available to them. Residents are enabled to use their electoral vote if they wish. The manager has responded promptly and appropriately when there has been practice which has had a potentially detrimental effect upon residents. All staff have training in abuse awareness and are told of their responsibility to protect the residents by reporting poor practice. Meresworth DS0000019465.V312933.R01.S.doc Version 5.2 Page 12 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 and 26 The interior and exterior environment was clean, pleasant and well maintained. Ground floor seating areas had low level lighting. Sound from both radio and TV distracted some residents. Procedures are in place for auditing the health and safety of the interior and exterior of the home. The quality in this outcome group is good. This judgement has been made using all available evidence including a visit to this service. EVIDENCE: The inspectors made a tour of Meresworth and all areas were clean and in good decorative order. The home was bright and well lit, with the exception of lower lighting levels in the ground floor seating areas where the corridors intersect. In one ground floor unit, the radio was on immediately outside the door of the lounge where the TV was on. Two residents said they tried to sleep as they couldnt concentrate. The vacuum was being used outside the dining room at lunchtime. The handyman undertakes ongoing repairs as they occur to ensure the safety of the residents. Records showed that fire safety protocols are in place and there are lines of responsibility for ensuring safety checks and procedures are carried out.
Meresworth DS0000019465.V312933.R01.S.doc Version 5.2 Page 13 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 and 30 Staffing levels were adequate and the skill mix of staff are suitable to meet the needs of the residents. There is a training programme for all staff to ensure the safety of the residents. Recruitment policy and procedures are in place, however some staffs work permits or visas were nearing the expiry date. There is an induction and training programme for all staff, to maintain competency in their post. Dementia training is planned for all staff. The quality in this outcome group is good . This judgement has been made using all available evidence including a visit to this service. EVIDENCE: Staff rotas for the previous four weeks showed an adequate number of staff on duty but this must be reassessed in order to ensure more individualised person centred care. Residents were relaxed and comfortable with the staff during the inspection. Staff are supervised to ensure they feel supported and to discuss their training needs. The induction programme is clearly defined and new members of staff do not work alone until more senior staff agree they are competent to do so. The manager liaises with personnel at head office to ensure CRB checks have been made before employment and to record when work permits are about to expire. A check of some copy passports and visas showed some were about to expire. Dementia care training and dementia care mapping is being developed so that the staff will become competent in the most effective and supportive ways of assisting people with dementia. Meresworth DS0000019465.V312933.R01.S.doc Version 5.2 Page 14 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 and 38 The home is well run and managed in the best interests of the residents. The residents financial interests are safeguarded. There are policies and procedures in place to protect the health, safety and welfare of the staff. The quality in this outcome group is good. This judgement has been made using all available evidence including a visit to this service. EVIDENCE: It was evident that the manager has worked hard to resolve the issues which arose from the previous inspection. She has the support of her senior team to ensure good practice continues throughout the home. It would appear that staff have the confidence to report any concerns they have, knowing that response will be fair and appropriate. Relatives and visiting professionals described the manager as approachable and willing to listen. The manager and her deputy have a good knowledge of quality dementia care and the manager is keen to have every member of staff putting into practice what they have learned so that every resident can be safely and appropriately supported.
Meresworth DS0000019465.V312933.R01.S.doc Version 5.2 Page 15 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 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Meresworth DS0000019465.V312933.R01.S.doc Version 5.2 Page 16 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP27 Regulation 18 Requirement Timescale for action 15/11/06 2 OP29 18 Staffing arrangements must be reviewed to ensure sufficient staff are available to meet the assessed needs of the residents. Work permits, visas and other 15/11/06 legislative documents must be monitored to ensure staff are eligible to remain in post in order to provide continuity of care for the residents. 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 Refer to Standard OP19 OP19 Good Practice Recommendations Audits of the sound levels in the dining and seating areas throughout the day would ensure residents are able to choose what they want to listen to. It would be advisable to seek specialist guidance about the most suitable lighting for people with dementia and for those in older age whos eyesight may have deteriorated. Meresworth DS0000019465.V312933.R01.S.doc Version 5.2 Page 17 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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