CARE HOMES FOR OLDER PEOPLE
Meresworth Dell Wood Field Way Rickmansworth Hertfordshire WD3 7EJ Lead Inspector
Patricia Rogan Unannounced Inspection 29th June 2007 14:00 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 Meresworth DS0000019465.V344785.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.V344785.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.V344785.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th September 2006 Brief Description of the Service: Meresworth is a purpose built care home and was registered in 1996 to provide single bedded en-suite accommodation for up to 51 older people, including people with dementia and or physical disability. Located in the suburb of Rickmansworth, it is easily accessed by local buses from Watford and Uxbridge. The home is a short drive from the M25 motorway and is also near to the Metropolitan line station. Parking is available outside the home. The home is divided into four units. Each unit has a lounge and additional seating areas; a dining room; a fully fitted kitchenette; a medication storage station; an assisted bathroom and an assisted shower room. The home has a hairdressing salon and a large activities room; a fully equipped kitchen for the preparation of all main meals and an on site laundry. A sun lounge leads to a courtyard garden with patio and seating areas. The gardens extend around all sides of the home except for the front of the building and are screened by mature trees. At the date of this inspection, the weekly fees range from £408 to £650 per week and further information about these can be obtained by contacting the home. Services such as hairdressing and chiropody are not included in these fees. The service user guide and a copy of the most recently published inspection report can be obtained by contacting the home. Meresworth DS0000019465.V344785.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection of all the key standards included information provided by the service provider and the home manager since the previous inspection. Additional information was gathered from questionnaires and face to face interviews with a random selection of people who use the service and from family members and health and social care professionals. A site visit took place in the afternoon and early evening when people who use the service and members of staff were asked for their views. Staff records and other documents were examined. Information written in care plans and risk assessments was compared with the way in which care which was being provided. Where there has been no change since the previous inspection, this information has been carried forward from that report. Many people living in Meresworth said they preferred to be referred to as residents rather than service users and therefore, where appropriate, this is the term is used. What the service does well: What has improved since the last inspection?
The manager has responded to the following suggestions from the previous inspection: Meresworth DS0000019465.V344785.R01.S.doc Version 5.2 Page 6 A key worker system has improved sharing information about changes to the care needs of people who use the service. Care Team Managers in each unit audit medication and storage to ensure there are no errors. Environmental noise is more closely monitored to ensure that the volume is at a comfortable level. The lighting level in the ground floor seating levels has been improved. The manager has been completing a project on the importance of communication and recording and is What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Meresworth DS0000019465.V344785.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.V344785.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. (Standard 6 is not applicable to this service) Quality in this outcome area is good. This judgement has been made using available evidence including a visit 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. EVIDENCE: The written assessments of the most recent admissions to included sufficient information to ensure that the prospective residents needs could be met. The assessments had been signed by the assessor and the prospective resident or representative. Prospective residents are invited to bring a friend or family with them to view the home and meet with people already using the service and with staff. One person said, When we went to view Meresworth, right from the moment we were met by the reception staff, everyone was very nice and we both knew it was the right place.
Meresworth DS0000019465.V344785.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are individualised and in detail. Effective systems are in place to access health care professionals and to respond to advice given. Medication administration is audited to ensure procedures are followed. People who use the service said they were treated with respect and good practice was seen during the site visit. EVIDENCE: Care plans were written when the person moved into the home and included information from the initial assessment. Residents and families said they had been involved in care plan reviews. Health and social care professionals said the manager and staff would act on any advice they were given regarding the health of a resident. Families said they were kept informed of any changes. A senior member of staff on each unit audits the medication administration every month. Good practice was seen throughout the visit and several residents said that staff were respectful towards them. People with dementia were being assisted courteously in an unhurried manner.
Meresworth DS0000019465.V344785.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use this service have many choices and opportunities to enjoy a lifestyle, which provides interest and stimulation. Contact with families, friends and the wider community is always encouraged. Meals are nutritious and seasonal, with choices available and they are served in clean, pleasantly furnished dining rooms. EVIDENCE: People who use the service have a very varied programme of activities throughout the year. One resident said, I do more things here than I ever did at home. Families are very supportive and often attend events in the home and also help with fundraising for outings and leisure activities. Involvement by voluntary groups also helps to make the residents lives interesting and varied. These include an active Friends of Meresworth group and the Ancient Order of Foresters and the Womens Guild. Members of staff sometimes attend the home in their off duty hours to join residents in birthday celebrations and other events. Meresworth DS0000019465.V344785.R01.S.doc Version 5.2 Page 11 People who use the service are helped to meet their cultural and spiritual needs. Non-denominational religious services are held regularly and representatives of different faiths also visit people in the home. An informative and easy to read newsletter is produced on a regular basis and has news about residents and about future events. There were numerous compliments about this newsletter. Many people commented about the home cooked food and the tasty meals. The menu is planned to offer a variety of well-balanced meals, which are seasonal, and freshly prepared and special diets are catered for. The dining rooms in each unit have tables which seat four people and this is encourages conversation between residents. During the inspection, a meal was served and a member of staff was helping a resident to eat her food. The member of staff sat alongside the resident and was offering each spoonful of food without rushing the resident and was chatting quietly with the resident as she did so. At the previous inspection and during this inspection, the dining tables had been set ready for the next meal and the closed door implied the room was not available outside meal times. People with dementia, who did not have full awareness of the time of day may be given the impression that a meal is due to be served when the table is set. The manager said this is not a regular occurrence and is again going to tell staff that this should not happen and that tables should not be set too early. The manager is also going to remind staff that people who use the service should be supported in making use of the dining rooms at other times as might happen in a domestic setting. Meresworth DS0000019465.V344785.R01.S.doc Version 5.2 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service and their families said they are confident any concern they have will be investigated. The organisations robust policies and procedures are followed to protect people who use this service. EVIDENCE: A record is kept of concerns that have been raised and how the concern is resolved is also recorded. Since the last inspection a more serious issue was raised. The manager responded promptly and in the correct manner, informing all relevant people and organisations. This is evidence that the manager regards the protection of the residents as paramount and works in an open and transparent manner. All residents have access to an advocate who visits the home every month. This means that any resident who wishes to speak privately to an independent person can do so. The advocate supports residents to express any concern or could attend reviews if the residents wish. Meresworth DS0000019465.V344785.R01.S.doc Version 5.2 Page 13 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, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The interior and exterior of the premises is maintained to a very high standard. Staff should be more pro-active by helping less able residents to personalise their bedrooms. The atmosphere in the home is welcoming and it is clean and hygienic throughout. EVIDENCE: The home has a pleasant atmosphere, which further is enhanced by the friendliness of the staff. One resident and the family who were visiting said, Add the niceness of the staff to the way the place is looked after and Meresworth is really good. The lighting in the ground floor corridors and seating areas has been improved and this is better for the residents who have memory impairment and for people with poor vision or poor mobility.
Meresworth DS0000019465.V344785.R01.S.doc Version 5.2 Page 14 The staff said the majority of bedrooms are personalised and individualised. An exception to this was seen during a meeting with one resident. The bedroom was clean and furnished but very bare. A member of staff said that nothing was brought in. Staff should understand the beneficial effect of personalising bedrooms and recognise that some people may need assistance to do this. There was copious social information recorded in the residents file and staff could have used this to create a bedroom which reflected interests and personal history. This has been discussed with the manager who is going to ensure that all residents have a room that is personalised according to their wishes and that when residents are unable to do this for themselves, staff will help. The gardens are very attractive and provide a relaxing and interesting place for residents to sit outside. Several residents said how much they liked the gardens and one person remarked, Even when the weather is bad, the gardens are lovely to look at from my room or from the sun lounge. Meresworth DS0000019465.V344785.R01.S.doc Version 5.2 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are good and the skill mix is appropriate for this service. Recruitment and vetting procedures are robust. The training programme is wide-ranging and appropriate to the role of each member of staff. EVIDENCE: A competent senior team oversees the practice of the staff in the home. Many members of staff have worked in Meresworth for many years, providing a core staff team, supporting new recruits and continuing the ethos of the home. Induction into the way the care is provided is mandatory and a more experienced member of staff will work alongside a new member of the team until that person is considered to be competent to work alone. The recruitment procedures are closely followed and a member of the organisational management also audits staff files periodically. Staff have varied training to ensure skills are up to date and reflect the needs of the residents. Many members of staff are either studying for, or have gained, their NVQ at level 2, 3 or 4 which shows commitment to training.
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The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The manager is trained and experienced and has the welfare of the residents as the core focus of her role. Financial procedures are scrupulously managed. Residents and staff are protected by strict policies and procedures. EVIDENCE: The manager is committed to ensuring the home is well run and has the skills to maintain the good reputation of the home. She appreciates her hardworking and enthusiastic team of staff and welcomes the input from families and volunteers to help Meresworth residents feel cared for. Feedback from residents, families, staff and professionals who know the service was very positive. The manager does a great job, was a comment from a resident. A member of staff said, The manager is there for us all.
Meresworth DS0000019465.V344785.R01.S.doc Version 5.2 Page 17 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 4 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x 2 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 4 x 4 x x 4 Meresworth DS0000019465.V344785.R01.S.doc Version 5.2 Page 18 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. Standard Regulation Requirement Timescale for action 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 OP19 Good Practice Recommendations Staff should be proactive in ensuring that each resident and family has the help needed to make the residents room more personalised, reflecting individual lifestyle and interests. Meresworth DS0000019465.V344785.R01.S.doc Version 5.2 Page 19 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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
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