Inspection on 01/05/07 for Mid Meadows Care Home

This inspection was carried out on 1st May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mid Meadows Care Home 11/05/09

Mid Meadows Care Home 23/04/08

Mid Meadows Care Home 03/05/06

Mid Meadows Care Home 10/10/05

Mid Meadows Care Home 21/05/05

Mid Meadows Care Home 03/02/05

Mid Meadows Care Home 27/05/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Mid Meadows 72/74 Elm Tree Avenue Frinton On Sea Essex CO13 0AS Lead Inspector Kathryn Moss Unannounced Inspection 1st May 2007 10:00 Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 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 Mid Meadows DS0000017885.V339003.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 Adults 18-65. 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. Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mid Meadows Address 72/74 Elm Tree Avenue Frinton On Sea Essex CO13 0AS 01255 675085 F/P 01255 675085 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) Black Swan International Limited Mrs Violet Ruth Ann Smith Care Home 17 Category(ies) of Physical disability (17), Physical disability over registration, with number 65 years of age (17) of places Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Persons of either sex, under the age of 65 years, who require care by reason of a physical disability (not to exceed 17 persons) Persons of either sex, aged 65 years and over, who require care by reason of a physical disability (not to exceed 17 persons) The total number of service users accommodated must not exceed 17 persons The 3 bedrooms on the first floor of Mid Meadows may only be offered to service users who are able to access them independently via the stairs 6th December 2006 Date of last inspection Brief Description of the Service: Mid Meadows is a detached two-storey property on the outskirts of Frinton-onSea. The home provides a service for 17 physically disabled people aged 1865. There are 14 bedrooms on the ground floor, 3 of which are used for respite care, and 3 bedrooms on the first floor that are used by service users who can access stairs independently. These rooms are to enable individuals to test skills of independence prior to moving into the community. The ground floor communal rooms comprise a dining room, a computer room, a quiet lounge and a lounge where smoking is currently permitted. At the rear of the house there is a fully enclosed garden and to the front of the property there is ample off road parking. A copy of the most recent report by Commission for Social Care Inspection is displayed on the notice board and a copy of the home’s service user guide is present in service users’ rooms. Information from the registered provider received by the commission in May 2007 showed that the fees payable ranged from £567 to £730 per week, with additional charges for items such as Chiropodist, Hairdresser and daily papers. Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place over two days (1st and 2nd May 2007), lasting nine hours. The inspection process included: • • • • • • Discussion with manager and deputy manager Inspection of communal areas and two rooms Inspection of a sample of records and policies Conversations with two staff Conversations with four residents Feedback questionnaires from two residents This report also draws on any other information relating to the home received by the CSCI since the last inspection (e.g. notifications from the home, complaints, quality of care reports, reports of visits by the responsible individual, etc.), and on outcomes from a random inspection visit to the home that took place on 6.12.06. 29 Standards were covered on this inspection, with 5 requirements and 7 good practice recommendations made. Residents spoken to continued to be positive about living at Mid Meadows. What the service does well: Several residents spoken to considered that one of the good things about the home was that it was friendly and homely, and they liked its relaxed and informal atmosphere. They got on well with the staff and manager, reporting that they were helpful, approachable and supportive. It was good to hear that the directors of the organisation also have regular contact with the home, and are accessible to residents when they visit. Residents are able to bring their own possessions into the home with them, and to pursue their own interests. This is particularly evident in residents’ rooms, which are equipped with a wide variety of personal technology (computers, TVs, etc.). Rooms are well personalised, and staff clearly encourage and promote individual choices in relation to this. It was good to see that the home has systems in place to enable residents to have a say in the way the home is run. Consultation taking place was both informal (in terms of day-to-day discussions and choices) and formal (in terms of residents’ meetings), and both manager and owners appear willing to listen to residents and to act on their suggestions. Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available to enable prospective residents to make an informed choice about the home, and the home’s admission process ensures that it can meet prospective residents’ needs before they make a decision to move in. EVIDENCE: The home has a Statement of Purpose and a Service User Guide. The Service User Guide was available in the office and is provided to residents, and contains appropriate information about the home. The office copy had not been amended since the current manager was registered, and the manager was advised to ensure this is done. The service only had six residents at the time of this inspection, and there had been no new residents admitted since the last inspection. Although the home regularly admits people for respite stays, there were none visiting the home at the time of this inspection: the manager confirmed that most people who attend for respite stays are already known to the home (therefore new assessments are not required before each admission). Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 9 Although evidence of the pre-admission assessment process could therefore not be reviewed on this occasion, staff spoken to confirmed that new residents may be referred by social services, in which case care managers provide the home with pre-admission information; all new people are encouraged to visit the home first, when the staff carry out their own assessment of the person’s needs. People looking to move into the home on a permanent basis (i.e. not just for a respite stay) are encouraged to visit for a short stay, or for several visits over a period of time, to ensure that they can make an informed choice and that they are confidant the home can meet their needs. Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual plans reflect residents’ assessed needs, so residents can be sure that staff know what support they need. Practices in the home promote individual choice and residents’ participation in the daily life of the home. Residents are supported to take risks, but documentation does not demonstrate sufficient staff understanding of the risk assessment process to ensure residents’ safety. EVIDENCE: Service user plans were present on all residents’ files inspected during this visit. Service user plans consisted of a printed double page form, with standard categories of need/goals and details recorded alongside each to describe the support required from staff to help the person meet their need or achieve the goal. Although these plans were clear, details of the support required to be given by staff was very brief. Whilst it is noted that current Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 11 residents are able to advise staff of their needs, likes and wishes, the home should develop care plans that provide fuller detail of the support being provided. This is particularly important in the case of healthcare needs: for example, it was some residents suffered with epilepsy, but although one care file viewed contained a chart for recording any incidence of epileptic fits, this issue was not adequately covered in risk assessments and care plans, which need to show clear details of the type and frequency of the epilepsy, and the action required by staff in the event of the person suffering a fit. There was evidence that care plans were regularly reviewed: however, review notes described specific events that had occurred since the last review (e.g. issues that should have been detailed in daily records), but did not show whether the support detailed in the care plans had been reviewed and still met the person’s current needs (or that needs had not changed). Daily notes were well maintained and provided an appropriate and relevant record. Residents spoken to were clear that they made decisions about their daily lives and spent their time as they wanted. Where able to, they could come and go from the home as they wished, and were just asked to let staff know if they went out. All were able to make their own decisions, and were encouraged to do so. One person chose to deal with their own care and meals, and another chose to eat out regularly; this was respected by staff. From discussion during the inspection it was clear that the staff only considered imposing limitations on choice if they felt a person’s choices could put them at risk. The home has regular residents meetings, that are chaired by one of the directors and minuted. One of the residents nominated as a representative at staff meetings, and the residents had recently voted on a new representative. Evidence of residents being consulted on day-to-day issues was observed during the inspection (e.g. ideas for food shopping list, decision to get a takeaway one evening, etc.). Risk taking by residents was supported, and measures put in place to address risks (e.g. when going out of the home unaccompanied, if residents chose to lock their door when in their rooms, etc.). However, risks were not adequately documented on personal files; this had also been identified at previous inspections. The home has a general risk assessment form covering a series of set categories of risks, with tick boxes to identify if there is a risk: however, this form contains minimal space for analysing a risk, or detailing the action to minimise a risk. The manager stated that they would complete a separate assessment if a specific risk was identified, but no specific risk assessment form was available for recording this. The manager provided examples of two specific ‘risk assessments’, one relating to an individual issue and the other relating to a holiday: however, although these provided a good factual summary of the situation and/or general information relating to the issue, neither constituted a structured risk assessment. This demonstrates an insufficient understanding of the risk assessment process. Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, and 17 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home generally supports residents to engage in daily routines, activities and lifestyles of their choice, respecting individual wishes in relation to their daily lives. Residents’ health is maintained through the provision of a satisfactory diet, and the enjoyment of meals is promoted through the variety and choice of food. EVIDENCE: No one living at the home is currently doing any paid or voluntary work, or any college courses. However, this appeared to be a matter of choice, and it was noted that residents had attended college courses in the past, and that staff will obtain information on options available if required. One person was expressing an interest in exploring work or training opportunities, and the manager confirmed that staff would be willing to offer support with this. Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 13 Residents can access the local community, using local shops, pubs, etc.; it was good to note one person using a local taxi to attend church each week. Many residents require the use of a wheelchair outside of the home, which makes some forms of public transport more difficult to access (e.g. the home had booked a taxi to take two people shopping, but the taxi had not been able to take an electric wheelchair, limiting one person’s independence). Several residents commented on the lack of a suitable vehicle at the home over the last year: they were without a minibus last summer, and although a replacement bus was obtained later in 2006, this only accommodates one wheelchair space and is not suitable for some electric wheelchairs. The staff can access alternative transport (e.g. booking a minibus from a sister home, and supporting residents to use taxis and trains): however, this means that impromptu trips and outings are less easy to accommodate. Staff are encouraged to continue to actively offer residents an escort on public transport or to book alternative vehicles, and to promote and enable opportunities for trips, shopping, attendance at college courses, etc. Currently there are three staff on duty in the morning (when one carer is usually responsible for cooking a main meal), and two staff on duty in the afternoons. When there are only two staff available in the home this can limit opportunities for staff to accompany someone outside of the home, as it would only leave one carer with the remaining residents. However, residents spoken to on this inspection to did not appear to feel this was limiting their opportunities. The manager confirmed that they are able to provide flexible staffing if they know in advance that someone needs staff support to go out, and that the maintenance person also drives the minibus and escort residents. The manager should continue to ensure that staffing levels allow for regular times when staff can take residents out. The home currently accommodates a wide age range (27 to 68). Staff spoken to showed a good understanding of individual needs and interests, and daily routines were seen to be flexible and enabled people to pursue their own interests. Rooms seen were individually and well personalised: it was good to see people choosing their décor, and being provided with suitable facilities (e.g. furniture, electric sockets, etc.) to enable them to use their own computers and TVs. One person was particularly pleased that they had been able to develop their room into an ‘entertainment centre’! The home has suitable facilities for leisure activities (e.g. a computer with internet access in one of the lounges, a TV with Freeview, smoking facilities, garden area, etc.). Staff respected residents’ privacy and individuality, enabling them to have keys to their rooms, not opening their post, and respecting their wishes and choices. Leisure activities at the home included occasional quiz nights and social events with their sister home (e.g. they had had a ‘Grease’ party for Valentine’s night). Whilst no one appeared to have any specific regular activities, most residents generally appeared content to do their own thing. However, one Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 14 person reported that they would like to go out more and appeared to spend a lot of their time watching TV and listening to music: where individuals would benefit from a more structured and purposeful programme of activities, the home should ensure this is identified and addressed. Opportunities for carrying out independent living skills in the home are limited: for example, most residents cannot access the washing machine as this is upstairs, and the kitchen is not adapted for wheelchairs. However, facilities for making drinks are available to residents, and it was good to see one person now being regularly taken to a launderette to enable them to assist with their laundry, and being provided with storage space that they could independently access. Residents were able to have family and friends visit them at the home, and some are supported to go and visit friends or family. There are links with a local sister home, with some joint social events organised. The home operates a key worker system, with residents consulted on who their key worker is. Staff were seen spending time in communal areas with residents. At the random inspection visit in December 2006 it was noted that the home no longer employed a cook, and that care staff now do the cooking as part of their duties. Residents spoken to were generally positive about the meals provided, and felt that care staff had the skills to produce good meals. Some new staff had not yet completed food hygiene training, and the manager should ensure that they complete this before being involved with meal preparation in the home. Although there are set weekly menus in the home, one resident was clear that if they did not fancy something they would be offered something different; another reported that meals were discussed in residents’ meetings. During the inspection the manager was observed seeking residents’ ideas and suggestions for items for the weekly shopping list, and a group decision was made to have a take-away rather than the planned meal for that day. Records of meals showed an appropriate range of main meals and vegetables being served. Two residents generally catered for themselves, with one going out for meals and the other cooking for themselves in their room, where a small kitchen area was provided. It was good to see the home supporting these individual choices. Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive personal support in a way that meets their requirements and preferences. However, a lack of moving and handling risk assessments puts staff and residents at potential risk. Physical and mental health needs are well supported. Medication practices do not satisfactorily protect residents. EVIDENCE: Residents’ care plans and daily records showed the general support they needed from staff to meet personal and healthcare needs. Residents spoken to were positive about the support they received from staff, reporting that this was provided in an appropriate manner and that daily routines were flexible in relation to personal support (e.g. getting up, going to bed, etc.). Residents’ choice in clothing, hair and appearance was encouraged, and where one person wished to be independent with their personal care, this was respected by staff. Staff were observed to give one person good encouragement and support with their mobility. However, there were no detailed written moving and handling risk assessments present on files to demonstrate that risks had Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 16 been assessed and appropriate support practices implemented in line with moving and handling legislation; the manager stated that the home did not have a specific moving and handling risk assessment form. A lack of adequate moving and handling risk assessments could put staff and residents at risk, and must be addressed. The home operates a key worker system. The manager stated that residents are consulted on who they would like as key worker, and that this is reviewed at regular intervals. Residents spoken to were generally positive about their key workers. Residents’ files contained evidence of appointments with healthcare professionals, and there were good examples of staff supporting individuals to attend appointments with medical consultants and therapists. Staff spoken to showed an awareness of both physical and mental health issues; where residents chose to manage their own healthcare or medication, staff were alert to possible concerns and risks. The home has appropriate and safe storage arrangements for medication looked after on behalf of residents, including a controlled drugs cabinet. The home’s medication policy contained appropriate guidance on the storage, administration and recording of medication in the home, and records showed that seven staff responsible for medication (the manager and seniors) had attended medication training. One resident self-medicates, and was seen to have a risk assessment and a medication administration record (showing details of prescribed medication). Another person chose to be fully responsible for all their healthcare needs, including obtaining any medication, but there was not currently a risk assessment relating to this (ref also Standard 9). Medication Administration Records (MAR) were pre-printed by the pharmacist with medication details; quantities of medication received by the home were recorded by staff on the MAR, and medication administration was clearly recorded and signed for. It was noted however, that where respite residents had brought supplies of their medication with them to the home, handwritten details of each medication transcribed by staff onto the MAR had not been signed or dated by the person making the record (or countersigned by a second person to confirm accuracy); also the quantities of medication brought in by the person (or returned to them when they left) had not been recorded. Additionally, several respite visits had been recorded on one MAR sheet: this appeared confusing, and is not recommended. During the inspection it was observed that staff were operating a practice of decanting service users’ medications into pots labelled with their names, before beginning a medication administration round. The manager was advised that this practice is unsafe and should cease immediately. Medication must be adminstered from the labelled containers it is dispensed in by the pharmacist directly to the person it belongs to, only decanting into a separate container at the point of administration to avoid staff handling medication or if the individual requires this to assist them to take their medication. Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to air concerns and are confident that these will be listened to. Systems are in place to protect residents from abuse. EVIDENCE: The home’s Service User Guide contained information on the home’s complaints procedure, and the manager confirmed that all residents have a copy of this document in their room. The CSCI had only been notified of one complaint relating to the home since the last inspection: this had been directed to the registered provider, who had provided an appropriate response to the complaint. On this inspection the home was noted to have carried out the action proposed to address the concern raised. The home was seen to maintain a record of complaints received. Residents spoken to felt able to voice concerns, saying that they could speak to the manager or to one of the directors, who are regularly present in the home and also chair residents’ meetings. Discussion with residents and staff on this inspection indicated that any concerns about staff attitudes or practices in the home can be raised by residents and are responded to by the manager and directors. The manager reported that the home has a DVD training pack on the Protection of Vulnerable Adults (POVA) that new staff complete at induction, together with a Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 18 Training pack produced by the company, which contained a good range of questions and scenarios to help staff explore and understand abuse issues. She confirmed that all staff receive a booklet on Abuse Awareness with their induction pack, and that existing staff have attended POVA training workshops, which will be provided on an ongoing basis. Training records showed that all staff had received POVA training, apart from two new staff and two staff that had been off work for a while. The pre-inspection questionnaire indicated that all residents maintained control over their own benefit books and handled their own financial affairs. Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 28 and 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is satisfactorily maintained, providing residents with a homely, safe and hygienic environment that suits their needs and lifestyles. EVIDENCE: The home provides facilities that are suited to its purpose, in a residential area close to local shops. The manager reported that a number of bedrooms had been decorated over the last year, and also the dining room. The home does not keep a record of decoration or refurbishing, and it is recommended that this is maintained. However, the maintenance person keeps a log book that shows other maintenance work completed. Communal areas viewed were generally homely and in a satisfactory condition; on the random inspection in December 2006 it was noted that some of the corridor carpets were quite marked, and the registered person should monitor this and ensure flooring is replaced when required. It was good to see one lounge area equipped with a Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 20 computer and internet, and communal areas also had TV and music equipment available. Two bedrooms were inspected and both were well personalised and met the person’s individual needs. One had been decorated during the last year in colours chosen by the person, and since the random inspection in December 2006 the room had also been fitted with a low level cupboard to enable the resident to access their clothes. Although the other resident’s room was in need of some refurbishment, they confirmed that this had been offered by the manager and that it was their choice not to have this done. Another resident spoken to appreciated the fact that they had been supported to install entertainment equipment in their room, and were being equipped with suitable electric sockets. One person described the home as ‘homely’, and confirmed that the organisation regularly carried out re-decoration. One the day of the inspection the home was clean and hygienic. There were appropriate Infection Control policies, with evidence that these had been read by staff and had recently been revised. Laundry facilities are upstairs in the home, and cannot be accessed by residents who are not independently mobile: this prevents most current residents from being able to do their own laundry. However, it was good to learn that staff were supporting one person to go to a local launderette each week, to enable them to be involved with their laundry. Laundry facilities were clean and tidy, and included a domestic washing machine and dryer: the washing machine did not have a 65°C wash cycle for infection control purpose: this was discussed with the manager, who stated that the home rarely has laundry soiled with body fluids. Red bags are available for handling soiled laundry if required; no commodes are used in the home. Evidence of staff training showed that, apart from new staff or staff that had been off on maternity leave, most of the regular staff team had completed infection control training within the last two years. Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides staff with training in core skills and knowledge, to ensure that residents are supported by competent staff. Staff numbers and roles effectively support the needs of current residents. However, the manager has insufficient dedicated management time to satisfactorily complete all management tasks. The home’s recruitment practices do not provide sufficient protection of residents. EVIDENCE: Due to the current low number of residents living at the home, staffing had been reduced from three throughout the day, to three on an early shift and two on a late shift. Night staffing had been changed from two waking staff to one waking and one sleeping. On the random inspection visit in December it was noted that the home no longer employs a cook and therefore care staff on duty now cook the main meal, and are therefore in the kitchen for part of their shift (generally the morning shift). Staff also carry out all the domestic and Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 22 laundry tasks in the home: on the random inspection the manager confirmed that night staff were now carrying out more of these tasks, but at this visit it was noted that with only one waking night carer less domestic work could be achieved at night. Staff reported that with only two staff on shift they are unable to take residents out, as this would only leave one carer in the home with other residents. However, it was noted that the maintenance person also acts as a driver and escort to take individuals out, and the manager confirmed that extra staffing can be arranged if they know in advance that a resident wants or needs to go out. Staffing levels and additional tasks (cooking and domestic) need to be closely monitored by the manager and owners, to ensure that activities outside of the home continue to be actively offered, encouraged and available. Rotas seen for the two weeks prior to the inspection showed that the above staffing levels had been maintained, and that the home uses minimal agency staff to cover shifts. However, it was noted that the manager was covering lots of care shifts and there were four times during the fortnight when the manager worked a night shift following a late shift, and one occasion when both the manager and deputy manager worked for 24 hours without a break (i.e. late shift, night shift and early shift). On the random inspection in December it had also been noted that staff were under strain through covering extra shifts: whilst the manager is commended on her commitment to the home, this is not an acceptable working pattern. The registered provider must monitor this and support the manager to arrange alternative cover. This also meant that the manager had little dedicated management time: this needs to be addressed in order to ensure that the manager has sufficient time to fulfil her management role (e.g. carrying out staff inductions, monitoring practices, involvement with recruitment practices, developing staff training, etc.). The pre-inspection questionnaire submitted by the organisation showed that eight care staff had left the home since the last key inspection. However, it was good to see that the home had been successful in recruiting new staff. Files of new staff were inspected at the random inspection in December 2006 and also on this inspection: on both occasions evidence of pre-recruitment checks were not satisfactory, and requirements made following the random inspection had not been addressed. Key issues included: unclear employment dates, indicating that employment histories could not been checked for gaps; unexplained gaps in some employment histories on the random inspection; and unsatisfactory references, with some references not received before carers started work, some last employer references not sought by Mid Meadows, and (on this inspection) evidence suggesting that some references had not been sent for until after the staff members started work. The manager was unable to explain how this had occurred, stating that recruitment processes are largely carried out by the organisation’s head office: the manager was advised to ensure that she sees copies of references before starting new staff. Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 23 The home was seen to have a new employee checklist and a workbook covering the Skills for Care Common Induction Standards. However, there was no evidence of these documents having been started or completed for a new employee who had been in post for over a month. The home also has workbooks on Safeguarding Vulnerable Adults and food hygiene: the manager advised that the new employee had been completing these. This person had started work prior to a full Criminal Records Bureau check having been received, but there was no evidence of specific supervisory arrangements in place in accordance with the 2006 amendments to Regulation 19 of the Care Homes Regulations 2001. This needs to be implemented. The home provided a summary of staff training as part of this inspection. The manager stated that the home was currently focusing mainly on training new staff and on core training up-dates. The training evidence showed a reasonable level of core training completed by staff: where there were gaps where staff had not completed this, further training was being arranged (e.g. the manager was in the process of booking training sessions in health and safety, moving and handling, protection of vulnerable adults, and food hygiene). Some of the existing staff team had previously completed training in other relevant topics (e.g. specific medical conditions, falls prevention, continence, etc.), but there had not been much training in other subjects completed over the last couple of years. It is recommended that this be developed further. At the time of this inspection the home employed thirteen care staff, one of whom was on long term sick), and four of whom were new staff. Training records showed that four staff had completed NVQ level 2, and the manager stated that two more were about to start and three more were hoping to start later in the year; three staff who had done NVQ level 2 were due to start NVQ level 3. Therefore, although the home does not currently have 50 of care staff trained to NVQ level 2 or above, it was good to see plans in progress to achieve this. Residents spoken to were positive about staff skills and competence, feeling safe in their care. Most were also positive about the attitude and approach of staff, finding them friendly and approachable. Some residents, whilst recognising that staff may sometimes be tired or have their own problems, felt that some staff could sometimes be off-hand in their approach. This was discussed with the manager, and staff are encouraged to be aware of how they may present to residents, even when feeling tired. Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The active involvement of the manager within the home ensures that residents benefit from good day-to-day management of the home. Quality assurance processes ensure that residents’ views on the home are sought and acted on. Health and safety practices protect staff and residents. EVIDENCE: Since the last inspection, the registered manager has enrolled on the Registered Manager’s Award (NVQ level 4 in Management), and had also completed a three-day course on ‘Leadership at the Point of Care’. She spoke positively about this course, and felt it had provided her with useful knowledge and skills that she had been able to apply within the home. Staff and residents Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 25 spoken to on both this visit and the random inspection in December 2006 were very positive about the manager, finding her approachable and supportive. Comments included support from Vi is brilliant and ‘I can talk to her about anything’. Staff confirmed that they are supervised and have team meetings, and felt that the manager encourages them to share ideas and be involved in the running of the home. The manager and staff also reported that the directors of the home have regular contact, visit the home each week, and are approachable and supportive. It was good to hear that staff felt able to contact the directors with any concerns. It was noted that the directors carry out regular monthly monitoring visits to the home, as required by Regulation 26 of the Care Homes Regulations 2001. However, the content of the reports on these visits was brief and almost identical each month, and therefore did not provide the manager with useful feedback. It is recommended that the provider consider how to provide the manager with more meaningful reports from these visits. The home has a Quality Assurance policy that refers to the quality assurance processes in place in the home, cross-referenced to the National Minimum Standards. This demonstrated that a range of monitoring and development processes were in place, including ways of consulting with residents. A file contained supporting evidence of the processes, including: Regulation 26 reports (referred to above), annual development plan, resident survey, a monthly management audit, minutes of residents’ meetings. The last survey of residents’ views had taken place in February 2007: responses had been summarised, but no action plan developed yet. However, the manager stated that an action plan is usually produced by the organisation following surveys. The home maintained clear evidence of health and safety practices in the home, with a file containing evidence of the home’s policy, risk assessments, external servicing and internal checks. The pre-inspection questionnaire provided information to show that equipment and utilities were regularly serviced. Records seen on the inspection showed evidence of checks on hot water temperatures and Legionella checks. Fire records were not inspected on this occasion; the manager was due to be visited by the fire officer the following day. Staff training records showed that most staff were up-to-date in key health and safety topics, and the manager confirmed that training was being arranged for new staff. Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 1 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 3 3 X 3 X X 3 X Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 27 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 YA6 Regulation 17, schedule 3(3)(m) Requirement Residents’ healthcare needs, and the action required by staff to support these, must be fully detailed in Service User Plans. This particularly relates to recording individual’s needs relating to epilepsy, and is in order to ensure that procedures promote their health and welfare Potential risks to residents must be identified, assessed, and clearly recorded, including any measures to prevent or minimise risks. This is a repeat requirement for the third time (last timescale 31.1.07). This is to ensure the safety and protection of residents, and to record any limitations of choice. The home must ensure that moving and handling practices are adequately assessed and documented, through clear moving and handling risk assessments. This is too ensure the safety of staff and residents. Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 28 Timescale for action 31/07/07 2. YA9 13(4)(c) 31/07/07 3 YA18 13(5) 31/07/07 4 YA20 13(2) 5. YA34 19, schedule 2 Medication practices must be 30/06/07 addressed to ensure that they adequately protect residents. This includes: 1. Clearly recording all medication received by the home and discharged from the home (this particularly relates to respite residents) 2. Ensuring staff do not decant medication into other containers prior to administration; and 3. Ensuring that risk assessments are completed for all residents who chose to control their own medication. To ensure the protection of 30/06/07 residents, all required checks must be carried out on new staff prior to them starting work. This particularly relates to: (i) obtaining full employment histories, including written explanation of any gaps; (ii) ensuring two written references are obtained, including a reference from the last employer. This is a repeat requirement (last timescale 5.1.07, following random inspection in Dec 2006). 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 YA1 YA6 Good Practice Recommendations The home’s Statement of Purpose and Service User Guide should be updated to reflect the current registered manager. It is recommended that the home develops service user plans further, to ensure that these include fuller details of the action required by staff to support each individual DS0000017885.V339003.R01.S.doc Version 5.2 Page 29 Mid Meadows need. The home should ensure that records of the review of care plans demonstrate that individual’s needs and care plans have been reviewed. It is recommended that the manager and staff attend training in risk assessment. It is recommended that the manager and staff continue to consult service users about their interests, encourage a range of activities, and make arrangements to enable them to engage in local social and community activities. Where individuals would benefit from a more structured and purposeful programme of activities, the home should ensure this is identified and addressed (Reference also Standards 12 and 13). It is recommended that the manager continue to monitor staffing levels, to ensure that there are sufficient staff on duty for the day-to-day running of the home (including domestic and cooking tasks) and for uninterrupted work with individuals. The registered provider should ensure that staff do not work excessive hours, including several consecutive shifts. This includes the manager of the home. The registered provider should ensure that the manager has sufficient management time for the effective administration and day-to-day running of the home, to ensure that service users benefit from a well run home (reference also Standard 37) The manager should ensure that there is clear evidence of the induction of new staff, and that when new staff start work pending receipt of a full CRB check, records also demonstrate the arrangements made for their monitoring and supervision over this period. 3 4 YA9 YA14 5 YA33 6 YA33 7 YA35 Mid Meadows DS0000017885.V339003.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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