Inspection on 10/10/05 for Mid Meadows Care Home

This inspection was carried out on 10th October 2005.

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 4 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 01/05/07

Mid Meadows Care Home 03/05/06

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 Jane Greaves Draft Unannounced Inspection 10th October 2005 09:45 Mid Meadows DS0000017885.V257226.R01.S.doc Version 5.0 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.V257226.R01.S.doc Version 5.0 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.V257226.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Mid Meadows Address 72/74 Elm Tree Avenue Frinton On Sea Essex CO13 0AS 01255 675085 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 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.V257226.R01.S.doc Version 5.0 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 21st May 2005 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 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. Mid Meadows DS0000017885.V257226.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine unannounced inspection took place one day in October over 4 ¾ hours. 19 of the 43 National Minimum Standards were assessed and 15 were met. For the purpose of this report the people living at Mid Meadows prefer to be referred to as ‘clients’. An application had been received to register the manager with the Commission for Social Care Inspection. This application has been deferred for a period of 6 months for the manager to undertake further personal development. Overall, the quality of care provided to the clients was good. During the inspection the inspector gathered views from 8 clients, the manager, the cook and two support staff members. What the service does well: What has improved since the last inspection? What they could do better: Risk assessments observed on clients’ files addressed some of the areas where clients may be at risk however the clients would benefit from the key workers and manager receiving further training to identify potential risks. Clients’ health and well being would benefit by the food menu being developed to deliver a nutritious and healthy balance. Mid Meadows DS0000017885.V257226.R01.S.doc Version 5.0 Page 6 Staff receiving external training in the Protection of Vulnerable adults from abuse would better protect clients’ safety and well being. The training delivered to date has been via video format and candidates’ competency had not been assessed. The manager had developed a staff training programme and had sourced an external training provider. Whilst there had been good progress in relation to the training provision at the home there were still areas such as infection control and PoVA that failed to meet the required standard. 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. Mid Meadows DS0000017885.V257226.R01.S.doc Version 5.0 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.V257226.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Prospective clients’ individual aspirations and needs were assessed. EVIDENCE: The manager reported that a full assessment of prospective clients’ needs was made before being admitted into the home. The assessment was made with the involvement of the client and family or representative. The home’s assessment together with the Social Services assessment of the clients’ needs and aspirations formed the basis of the care plan. Mid Meadows DS0000017885.V257226.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Clients know their assessed and changing needs and personal goals are reflected in their individual plan. Clients were supported to make decisions about their lives. Some of risks that clients were taking as part of an independent lifestyle had not been identified. EVIDENCE: As mentioned earlier in this report the clients’ care plans were generated from the home’s pre admission assessments and the Care Management Assessment. The plans set out how current and anticipated specialist healthcare needs would be met. The plans were clear and easy to navigate however would benefit from more detailed information regarding the actions to be taken to address assessed needs and assessed risks. There was a key working system in place at Mid Meadows, the manager had developed a matrix to ensure that monthly reviews of the care plans were made covering all aspects of the clients’ health and social care. Mid Meadows DS0000017885.V257226.R01.S.doc Version 5.0 Page 10 Staff respected clients’ rights to make decisions about their lives and that right was only limited through the risk assessment process involving the client and family representative. Two clients were in receipt of advocacy services. Risk assessments were present on the care plans sampled at this inspection. Risks identified included self-medication, falls, smoking and going out into the community alone. Clients were risk assessed as part of the admission process and family, representatives and the clients were involved in this process. There had been good progress in this area subsequent to the previous inspection however some areas of risk had not been identified or addressed. One client with identified healthcare concerns had refused the services of relevant specialist care. The refusal of care had not been documented nor the resulting risk to the client’s health, safety and well being. Mid Meadows DS0000017885.V257226.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 and 17 Clients were supported to participate in age and peer appropriate activities. Clients were supported to be part of the local community. Clients had some opportunities to engage in appropriate leisure activities. Clients were able to enjoy appropriate personal and family relationships. Clients’ rights were respected and responsibilities recognised in their daily lives. Clients cannot be assured they are receiving a nutritionally balanced diet. EVIDENCE: The manager reported that the clients at Mid Meadows did not wish to take up employment opportunities or continue their education or training; this was confirmed through conversation with the clients. This information was not however included in the individual clients’ care plans. One client had attended a disablement centre but decided they would like more involvement with ableMid Meadows DS0000017885.V257226.R01.S.doc Version 5.0 Page 12 bodied students. The manager was working with the client’s family to explore other avenues. One client living at Mid Meadows was able to access the community independently and five clients regularly went out into the community with support staff assisting. A list of community events was on the clients’ notice board. The manager reported that if interest was shown in an event every effort would be made to attend and additional staff cover would be provided if required. A suggestion box was positioned by the clients’ notice board; items from there were referred to in the minutes of clients’ meetings. The manager reported that monthly ‘entertainment’ had taken place until recently when clients lost interest. At the point of this inspection there had been no progress made in finding appropriate alternative entertainment. Clients spoken with confirmed they enjoyed pursuing their own hobbies and interests such as computing and watching television and were happy to be able to spend time on their own in their private rooms when they wished. The clients did not have, as part of the basic contract price, the option of a minimum 7 day annual holiday outside the home. The manager reported that a minimum of 7 day trips were to be planned each year, so far this year the clients had a day trip to France, Great Yarmouth and Lakeside shopping centre. Some clients said the home’s minibus was uncomfortable for long trips and consequently they were wary of suggesting potential venues for days away from the home. During the course of this inspection support staff were observed taking part in a board game with clients. All clients living at Mid Meadows were supported to maintain family contact. The manager organised transport for a client to visit a friend. Support staff were seen to talk and interact with clients. Three clients were supported to be involved with cleaning their personal rooms and to do some household chores such as laying the table for meals. The previous inspection identified that clients were unhappy the home did not have a dedicated cook. The manager had recently employed a new staff member for this post; two clients had been involved in the selection process. This new staff member did not have the experience necessary to formulate nutritionally balanced menus, during discussions with the manager it was reported that training in this area would be provided. Clients were non-committal with their comments regarding the food provided at the home, all confirmed that they were happy there was a permanent cook employed. The cook brought in fresh vegetables daily. Food stocks maintained in the home were appropriate for the number and needs of the clients living there. Mid Meadows DS0000017885.V257226.R01.S.doc Version 5.0 Page 13 One client who preferred to ‘self cater’ previously had to purchase private food stocks out of their own money, the organisation now provided the client with an allowance for this purpose. The manager reported that clients chose to have ‘take away’ food on occasions and that support staff sometimes accompanied clients to the local pub for dinner. The providers financed these outings. Mid Meadows DS0000017885.V257226.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 20 Clients’ physical and emotional needs were met. Clients were protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: Clients were supported to take control of their own healthcare requirements and manage their own medical conditions where appropriate. Care plans sampled at this inspection contained details of routine and specialist healthcare appointments made on behalf of clients. Clients were encouraged to access NHS healthcare facilities in the community however, when a client refused medical attention this was not documented and corresponding risk assessments were not made. Since the previous inspection the home had changed Pharmacy supplier. Medication was now administered under a monitored dosage system and all staff involved in the administration, handling and storage of medicines had received appropriate external competency assessed training. There were no controlled drugs maintained at Mid Meadows, there was a metal cupboard secured to a wall for the storage of controlled medication however this only had one lock. Clients who wished to self medicate had appropriate lockable storage facilities in their private rooms. Mid Meadows DS0000017885.V257226.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Clients reported feeling confident their views would be listened to and acted on. Clients cannot be assured they are adequately protected from abuse neglect and self harm. EVIDENCE: There had been no complaints received by the home or the Commission for Social Care Inspection since the last inspection. The home had robust complaints policy and procedures; the manager reported that these were subject to annual reviews. Minutes of clients’ meetings confirmed that they were comfortable raising any areas of concern. One client reported “I love this place, I tell them if there’s something I don’t like” Another client commented “If I do say anything they act on it”. 11 of the 13 support staff employed at Mid Meadows had received video training in abuse awareness. The manager had identified a new training provider and reported that external training in the Protection of Vulnerable Adults from abuse would take place within the next 12 months. Minutes of a clients meeting reported that the clients did not want or feel they required staff supervision whilst smoking. This was not documented on care plans and risk assessments were not in place on all files. Respite care clients and new admissions to the home must be risk assessed on admission regarding smoking unsupervised. Mid Meadows DS0000017885.V257226.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Clients live in a homely and safe environment. The home appeared clean and hygienic on the day of the inspection. EVIDENCE: Since the previous inspection the dining room, two clients’ bedrooms and the communal hallways had been redecorated; the flooring had been replaced in a bathroom. Clients spoken with confirmed they were happy and comfortable with the environment they lived in. The premises were accessible to all clients; doorways were wide enough to allow wheelchair users adequate access. Mid Meadows did not employ dedicated domestic staff. Support staff undertook cleaning tasks as part of their daily duties. The home appeared clean with no offensive odours present. The entrance hall carpet was marked with constant wheelchair use; the manager reported that it was cleaned frequently. Video training in the control of infection had been provided for all staff, the manager reported that external infection control training would be provided for all staff by the end of the year. Mid Meadows DS0000017885.V257226.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 35 Clients received support from an effective staff team. Clients’ individual and joint needs were not always met by appropriately trained staff. EVIDENCE: The manager, clients and staff confirmed that the staffing levels had improved and were adequate for the assessed needs. The home was registered for 17 clients and at the point of this inspection was providing accommodation and care for 9. The manager confirmed that staffing levels would be reviewed and amended accordingly when new clients were admitted either for respite care or permanently. The manager had made good progress with developing a staff-training programme. A new external training provider had been sourced and a programme of training courses was scheduled to ensure that all areas of mandatory training would be attended by all staff with a rolling programme of annual refresher courses to follow. A matrix had been developed to identify at a glance training needed for staff members. This demonstrated that there were still a number of gaps in the training required for care staff to protect the clients’ health, safety and well being. Six of the 13 support staff had achieved NVQ level 2, one had achieved NVQ level 3 and six were working towards their NVQ level 3. The manager reported Mid Meadows DS0000017885.V257226.R01.S.doc Version 5.0 Page 18 that all remaining care staff would be enrolled to do their NVQ level 2 by the end of the year. Mid Meadows DS0000017885.V257226.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 Clients were confident their views underpinned the self-monitoring, review and development of the home. EVIDENCE: The manager was able to demonstrate the home’s quality assurance system. Clients were surveyed annually about the service and facilities available to them at Mid Meadows. Families of clients only received surveys if they requested them. This was discussed with the families and representatives at admission and subsequent reviews. A summary was made of the clients survey forms and any areas of concern were identified and used to drive forward changes within the home. Mid Meadows DS0000017885.V257226.R01.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X 3 X 2 X CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Mid Meadows Score X 3 3 X Standard No 37 38 39 40 41 42 43 Score X X 3 X X X X DS0000017885.V257226.R01.S.doc Version 5.0 Page 21 YES 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 YA9 Regulation 13(4)(c) Requirement Timescale for action 31/12/05 2 YA17 16(2)(i) 3 YA23 13(6) 4. YA35 18(c)(1) The registered person shall ensure that unnecessary risks to clients are identified and so far as reasonably practicable free from avoidable risks. The registered person shall 31/12/05 provide in adequate quantities suitable, wholesome and nutritious food that is varied and properly prepared. This refers specifically to ensuring the menu offered to the clients is nutritionally balanced. The registered person shall make 31/12/05 arrangements by training staff or other measures to prevent clients being harmed, suffering abuse or being placed at risk from harm or abuse. The registered person must 31/12/05 ensure that staff continue to receive training appropriate to the work they are to perform in order to protect the health safety and welfare of service users. Mid Meadows DS0000017885.V257226.R01.S.doc Version 5.0 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Mid Meadows DS0000017885.V257226.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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