Inspection on 21/05/05 for Mid Meadows Care Home

This inspection was carried out on 21st May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 10/10/05

Mid Meadows Care Home 03/02/05

Mid Meadows Care Home 27/05/04

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Coopers Mill Ltd

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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 C013 0AS Lead Inspector Jane Greaves Final Unannounced 21/05/05 to /06/06/05 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 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 Stationary 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 Version 1.10 Page 3 SERVICE INFORMATION Name of service Mid Meadows Address 72/74 Elm Tree Avenue, Frinton-on-Sea, Essex C013 0AS Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01255 675085 01255 675085 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 Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: No conditions of registration apply. Date of last inspection 3rd February 2005 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 Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place due to concerns raised with the Commission of Social Care Inspection. The inspection process commenced on Saturday 21st May 2005 and was completed on 6th June 2005 when questionnaires had been returned from families and representatives of the people living at Mid Meadows. This report is a reflection of the service as assessed on the day of the inspection. 11 of the 43 National Minimum Standards were assessed with 3 being met. For the purpose of this report, the residents of Mid Meadows prefer to be referred to as ‘clients’. Two inspectors undertook this inspection and they appreciated the assistance provided by the home’s manager, deputy manager, support staff and clients. Overall the quality of care provided to the clients was good. During this visit inspectors spoke with 5 clients, 3 relatives, the manager, deputy manager and three care staff. What the service does well: What has improved since the last inspection? Support staff members had received training in Basic Food Hygiene and the Protection of Vulnerable Adults since the last inspection. Courses in the Control of Infection and the Prevention of Pressure Sores were scheduled to take place in the weeks following this inspection. The organisation had started the process of registering the home’s manager with the Commission for Social Care Inspection. The manager was able to provide evidence that Criminal Record Bureau Enhanced disclosures had been undertaken for all staff members. Mid Meadows Version 1.10 Page 6 Some communal areas of the home had been refurbished since the previous inspection involving some re-painting and replacement furniture in the ‘smokers’ lounge and carpet tiles had been replaced with carpeting. The lighting in the dining area had been replaced at the clients’ request. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Mid Meadows Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Mid Meadows Version 1.10 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 standard(s) 2 Prospective respite clients’ individual needs and aspirations were not assessed by the home before being admitted. EVIDENCE: Service user guides were evident in each client’s bedroom, however all guides studied contained reference to the NCSC and had not been updated to include contact details for the Commission for Social Care inspection. One client due to be admitted for a period of respite care on the day of the inspection had to return home because the placing agency had not provided an assessment of needs. Social Services had completed the relevant paperwork some weeks previously and received a cheque for the client’s contribution towards this period of respite a week previously. The manager later confirmed that she obtained a copy of the assessment and the client was admitted to the home for his respite care two days after the inspection. The assessment form used by the home is basic and comprised mostly of tick boxes with just a line to write details on. The form does not allow for detailed individual assessment of the clients prior to being admitted to the home. Both care plans sampled at this inspection contained completed forms. Discussions with the deputy manager revealed that respite clients were admitted on the basis of a Social services assessment (COM5) only and staff from the home did Mid Meadows Version 1.10 Page 9 not assess them before admission. If a client was re-admitted to the home within a year of the original period of respite a new assessment was not undertaken. Mid Meadows Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 Individual care plans did not contain sufficient detail in order for care staff to provide appropriate care tailored to clients’ specific needs. EVIDENCE: Clients are well aware of the staff and management’s responsibilities within the home. An elected client representative attends all staff meetings. At the inspection there was evidence of an impending vote amongst the clients to elect a new representative. Two care plans were reviewed; they were brief and did not contain much detail. The majority of the information required to provide appropriate care was contained within the daily progress notes and not clearly presented. Each file contained accident/incident forms but there was no evidence of resulting changes to the care plans. Each file sampled contained a completed pre assessment form albeit unsigned and neither file contained a photograph of the clients. Each file contained an incident/accident matrix and a medical appointment matrix to provide ‘at a glance’ information, however although it was evident in the progress notes that incidents/accidents/appointments had occurred these were not recorded in the matrix. Mid Meadows Version 1.10 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 standard(s) 14 and 17 Staffing levels were such that clients were not supported to engage in appropriate leisure activities. The home did not offer a nutritionally planned and balanced menu provided by appropriately skilled and competent staff. EVIDENCE: There was a large selection of videos for clients’ entertainment and the home had a computer in the communal lounge for all to use. Since the last inspection the clients had enjoyed a day trip to France, a shopping trip to Lakeside Shopping Centre and some Pub lunches. Staffing levels limit activities as two staff must be at the home at all times to assist clients with their personal needs, which means that with current staffing levels it is not always possible for clients to access activities within the local community. The organisation did not offer a minimum 7-day annual holiday outside the home as part of the basic contract price. They had addressed this shortfall by providing day trips such as the recent outing to France. The manager assured Mid Meadows Version 1.10 Page 12 the inspector that there would be a minimum of 7 days away funded by the organisation and that the clients were in agreement with this compromise. Evidence of this agreement was not seen on the day of the inspection. Mid meadows had a room where clients were able to smoke. The staffing levels often meant clients were not supervised during this activity creating a potential risk. The menu was developed by requesting a list of favourite meals from the clients. The menu offered choices but the nutritional content had not been assessed. Staff members working in the kitchen had undertaken a food hygiene video training course although one care assistant did not remember if she had seen the video as part of her recent mandatory training. The home did not employ a dedicated cook or cleaning staff. Staff meeting minutes recorded that staff were told by the providers “If we take on a cook we will have to lose a carer”. A staff member stated, “I came here to do a carer’s job, I can’t cook”. Clients confirmed that some staff members were “awful cooks but they did their best” and that they were quite fed up with the situation. Staff and clients stated they were uncomfortable that staff could be cleaning a bathroom, attending to a client’s personal needs and then cooking in a short space of time without even a change of clothing. The midday meal on the day of the inspection was as detailed on the menu board in the hallway. It was a ‘Fry up’ of egg, sausage, bacon and beans. It looked well cooked and nicely presented. One Client (a trained chef) bought food out of his own pocket and cooked it in his bedroom. The manager stated that she had offered to buy the ingredients for him but he preferred to do it himself. He said he was very happy living at Mid Meadows but preferred to cook his own food himself. Freezers were adequately stocked on the day of the inspection but there was a lack of fresh produce. The manager stated that the home purchased fresh produce on a daily basis to ensure the clients had a healthy diet. Clients’ comments did not confirm this statement. A client stated that if the meal offered was not to their liking they only had sandwiches as a replacement and only one hot meal per day was offered. Another comment made was “The amount is too small for me, once I asked for an extra slice of bread and was refused. But when another client asked they were given extra”. One client spoke of having the evening meal of sandwiches at 5pm and no more food being offered or available until breakfast the next day. One client Mid Meadows Version 1.10 Page 13 said, “There is never enough food”. The manager stated in response “There are always snacks available, they have been told to ask”. Mid Meadows Version 1.10 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 standard(s) 18, 20 Clients receive personal support according to their assessed needs. Medication procedures on the day of the inspection were poor but under improvement by the home. EVIDENCE: The mother of the respite client who was due to be admitted on the day of the inspection stated that she was very happy with the care they had received at Mid Meadows when they had stayed for previous periods of respite. GP contact with the home appeared to be very good, clients spoken with said the staff members were good at contacting their GPs and they always came out when asked. One client was displaying the symptoms of diabetes and these had not been identified or questioned by staff members, the deputy manager was recommended to arrange a GP appointment for this client. One client explained how they experienced difficulty reading small print but had not had an opticians review; another had broken their glasses the week prior to this inspection. They had not been mended and they were struggling with a pair that was not the correct prescription and did not fit properly. The Mid Meadows Version 1.10 Page 15 manager stated that optician appointments had been made for these clients, evidence was not seen. Medication procedures were generally poor. The service received from the local pharmacist was not supportive. The home was due to move to another pharmacy on 4th June. The medications will be in Monitored Dosage packs with appropriately typed Medication Administration Records, neither of which the present pharmacist is prepared to do. At present the pharmacist supplies the medication in bottles with administration records. When they arrive at the home the senior care puts the medications into separate NOMAD boxes on a weekly basis and hand writes the details onto a sheet designed by the home. No pharmacy audits have been carried out. The GP monitored and reviewed individual client’s medications at least 6 monthly. Three clients were selfmedicating at the time of this inspection and one who ordered and collected their own medication was not receiving supervision, which was their right. The deputy manager was not clear exactly what medication they were on and where it was kept, which could be a potential problem if the client became unwell. The newest client had been resident in the home for four weeks at the point of inspection but their medications were still in a plastic carrier bag on the medication trolley. The deputy manager stated that most staff members at the home had been trained in the safer handling and administration of medications although one person had failed the course. Some of the staff members had undertaken training in medications via distance learning. The current medication procedures fall short of the National Minimum Standards however the home’s systems are due to change the week following the inspection. Mid Meadows Version 1.10 Page 16 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 standard(s) 22 and 23 Clients felt their views were noted however not always acted on. Clients were not effectively protected from abuse and neglect. EVIDENCE: Clients stated they had been asking to have a Cook to plan and prepare their meals. The response to this had been “ If we employ a cook we will need to lose a member of care staff” Clients spoke of a time when they voiced objections to a proposal to reduce night staff hours from two waking staff to one waking staff and one sleep in. Their objections were due to the physical disabilities of some clients meaning that they required two staff to attend to their personal needs during the night. The response was reported to be “If you don’t like it you know where the door is”. Clients’ views had influenced the change of lighting in the dining room, outings taken during the past few months, choices of meals on the menu. The manager had ensured that all staff members had received training in the Protection of Vulnerable Adults from Abuse this was delivered by video. The manager had ensured that all staff working at the home undertook Enhanced Criminal Record Bureau disclosures. The one established staff member that did not have a disclosure at the last inspection now had a PoVA first check and was waiting for the full CRB to follow. Mid Meadows Version 1.10 Page 17 Staffing levels dropped from three staff during the day to two staff on occasions and night staff operated on one waking and one sleeping on occasions. Staff members stated they felt unsafe when this happened. There were occasions when the rota indicated that care staff had worked a ‘long day’ shift and then stayed on duty to work a ‘waking night’ shift. This was confirmed with the manager. Clients were permitted to smoke at the home and a dedicated smoking area was provided. Staff stated that often there were not enough staff members on duty to supervise clients when they were smoking and this created potential for danger and accidents. Records indicated that whilst training had been taking place there were areas such as fire safety that had not been addressed since early 2003. Only 7 of the 14 staff had current manual handling training, this was delivered by video. The complaints folder contained details of the two complaints received this year by the Commission for Social Care Inspection and the corresponding responses from the organisation. Clients spoke of voicing repeated concerns regarding the staffing levels and quality of food they received but these were not documented as complaints. Some concerns were documented as being raised during residents’ meetings but no details of action to be taken to address these issues. Mid Meadows Version 1.10 Page 18 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 standard(s) 27 The flooring in the bathroom downstairs posed a risk to clients’ safety. EVIDENCE: The home had a second hand Arjo bath installed and it was leaking. A repairman had been contacted. The bathroom flooring had been cut into to install the bath and was no longer a protective surface to prevent the floorboards rotting and weakening. The manager stated that the flooring in the bathroom was to be replaced in the week following the inspection. Mid Meadows Version 1.10 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 35 Clients were not supported at all times by an effective staff team. Clients’ individual and joint needs were not always met by appropriately trained staff. EVIDENCE: Scrutiny of staffing rotas identified there were occasions when support staff were on duty for a 14-hour day shift and continued into a 10 hour waking night shift. The manager confirmed the staffing rotas were accurate. In the event of staff shortages the organisation did not provide agency cover. As part of the inspection process the manager was asked to supply a breakdown of the staff rota to identify how many hours were dedicated to cleaning, catering duties and care. The manager stated that this was not possible to assess because all these duties were combined in the one role. On the day of the inspection a member of the care staff team had telephoned to say she was ill and would not be attending duty that afternoon. The deputy manager was not able to find someone to cover this shift and was concerned that the home would be unsafe with just two staff on duty. However, the manager felt that staff were adequate to maintain and protect the health, safety and welfare of clients at the home despite the deputy’s concerns, voiced in the presence of the inspector. Mid Meadows Version 1.10 Page 20 The Deputy manager provided copies of the previous months staffing rotas, this identified that the manager and her deputy had worked very long hours in care and that the manager had had only 14 hours dedicated ‘office’ time to run the home in the month up to this inspection. As mentioned previously in this report the manager had secured some staff training since the previous inspection however areas such as Health and Safety, Fire Safety and specific training in relation to caring for people with physical disabilities had not yet been provided. Training in the Control of Infection and in the impending new medication system had been scheduled for staff. Records showed that moving and handling training had been provided for half of the staff members, this had been delivered by video. This did not involve a practical assessment of the carers’ competency to perform safe moving and handling techniques. Staff spoke of completing questionnaires to ascertain the knowledge gained from the video courses, these questionnaires were completed whilst viewing the videos. Clients spoken with praised the commitment of the staff team and the manager. Clients and staff members stated that activities outside the home are limited on a day to day basis due to reduced staffing numbers. Mid Meadows Version 1.10 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These standards were not specifically assessed at this inspection. Mid Meadows Version 1.10 Page 22 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 x x x Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x 3 x x x Standard No 11 12 13 14 15 16 17 x x x 2 x x 1 Standard No 31 32 33 34 35 36 Score x x 2 x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x Mid Meadows Version 1.10 Page 23 NO 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 2 Regulation 14 Requirement The manager must ensure new/respite clients are admitted only on the basis of a full assessment undertaken by people competent to do so, involving the prospective client using an appropriate communication method and with an independent advocate as appropriate. The registered person must, after consultation with the client or representative, prepare a written plan detailing how the care staff deliver the clients health and welfare needs and keep the plan under review. The home must ensure that staffing levels are sufficient to ensure that clients have access to and choose from a range of appropriate leisure activities. The registered person must provide, in adequate quantities, suitable, wholesome and nutritious food which is varied and properly prepared. The registered person and staff must listen to and act on the views and concerns of clients and others, encourage discussion Version 1.10 Timescale for action 30th June 2005. 2. 6 15 30th June 2005. 3. 14 16(m) 30th June 2005 4. 17 16 (i) 30th June 2005 5. 22 22 30th June 2005 Mid Meadows Page 24 and action on issues raised. 6. 23 13 The registered person must ensure that any activities in which clients participate, such as smoking, are appropriately supervised. The registered person must ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of clients. The registered person must ensure that staff receive training appropriate to the work they are to perform in order to protect the health safety and welfare of service users. June 30th 2005 7. 33 18(a) June 30th 2005 8. 35 18(c)(1) 30th June 2005 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 17 30 Good Practice Recommendations The home should consider securing the services of an experienced cook on the basis of a few hours daily until occupancy levels increase to allow for a fulltime post. The home should consider hiring part time cleaning staff until the occupancy levels increase to allow for fulltime domestic staff. Mid Meadows Version 1.10 Page 25 Commission for Social Care Inspection Fairfax House Causton Road Colchester Essex C01 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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