Inspection on 23/04/08 for Mid Meadows Care Home

This inspection was carried out on 23rd April 2008.

CSCI found this care home to be providing an Good service.

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 01/05/07

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 28/09/2008.

CARE HOME ADULTS 18-65 Mid Meadows 72/74 Elm Tree Avenue Frinton On Sea Essex CO13 0AS Lead Inspector Pauline Dean Unannounced Inspection 23rd April 2008 09:30 Mid Meadows DS0000017885.V362943.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.V362943.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.V362943.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) www.blackswan.co.uk 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.V362943.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 1st May 2007 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 18 and above. There are 14 bedrooms on the ground floor and 3 bedrooms on the first floor that are used by residents 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 and two lounges, one at the front and one to the rear of the property, which has access to garden area. 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 received on the day of the inspection was that fees payable are set at £750 per week, with additional charges for items such as Chiropodist, Hairdresser, own transport to activities and outings, holidays and daily papers. Mid Meadows DS0000017885.V362943.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This unannounced inspection of Mid Meadows took place on 23rd April 2008 over a 9½f hour period. The inspection involved checking information received by Commission for Social Care Inspection (CSCI) since the last inspection in May 2007, looking at records and documents at the care home and talking to the two of the management company’s Operational Managers, the registered manager, care staff and the people living at the home. In addition the Annual Quality Assurance Assessment (AQAA) completed in February 2008 was considered as part of the inspection process and a tour of the premises was completed at the site inspection. Surveys were sent to the home prior to the site visit and they had been distributed to the people living at Mid Meadows. Furthermore staff surveys were sent, as were relative surveys and healthcare professional surveys. At the time of writing this report, none had been received by the Commission for Social Care Inspection (CSCI). We were however informed that some surveys had been completed and returned to the CSCI. What the service does well: Mid Meadows provides a homely care environment. This was noticeable at the site inspection and was commented on by three residents. They spoke of staff and other residents being supportive and welcoming. One resident gave an example of how both a resident and staff had helped them to adjust to their new environment. In addition residents commented on the support and assistance they had received from the directors of the organisation; for the Operational Managers had frequent contact with the home and they are accessible when they visit. Residents bedrooms were decorated and furnished according to the wishes of the occupant and examples were seen of personal technology such as computers, sound and TV equipment in their rooms. Mid Meadows DS0000017885.V362943.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.V362943.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.V362943.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 & 2. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who come to live at Mid Meadows have the information they need to make a choice to live at the care home and they can be assured that their needs are met. EVIDENCE: Mid Meadows has updated and revised their Service User Guide in March 2008 to add details of the registered manager. Details of her care work experience and qualifications were also found in this document. A copy of the guide was available in the home’s office and copies are given to residents. A copy was seen in the bedroom of prospective resident ready for when they enter the home. This is to ensure that they have the information they need to make an informed choice about where they live. There were seven residents at Mid Meadows on the day of the inspection. Three residents had been admitted to the home since the last inspection and regular respite residents have stayed at the home during the year. None of these were visiting the home at the time of the inspection. However care staff Mid Meadows DS0000017885.V362943.R01.S.doc Version 5.2 Page 9 confirmed that for two of the respite residents regularly stayed at the home for visits of 4 to 6 weeks at a time and they knew them well. The initial assessment paperwork for two new residents were sampled and inspected. An Operational Manager of the home told us that prior to admission, prospective residents are visited and if possible they or their relatives visit the home. For both of the most recent admissions their relatives had visited Mid Meadows on their behalf as they were in hospital prior to their admission. This was confirmed in discussion with both of the residents. The Annual Quality Assurance Assessment (AQAA) stated that a ‘Complete a comprehensive pre-admission assessment of needs by way of visits to potential service user, invitation to visit the Home, eat at the Home, meet staff and other Residents, free trial overnight stay at the Home’ is offered . We were told that a Care Plan Information Card is completed as part of the initial assessment. Completed Information Cards were found on the two files of the most recent admissions and they detailed recent personal history, family and contacts and health and social care needs. The home’s Operational Manager said that this information was collated prior to admission and on admission. It was not possible however to confirm this for there was no supporting evidence of visits and interviews with the prospective resident and their family and the Information Cards were dated on the day of admission not as the information had been collected. Both Operational Managers said that with future admissions evidence would be collated and added to evidence that new residents are only admitted on the basis of a full assessment process prior to admission. In support of the admission of both new residents, assessments from the placing authority and a letter from their GP had been received by the home. Mid Meadows DS0000017885.V362943.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 & 9. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use this service should be assured that their care needs will be met through care planning, risk assessment and staff support. EVIDENCE: Care plans were sampled and inspected for three people living at Mid Meadows. These included the two of the most recent admissions to the home. All three people living at Mid Meadows had care plans, which had been created, reviewed and revised in 2007/2008. Care plans consisted of a printed double page format listing headings of the Need/Difficulty, Goal/Objective and the Agreed Action with Person Responsible and the Target Date noted. Topics covered were Medical Care, Personal Needs, Mobility, Moving & Handling & Transferring, Behavioural & Emotional Mid Meadows DS0000017885.V362943.R01.S.doc Version 5.2 Page 11 Needs, Activities, Financial Management, Restriction of Choice & Specific Risks as identified. As found at the last inspection, whilst the plans were clear, the detail of the support given by staff was very brief. An example of this was found in a personal care need - ‘needs assistance with lower half of body’ and another around emotional needs - ‘may need support from staff.’ Neither of these objectives had any detail of the action staff need to take to support the individual. Whilst it is recognised that the majority of the current resident group are able to tell staff of their needs, likes and dislikes, the home does need to develop care plans that fully detail the support required. The provider in the response to the draft report raised the brevity of care planning and whilst they felt the current care plans were comprehensive, they did say they would endeavour to improve care planning. In another care plan for an individual the care planning goal/objective was around the person’s mobility and going out in the locality alone. The care planning goal/ objective were not clear and the action to be taken by staff was equally unclear for it listed the ‘Person Responsible – All Staff’ and the ‘Target Date - Ongoing’. However, from speaking to the individual and the Operational Manager it was evident that this was when they had first come into the home and this specific care plan objective was no longer ongoing for their strength had improved and they were able manage this task alone. It was agreed at the inspection that this care plan objective should be reviewed and revised and on receipt of a response to the draft report it was said that this care plan objective would have been reviewed and revised as need or at the latest at a monthly review. Overall daily records were well maintained giving an accurate account of events in the home. During the key inspection the inspector was able to speak with four of the residents. All four gave examples of how they are supported to make decisions about their life. One person said that they had been enabled to care from themselves. They had their own kitchen facilities and they were able to shop and cook for themselves. Another person said that they were supported to attend church and another said that when they had first come to the home another resident and the staff had introduced them to the facilities in the neighbourhood. This had enabled them to make new friends in the area. All three residents said they were able to come and go as they pleased and when they left the home to go out they just had to let the staff know that they are going out. Within the AQAA it was stated that ‘Residents are encouraged to participate in the running of the Home and to take risks where appropriate. Independence and choice over personal care is promoted so that Residents can live their own lives with dignity and privacy’. Mid Meadows DS0000017885.V362943.R01.S.doc Version 5.2 Page 12 Risk assessments were seen in place. As with care planning a standard format had been devised which covered twelve areas - self-medication, prevention of falls, scalding, diabetes, bedside rails, pressure sores, smoking, going out of the home unaccompanied, manual handling, challenging behaviour, nutrition & health and other. Some of these risk assessments were not needed and where they were used the format gave little space for analysing the risk or detailing the action to be taken to minimise the risk. It was said that additional paper would be added if further comments are needed. Within the format there was the opportunity to identify whether the risk was a medium or high risk, but on none of the completed assessments had this been considered. An example was seen of a risk assessment around weight loss. From the information given it was unclear as to problem, the action to be taken and by whom and the ongoing monitoring in place. The home’s Operational Managers were able to clarify what the problem was, but it was still not clear as to the action to be taken. Another risk assessment made reference to depression, but once again it was not clear as to the problem, the level of the risk and the action to be taken by whom. A third risk assessment around going out alone gave little information save ‘mobility aids’ as reducing risks. There was no detail as to the aids in place and the action to be taken by staff to reduce risks. There were however, some completed risk assessments, which gave good factual information and detailed the action to be taken to elevate the risk. An example of this was to enable a resident to do their ironing. This risk assessment detailed how the home supported the resident to take a risk as part of ensuring that they have an independent lifestyle. The home needs to develop consistency in the completion of the risk assessment process to ensure that residents are fully supported to take risks to be independent. Mid Meadows DS0000017885.V362943.R01.S.doc Version 5.2 Page 13 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 & 17. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use this service are assured that they are able to make choices with staff offering support and guidance with regard to their daily routine and leisure activities and contact with their family. People who use this service are provided with a varied and healthy diet to promote good health. EVIDENCE: None of the residents at Mid Meadows are attending college courses or are in paid or voluntary work. They access the local community using the local shops, pubs and cafes in The Triangle shopping centre. One person spoke of shopping at the local supermarket and being able to use their electric wheelchair to go into Frinton on sea and ride to the seafront. Mid Meadows DS0000017885.V362943.R01.S.doc Version 5.2 Page 14 Three residents all wheelchair users commented on the lack of a suitable vehicle at the home to transport them. Whilst the home has a mini bus, this is only able to accommodate one wheelchair and is not suitable for some electric wheelchairs. This was a similar position at the last inspection. As was stated then, the home can access alternative transport from their sister home and residents are encouraged and supported to use taxis and trains. Two residents confirmed this. However, these arrangements do mean that impromptu outings and trips are less likely to occur. Two staff members spoken to and the two Operational Managers confirmed that the home does encourage and support residents on pubic transport and with planning the other mini bus can be used. One carer said that the home is actively looking into a suitable replacement mini bus; a mini bus, which could transport electric wheelchair users. The Operational Managers at the inspection confirmed this. Staffing levels during the day are three staff on duty during the morning, with one carer responsible for cooking the main meal of the day at lunchtime and two staff on duty in the afternoons. At night there are two care staff who as with daytime staff are responsible for cleaning tasks. When there are only two staff available this can limit the opportunities for staff to accompany a resident outside the home, as this would leave one carer with the remaining resident. However when we spoke to residents and staff at this inspection they did not appear to feel that this limited their opportunities for outings. At the inspection it was noted that residents were either coming or going as they wished unescorted or staff volunteered to accompany residents on short shopping trips to local shops, as they were able. Mid Meadows currently accommodates a wide age range (28 – 69). From speaking to staff and from observation it was obvious that carers have a good understanding of the individual needs and interests of the people living at Mid Meadows. Bedroom accommodation were personalised with evidence of their own interests accommodated. One person had a cat and another person had their own music, DVD entertainment centre. Within the communal areas of the home there was both a large lounge and a small lounge area with a computer with Internet access and a television with Freeview. In addition all of the residents had their own televisions in their room. Within the AQAA it was stated that additional activities had been introduced in the last year. Some games had been purchased and on the day of the inspection the majority of residents and staff enjoyed a game of musical bingo. From speaking to one resident we were told that consideration is given to what they would like to do. They said that they had recently raised that they enjoyed fishing and a carer who also enjoys fishing had agreed to arrange a Mid Meadows DS0000017885.V362943.R01.S.doc Version 5.2 Page 15 fishing trip. The carer popped into the home during the inspection and they confirmed that they were looking to arrange this. None of the people living at Mid Meadows had specific regular activities, preferring to do their own thing. Within care planning there was little evidence of planned specific social activities. This was raised with both care staff, management (Operational Managers) and residents and whilst it is acknowledged that many of the residents are happy doing their own thing, consideration is being given to a more structured programme of activities and outings. As stated in the last inspection opportunities for carrying out independent living skills in the home are limited: for example, the kitchen is not adapted for wheelchairs and the main laundry facilities are located on the first floor. However, additional laundry facilities have been fitted in a vacant ground floor room and this has enabled those residents who wish to do their own laundry. This is seen as a positive move by both staff and residents. People living at Mid Meadows said that they are supported and encouraged to maintain family links and friendships inside and outside the home. One resident said that as they were new to the home they had been taken to the local shops and pub and had been introduced to new people. They also said that they had been supported in their links with their family, who had been able to visit them frequently. Another resident spoke of continuing links with their family and being able to visit their family. This was evidenced in their daily records. A third resident was also seen to regularly stay with their family. This was confirmed from speaking to them and noted in their records. During the inspection we noted that staff respected residents’ privacy and individuality. Residents were seen using a key to lock and unlock their room and staff knocked and waited to be admitted to their room before entering. Three people living at Mid Meadows confirmed that they felt their rights and independence was respected and recognised. Two people said that they were very happy with the support given by care staff. As stated above care staff now cover catering tasks. A carer confirmed this and during the inspection was able to show the inspector fresh, frozen, dried and canned food supplies. The carer said that normally all of the residents, bar one have the same main meal at lunchtime. The exception is the person living at the home who shops and caters for the themselves. It was said that, if a resident does not like the main choice, they are offered an alternative. This was confirmed by a resident who spoke of the home taking into consideration their likes and dislikes in planning meals. Mid Meadows DS0000017885.V362943.R01.S.doc Version 5.2 Page 16 Records are kept of the meals eaten by each resident. Whilst the collection of the records was muddled, overall with the exception of the breakfast record keeping they were completed well. The breakfast record keeping however was poor. For in recent records, staff had omitted to complete this section. The home does need to ensure that these records are completed in full to fully detail that the people living at Mid Meadows are having a nutritious, varied and balanced diet. The Operational Managers said that they would raise this with the home’s manager and see that these records are completed in full. Care staff confirmed that food supplies are purchased through local supermarkets and greengrocers and some takeaway meals e.g. fish and chips and Chinese are purchased. The inspector was informed that all staff who are involved in catering have completed Basic Food Hygiene training, a course had taken place in 2007. This is to ensure that the health, safety and welfare of residents is safeguarded. Mid Meadows DS0000017885.V362943.R01.S.doc Version 5.2 Page 17 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 & 20. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use this service can be assured that they will receive personal care and support in a sensitive and respectful way and their physical and emotional health needs will be met. EVIDENCE: Within care plans and daily records there was evidence of the detail of general support required from staff to meet residents’ personal and healthcare needs. People living at Mid Meadows were positive regarding the care and support they receive from staff. Three people said that they are able to choose when they get up and when they wish to go to bed and staff support is there as needed. A carer also confirmed that this was the position, with care taken to ensure that residents maintain as much independence as is possible. As at the last inspection there was no detailed written moving and handling risk assessments on files to demonstrate that risks had been assessed and Mid Meadows DS0000017885.V362943.R01.S.doc Version 5.2 Page 18 appropriate support practices implemented in line with moving and handling legislation. Risk assessments seen relating to manual handling were lacking in detail. An example seen did not detail the level of the risk, low, medium or high and the only information given was ‘Transfer to and from bath/shower.’ It went on to say ‘Two members of staff to assist if shower required. Chair needed.’ The inspector sought clarification at the inspection and whilst management and staff were able to surmise what action was required, it was acknowledged that it was not clear what was required. Whilst it is acknowledged that the outcomes for residents are good, the home does need to review their risk assessment procedure to ensure that comprehensive, consistent risk assessments are in place to ensure that staff and residents health and welfare is safeguarded. Medication administration, storage and record keeping was sampled and inspected at the inspection. Medication is held in a medication trolley or Controlled Drug cabinet, which are locked in a cupboard. No Controlled Drugs were said to be held at the home on the day of the inspection. The registered manager confirmed that two residents are self-medicating. Brief risk assessments were in place for these two people and it was said that any additional information would be added. The home was holding medication for four people and they were using Boots the Chemist as their pharmacist. Pre-printed Medication Administration Record (MAR) sheets were used for both auditing purposes and dispensing medication. The practice of decanting medication into small pots before commencing the medication administration round was said to have stopped. The registered manager said that the small pots are used only at the point of administration to avoid staff handling medication or if the individual needs this to assist them with taking their medication. Overall the record keeping and practices seen at the home were good. Record keeping, storage and administration was seen to be in good order. Some recommendations were made around record keeping in line with good practice. The registered manager said that medication training is planned for May 2008. They said that this course was a competence-based training with assessment of competence required on completion. They said that only senior staff give medication. Mid Meadows DS0000017885.V362943.R01.S.doc Version 5.2 Page 19 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 & 23. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home can be assured that their concerns will be listened to and acted upon and that they will be protected from abuse.’ EVIDENCE: Within the home copies of the Complaints Procedure were to be found on display, in the home’s policy and procedure file and within the home’s Service User Guide. As stated earlier in this report copies of the guide are given to each resident. The Complaints Procedure had been updated and revised in March 2008 with the new contact details for the Commission for Social Care Inspection (CSCI). A record of complaints is held in the home’s General Ledger and records were seen of recent complaints and correspondence dating from October 2007 to March 2008. The Commission for Social Care Inspection (CSCI) was aware of these complaints. The issues raised in the complaints were around the quality of care, which had been individually considered and responded to by an Operational Manager. They said that the home had requested a meeting with the complainant, resident and their care manager to fully discuss these issues as there continued to be concerns raised. All three people spoken to at the inspection said that if they had to complain they would raise their concerns with the manager, deputy manager or an Mid Meadows DS0000017885.V362943.R01.S.doc Version 5.2 Page 20 Operational Manager, who was regularly in the home and chaired residents meetings. The home’s adult Protection policy had been updated and detailed the Essex County Council Safeguarding Adults processes. The Operational Managers said that the revised policy had been shared with staff yesterday at the staff meeting. This was confirmed by a staff member. There have been no Safeguarding Referrals made since the last inspection. Two care staff spoken to were aware of the need to make a referral and said that would raise concerns with the registered manager. We were told by the Operational Managers that it is the company’s expectation that all new care staff would be required to complete Safeguarding training within their induction training. Mid Meadows DS0000017885.V362943.R01.S.doc Version 5.2 Page 21 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 & 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: Mid Meadows provides a homely, comfortable and safe environment. A tour of the premises was conducted with the majority of the accommodation viewed. All of the current residents have single ground floor bedrooms with wash hand basins. One person has their own kitchen facilities in their room. Bathing facilities consist of a bathroom with a bath and a bath chair lift, a bathroom with a Parker bath and a shower/wet room. Further accommodation is to be found on the first floor. This is access by a staircase and chair lift and is for more physically independent people. On the first floor there are three single rooms with a lounge and kitchen area. At the Mid Meadows DS0000017885.V362943.R01.S.doc Version 5.2 Page 22 time of this inspection, this accommodation was vacant. There is separate access to this floor via a second front door. The home has an Annual Maintenance Programme in place for 2007 – 2008. This detailed planned repairs and replacements in decoration and refurbishment. The carpeting in the corridors was highlighted in this report and on this inspection it was still seen to need attention for the carpet tiles were seen to be loose, worn and stained in places. The Operational Manager said that this was in hand and had been picked up in their Regulation 26 visit report. This was seen in the March 2008 report and it was stated that carpet for the corridor was on order and to be fitted soon. Furthermore some repairs had been noted in the shower/wet room and on the day of the inspection a new grab rail was installed and a wooden fixing replaced. The Operational Managers said that Mid Meadows no longer has their own maintenance person, but they share the services of another home’s handyman. They are responsible for all of the decoration and repairs as required and they had recently decorated a room ready for a new admission to the home. Communal areas were clean and bright with a main lounge at the rear of the home having access to the enclosed rear garden, a smaller quiet lounge at the front of the home and a small lounge/ desk area where the home has a computer with Internet access. In addition located next to the kitchen there is a dining area. The main laundry facilities are upstairs in the home, and cannot be accessed by residents who are not independently mobile. However, as stated earlier in this report, the home has installed a second washing machine and dryer in a ground floor bedroom. We were told that at least three residents regularly do their own laundry here. Whilst not ideal, the flooring is carpet, it does provide a facility for those residents who wish to do their own laundry and the home will need to consider how they will improve infection control in this area. Mid Meadows DS0000017885.V362943.R01.S.doc Version 5.2 Page 23 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 & 35. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home can be assured that staff will have sufficient skills, knowledge and support to meet all of their needs, but they are not fully supported and protected by the home’s recruitment practices and procedures. EVIDENCE: Senior care staff spoken to at the inspection said that there had been few changes in the staff group. Within the AQAA it was stated that 64 of the care staff have or are working towards a National Vocational Qualification (NVQ) Level 2 in care or above. As stated earlier in this report staffing levels are three on an early shift and two on a late shift with two awake night staff. This is a change from the last inspection to accommodate the needs of residents at night. Care staff during the day and night have to cover care duties and domestic and catering tasks. Mid Meadows DS0000017885.V362943.R01.S.doc Version 5.2 Page 24 From speaking to care staff and the Operational Managers it was clear the staffing levels need to be closely monitored by the registered manager and Black Swan to ensure that activities outside of the home continue to be actively offered, encouraged and available. This is particularly important when additional residents on respite are admitted to the home. On the day of the inspection staffing levels were seen to be sufficient. Three staff recruitment files were sampled and inspected at this inspection. One of these sampled was of the most recent recruited staff member. Some shortfalls were found. These were that there was an incomplete and muddled employment history for the most recent staff member and no second reference was found on the file of another staff member. Both Operational Managers were disappointed to find this and said that these issues should have been picked up before interviews and discussed during with the applicant. They agreed to discuss these matters with the registered manager, for it was recognised that staff recruitment processes must be fully compliant to ensure the safety and welfare of the residents. At the inspection no evidence could be found of the most recent member of staff completing a Skills for Care Induction training pack. However, following the inspection on 1st May 2008, an Operational Manager contacted the Commission for Social Care Inspection (CSCI) to inform us that this had mistakenly been sent to the company’s head office and was completed. Whilst not considered in full, support and supervision for care staff had shortfalls. Whilst there was some evidence of 1:1 supervisions on two staff files, there was no record of any formal 1:1 supervision for the newest recruit since they had started working at the home. Staff team meetings and group supervisions were seen however. The Operational Managers agreed to raise this with the registered manager. Within the staff records and in discussion with staff and management it was evident that there has been some basic training courses in the last year. Care staff confirmed that they had attended Basic First Aid, Basic Food Hygiene, Manual Handling, Fire Safety, Protection of Vulnerable Adults (POVA) and training in Control of substances Hazardous to Health Regulations (COSHH) in 2007 and further planned training such as Medication training was mentioned. Two carers said that they had attended Manual Handling training and on the day of the inspection staff were being instructed in the use of a new wheelchair for a resident. Mid Meadows DS0000017885.V362943.R01.S.doc Version 5.2 Page 25 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 & 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: The registered manager was not on duty on the day of the inspection, although they did come into assist with the inspection during the day. They told the inspector that they had experienced a problem with completing their Registered Manager’s Award (RMA) - NVQ Level 4 in Management, for the company they had signed up with had folded. Mid Meadows DS0000017885.V362943.R01.S.doc Version 5.2 Page 26 The Operational Managers said that they were aware of this problem and intended to ensure that the manager is able to complete her training with another company. They said that they are looking into this for them. The registered manager said that she receives regular support from the directors of the management company and the home has regular visits from two Operational Managers who were present on the day of the inspection. The Operational Managers confirmed that they are responsible for completing the monitoring visits as required under Care Homes Regulations - Regulation 26. The company has devised a new more detailed format for this purpose and copies were seen of the last three months reports. These were found to be greatly improved, for they did detail what was seen, what was to be done and the progress of the work. As at the last inspection the home has a Quality Assurance policy that refers to the quality assurance processes in place in the home, cross-referencing o the National Minimum Standards. This demonstrated that a range of monitoring and development processes were in place, including ways of consulting with residents. The last survey of residents’ views had taken place in January 2008. There were positive responses with regard to catering and food. The Operational Manager said that the company planned to share the outcome of these surveys with the residents at meetings they will call when they visit the home. Following this an action plan would be agreed and followed. The home had 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. These were sampled and evidence was seen of monthly hot water temperature checks completed, monthly visual electrical appliance checks and Portable Appliance Testing (PAT) completed in March 2008. The home is advised to increase the frequency of the hot water temperature checks for on each inspection only one outlet was being checked each month and this resulted in each outlet being checked roughly every fifteen months, which is not sufficient to monitor temperature control. The accident records are held in a ledger of accidents. The most recent entries were inspected and appropriate action and clear records had been made. Mid Meadows DS0000017885.V362943.R01.S.doc Version 5.2 Page 27 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 3 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 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 3 X 3 X X 3 X Mid Meadows DS0000017885.V362943.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations People living in the home should be assured that all of their care needs will be met through the development of care plans which fully detail the action, support required by care staff to support each individual need. People living in the home should be assured that all potential risks to residents would be identified, assessed and clearly recorded, including any measures taken to prevent or minimise risks. People living in the home should have provision of appropriate transport for wheelchair users to enable them to access a range of social and recreational activities as they wish. People living in the home should be assured that their safety is safeguarded through thorough structured recruitment practices, which should include a full comprehensive employment history and a minimum of two written references, including a reference from the last employer. DS0000017885.V362943.R01.S.doc Version 5.2 Page 29 2. YA9 3. YA13 4. YA34 Mid Meadows Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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