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Inspection on 10/05/05 for Queens Meadow Care Home

Also see our care home review for Queens Meadow Care Home for more information

This inspection was carried out on 10th 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Some of the staff were described as being very friendly, thoughtful, caring and good at interacting with service users.

What has improved since the last inspection?

The previous inspector had recommended a review of the dining room furniture. This had been replaced with new furniture, which was considered to be domestic in nature. The dining area upstairs had been changed and staff and relatives confirmed that this was more appropriate to meet the needs of service users.

What the care home could do better:

Care planning within the home should be more consistent to ensure that all staff are aware of how to look after all of the people in the home. The recording of medication needs to be monitored to ensure they are safely managed and administered. An official letter was left at the home to tell the owner to attend to this immediately or enforcement action would be taken. Complaints must be looked into properly so that the person who makes the complaint feels that they have been listened to. All rooms throughout the home need to be audited by the operations manager and an action plan drawn up to address the issues with regard to furniture.

CARE HOMES FOR OLDER PEOPLE Queens Meadow Care Home 327 Stockton Road Hartlepool TS25 5DA Lead Inspector Susan Lowther Unannounced 10 & 17 May, 7 & 8 July & 5 August 2005 th th th th th 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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. B54 S181 Queens Meadow V219845 290405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Queens Meadow Care Home Address 327 Stockton Road Hartlepool TS25 5da 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) 01429 267424 01429 868366 T L Care Limited CRH 61 Category(ies) of OP Old age, not falling within any other category registration, with number DE(E) Dementia - over 65 years of age of places B54 S181 Queens Meadow V219845 290405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: One named individual who is under the age category is allowed to reside in the home. One specified bedroom to be used to allow service users under the age of 65 years to have periods of rolling respite care. Date of last inspection 22/11/04 Brief Description of the Service: The home was purpose built in 1991. Accomodation for up two 61 sevice users is provided in a two storey building. There are two units which both provide personal care, however downstairs is for older persons whilst upstairs provides care for older persons with dementia. The home is situated close to Hartlepool Town Centre. It stands in its own grounds and there are spacious lounge and dining areas available. B54 S181 Queens Meadow V219845 290405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. CSCI has a statutory duty to inspect all care homes at least twice a year. This unannounced inspection was carried out in accordance with this duty. The inspection took place over 13hours on the 10th& 17th May, 7th & 8th July & 5th August. Two inspectors carried out the inspection of the home and time was spent talking to service users, staff and relatives. Records were examined and a tour of the building took place. The requirements in the previous inspection report of the home were the main focus of this inspection. In line with current CSCI policy on Proportionality, the inspection focused upon a number of key standard outcomes for service users. The key standard outcomes not inspected on this occasion will be raised during the next inspection of the home. What the service does well: What has improved since the last inspection? The previous inspector had recommended a review of the dining room furniture. This had been replaced with new furniture, which was considered to be domestic in nature. The dining area upstairs had been changed and staff and relatives confirmed that this was more appropriate to meet the needs of service users. B54 S181 Queens Meadow V219845 290405 Stage 4.doc Version 1.30 Page 6 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. B54 S181 Queens Meadow V219845 290405 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection B54 S181 Queens Meadow V219845 290405 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3&4 Sufficient information is given to prospective service users within the Statement of Purpose and Service User Guide to help them make an informed decision about moving into Queens Meadow Care Home. Appropriate assessment procedures are in place. EVIDENCE: Copies of the Statement of Purpose and Service User Guide were available within the reception area of Queens Meadow Care Home along with a copy of the home’s most recent inspection reports. Copies of the Terms and Conditions document was viewed within service user documentation and contained all of the information required. Assessments from Care Managers are obtained for all new admissions funded by the Local Authority. The home also carries out its own assessments on service users; some of the areas within these were blank, not all had a completed social assessment and risk assessments were not fully completed. Assessments form the basis from which the individual plan of care will be B54 S181 Queens Meadow V219845 290405 Stage 4.doc Version 1.30 Page 9 written and demonstrate how the home will meet an individuals needs. The information provided within assessments must cover all areas of physical, social, emotional and psychological needs. Where possible service users and/or their relatives should be involved in the assessment process. Queens Meadow does not currently provide intermediate care and therefore assessment of Standard 6 is not required. B54 S181 Queens Meadow V219845 290405 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10&11 Service users views should be sought when care planning to ensure that the needs and wishes of service users are identified and met. At the time of this inspection medication was not always being managed correctly, with some practices considered to be unsafe. EVIDENCE: Five care plans were reviewed during the inspection. The care records examined did not contain plans to meet all of the needs identified in the assessment. One service user who had been recently admitted had an incomplete assessment and no care plans available. Staff confirmed that the needs of these people were being met even though there was a lack of clear plans. This approach is dependant on informal communication systems. Residents are at risk of not having their needs met if these informal systems break down. Where appropriate, plans contained some evidence of input from other health care professionals. B54 S181 Queens Meadow V219845 290405 Stage 4.doc Version 1.30 Page 11 During the inspection it became evident that the recording and administration of drugs was not always being managed correctly and was therefore a potential risk to the health and wellbeing of service users, which resulted in immediate requirements being implemented on the home. These shortfalls included numerous occasions where medication had not been signed for and the audit trail could not confirm whether these had been given or not and numerous occasions where medication had been omitted because stocks had run out. A review of these on the last day of inspection 05/08/05 identified that appropriate action had been taken. Service users spoken to confirmed that staff treat them with dignity and respect and always knock before entering their rooms. This was observed during the inspection process. Policies are available for staff to consult with regard to death and dying and specialist services are utilised when required. No concerns were raised during interviews with service users, staff or visitors and no adverse observations were made during the inspection process. B54 S181 Queens Meadow V219845 290405 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards/outcomes area were not assessed during the course of this inspection. They will be examined at the next inspection EVIDENCE: B54 S181 Queens Meadow V219845 290405 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16&18 The home has a complaints policy, which was not being utilised effectively. EVIDENCE: There are 4 complaints currently being investigated under the locally agreed protection of vulnerable adult procedures with the Department of Social Care and Health taking the lead role with input from the CSCI and the Registered Person for the home when required. These revolve in the main around communication, care practices and environmental issues. The home need to take further action to encourage staff and service users to raise concerns directly within the service and to take the appropriate action in recording and investigating complaints. All staff must receive training in adult protection, which should include whistle blowing. B54 S181 Queens Meadow V219845 290405 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,24&26 The quality of furniture and fittings in some areas was found to be poor and potentially dangerous placing service users and relatives at risk of injury. EVIDENCE: During a tour of the building radiator guards were found to be of a type where service users could still touch the surface. Although it was noted that service users could personalise their own rooms, some of the furniture provided by the company was noted to require urgent replacement. For example fronts were missing from drawers and some handles of furniture broken resulting in sharp edges, which could cause injury to service users and visitors. There were no unpleasant odours apparent on any of the visits. B54 S181 Queens Meadow V219845 290405 Stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29&30 Staff morale was low resulting in some staff turnover and sickness which led to a lack of consistency of care to service users. Staff training required updating in several areas. EVIDENCE: There had been some staff turnover due to the Registered Manger’s recent resignation. The Operations Manger in charge of the home had found it necessary to review staff rotas, and roster staff according to their skills and knowledge, to meet service user need. This had resulted in resistance from some members of staff, however by the final day of inspection staff confirmed that they felt much more supported and a more relaxed atmosphere was apparent to the inspector. As identified in other areas of this report, staff training with regard to dementia, challenging behaviour, abuse and the administration of medications must be updated on a regular basis B54 S181 Queens Meadow V219845 290405 Stage 4.doc Version 1.30 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,35, 36&38 The Operations Manager had a good understanding of the areas in which the home needs to improve. Considerable planning was in place, indicating how this improvement was going to be resourced and managed. EVIDENCE: The registered manager left the home on 12th May 2005 and the Operations Manager for the company is covering on a temporary basis. The company have advised that a full time manager will commence on the 4th September 2005 with support from the Operations Manager to ensure that standards improve and requirements are met. A random check on some of the financial records was carried out, records were well maintained and accurately recorded. B54 S181 Queens Meadow V219845 290405 Stage 4.doc Version 1.30 Page 17 The supervision arrangements in the home are carried out on a daily basis , but the implementation of a formal system is outstanding. Policies and procedures were under review by the Operations Manager. B54 S181 Queens Meadow V219845 290405 Stage 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION 2 2 x x x 2 x 3 STAFFING Standard No Score 27 x 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 2 x 3 x 3 2 x 2 B54 S181 Queens Meadow V219845 290405 Stage 4.doc Version 1.30 Page 19 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 OP 3,4,7 & 8 Regulation 14(1)(b), 15(1)&(2) 17 & Schedule 2 13 & 17 Requirement Timescale for action 30/09/05 2. OP 9 Comprehensive assessments must be undertaken upon admission and care plans formulated for all service users. These must be reviewed on a regular basis (at least monthly). 05/08/05 (i) To ensure that an adequate supply of all prescribed medicines is available at all times for all service users. (ii) To ensure that full and accurate records are maintained of all medicine receipt, administration and disposal in accordance with published guidance.. (iii) To ensure that medicines are administered to service users in accordance with the prescriber’s directions (Medicine’s Act 1968). The service must take the 31/08/05 appropriate action in recording and investigating complaints. The Registered person must 30/09/05 ensure that all staff receive training on abuse and the correct reporting procedures.(Previous requirement-Timescale of 31/12/04 unmet. Version 1.30 3. 4. OP 16 OP 18 22 12(1)& 13(6). B54 S181 Queens Meadow V219845 290405 Stage 4.doc Page 20 5. OP 19 13 & 23 6. 7. OP 29 OP30 18,19 & Schedule 4 13 8. OP 31 8&9 9. 10. OP 36 OP 38 18(2) 13 A review of radiator guards is required to ensure they comply with current health and safety guidelines. Staff files must contain all of the requirements outlined in the regulations. Staff training with regard to dementia, challenging behaviour, abuse and the administration of medications must be implemented. The company must ensure that the proposed manager makes application to be registered with the CSCI. A formal system for staff supervision must be implemented. The Registered Person must review and update the full range of policies and procedures. 30/09/05 30/09/05 31/10/05 31/10/05 31/10/05 31/10/05 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 20 & 24 Good Practice Recommendations The registered person should make arrangements for an audit of all bedroom furniture and consider the replacement of wardrobes, headboards and drawers in rooms where issues are identified. B54 S181 Queens Meadow V219845 290405 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection No 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS 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. Extracts may not be used or reproduced without the express permission of CSCI B54 S181 Queens Meadow V219845 290405 Stage 4.doc Version 1.30 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!