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Inspection on 04/10/05 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 4th October 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

The service users spoken to were very complimentary about the staff. The comments made included `very good` and `absolutely marvellous`. Another said `The staff are lovely and I have no complaints`. Relatives generally felt that they can approach the acting manager to discuss their concerns and that she deals with them promptly.

What has improved since the last inspection?

Staff spoken to felt that the support now offered to them by the company and the acting manager had resulted in a major improvement in staff morale. They felt that this in turn had led to a more relaxed atmosphere, making it `more of a home for service users`. All staff involved in the administration of medications have been updated with regard to the procedures to follow. The management of medications is now of an acceptable standard an acceptable standard. There has been some improvement in the environment where refurbishment has commenced, however this work must continue to provide an acceptable standard throughout the home. An activities co-ordinator has recently been appointed. Service users spoken to said that it makes daily life more enjoyable.

What the care home could do better:

13 requirements have been made as a result of this inspection. 2 requirements were with regard to fire safety. An immediate requirement notice was left at the home on the first day of the inspection telling them what they must do to address this. Although it is acknowledged that there has been some improvement in the assessment and care planning documentation, further work is required to demonstrate that service users have been consulted with regard to their care and to ensure that all of their needs are met. One service user spoken to said that his food portions were not always adequate. This was discussed with the chef on the first day of inspection who said he would speak to the gentleman immediately and consult all service users on a regular basis. Not all staff have received training in abuse. This must be addressed. All staff must receive training in the management of abuse, dementia care and challenging behaviour. The refurbishment programme must continue and be completed so that all areas are of an acceptable standard. Although staff are supervised on a daily basis, all staff must receive formal supervision on a daily basis. The ongoing review of policies and procedures needs to be completed. 1 recommendation has also been made as a result of this inspection. Whilst it is acknowledged that the company have checked that the radiator guards are not a health and safety issue, replacement of these should be considered to provide a more homely environment.

CARE HOMES FOR OLDER PEOPLE Queens Meadow Care Home 327 Stockton Road Hartlepool TS25 5DA Lead Inspector Mrs Sue Lowther Announced Inspection 09:30 4th October 2005 & 1 November 2005 st X10015.doc Version 1.40 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 Queens Meadow Care Home DS0000000181.V253969.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Queens Meadow Care Home DS0000000181.V253969.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Queens Meadow Care Home Address 327 Stockton Road Hartlepool TS25 5DA 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) 01429 267424 01429 868366 T L Care Ltd Care Home 61 Category(ies) of Dementia - over 65 years of age (31), Old age, registration, with number not falling within any other category (30) of places Queens Meadow Care Home DS0000000181.V253969.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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. 10th May 2005 Date of last inspection Brief Description of the Service: The home was purpose built in 1991.Accomodation is provided for up to 61 older people who require help with personal care. There are two units with upstairs providing care to older persons who also have dementia. The home is situated close to Hartlepool Town centre. It stands in it’s own grounds and there are spacious lounge and dining areas available. Queens Meadow Care Home DS0000000181.V253969.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. By law we have to inspect all care homes at least twice a year. This announced inspection was carried out in accordance with this obligation. The inspection took place over 2 days on 4th October & 1st November 2005. 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 were assessed during the last inspection of the home. Two inspectors, Sue Lowther & Tanya Newton, carried out the inspection. They looked around the building and a number of records were examined. 12 service users, the acting manager, 9 members of staff and 8 visitors were spoken to during the course of the inspection. What the service does well: What has improved since the last inspection? Staff spoken to felt that the support now offered to them by the company and the acting manager had resulted in a major improvement in staff morale. They felt that this in turn had led to a more relaxed atmosphere, making it ‘more of a home for service users’. All staff involved in the administration of medications have been updated with regard to the procedures to follow. The management of medications is now of an acceptable standard an acceptable standard. There has been some improvement in the environment where refurbishment has commenced, however this work must continue to provide an acceptable standard throughout the home. An activities co-ordinator has recently been appointed. Service users spoken to said that it makes daily life more enjoyable. Queens Meadow Care Home DS0000000181.V253969.R01.S.doc Version 5.0 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. Queens Meadow Care Home DS0000000181.V253969.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Queens Meadow Care Home DS0000000181.V253969.R01.S.doc Version 5.0 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 the following standard(s): 1,2, 3, 4 & 5 The assessment process could be further improved to demonstrate how the home will meet the individual needs of the service users placed. The home do not provide intermediate care therefore assessment of standard 6 is not required. EVIDENCE: The statement of purpose and service user guide has been reviewed and updated to reflect the recent changes within the home. The terms and conditions document was reviewed and found to contain the information outlined in the regulations. The assessments viewed during the inspection had improved slightly since the last inspection, however some were not up to date and there were still gaps in the recording of information despite the recommendation made in the previous inspection report of the home. As stated in the previous report assessments form the basis from which the individual plan of care will be 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 Queens Meadow Care Home DS0000000181.V253969.R01.S.doc Version 5.0 Page 9 possible service users and/or their relatives should be involved in the assessment process. One of the people who had recently gone to live in the home confirmed that she had visited and looked around the home before she decided whether or not she wanted to live there. Queens Meadow Care Home DS0000000181.V253969.R01.S.doc Version 5.0 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 the following standard(s): 7, 8 & 9 The views of service users should be sought when care planning to ensure that their needs and wishes are identified and met. EVIDENCE: Although some work has been done to improve the care plans they still do not contain all of the information to ensure that all aspects of physical, emotional, social care and psychological needs are identified and planned for. Six care plans were audited; care plans detail how the home will meet individual service users needs, there is some evidence to demonstrate that some of these care plans are being reviewed regularly, not all of them had been reviewed over recent months. The home said that it is trying to involve service users/relatives within the care planning process; this should be evidenced within care plans. There is some evidence that service users health needs are being met; district nurses visit the home where it is required. Records kept by the home need to improve to evidence this further. Most residents spoken to said they were well looked after. Queens Meadow Care Home DS0000000181.V253969.R01.S.doc Version 5.0 Page 11 A review of medications confirmed that MAR sheets (medication sheets) were now being recorded properly; this provides an audit trail of medication given to service users. Staff involved in the administration of medication have had further training. Standard 11 was not reassessed on this occasion however relatives who were sitting with a service user who was extremely ill were very complimentary with regard to the care their relative was receiving and the support that staff were offering them. Queens Meadow Care Home DS0000000181.V253969.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14 & 15 An activities co-ordinator organises events, which provides stimulation and interest for people living at the home. Relatives and friends can visit at any time. EVIDENCE: The home recently employed an activity co-ordinator who provides a range of activities to residents. She had started this job on the first day of the inspection and was extremely enthusiastic about her plans. Residents spoken to on the second day of the inspection felt that the provision of activities had improved the quality of their lives. Several service users confirmed that they can get up and go to bed when they wish. Evidence must be available within the care plan to confirm that they have been consulted with regard to their care. Visitors were observed coming in and out of the home, visitors spoken with confirmed that they could visit at any time and contact with relatives is encouraged by the home. Comments about the food were in the main good residents get offered a choice, however one person felt that sometimes the portions offered were not large enough and that he was not given the opportunity to have extra. This was discussed with the cook on the first day of Queens Meadow Care Home DS0000000181.V253969.R01.S.doc Version 5.0 Page 13 inspection. He told the inspector that this had not been brought to his attention and said he would talk to the people who live there on an individual basis. Queens Meadow Care Home DS0000000181.V253969.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 16 & 18 Complaints and adult protection systems in the home serve to safeguard service users. EVIDENCE: Information about complaints, how and who to make them to, is made available to service users and their families through information displayed in the main entrance and in the home’s ‘Service Users Guide’. 2 relatives confirmed on the feedback cards that they are aware of the procedure to follow. 2 were unsure. The acting manager informed the inspector that she would reinforce this when speaking to relatives. The people who live in the home said that they would know who to speak to. The records of recent complaints made to the home were looked at. These demonstrated that the home is now dealing with them more effectively. The CSCI have not been approached with any new complaints. However at the time of inspection the 4 mentioned in the previous inspection report had not been concluded. Service users’ views are obtained through regular contact and an ‘open door policy’. Staff interviewed voiced a commitment to the service users they work with and to upholding service users’ rights. A number of the staff interviewed said they had received training relating to whistle-blowing and adult protection within their NVQ training programme. All staff must be trained in what to do should an allegation of abuse occur. The acting manager told the inspector that this is planned for staff not already trained. Queens Meadow Care Home DS0000000181.V253969.R01.S.doc Version 5.0 Page 15 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 the following standard(s): 19, 20, 24 & 26 The standards in parts of the environment have improved; however work needs to continue in this area. EVIDENCE: During a tour of the building the inspector could see improvements in some areas, which have been refurbished with new furniture. This programme of refurbishment needs to continue to provide a safe and well-maintained environment for all service users. The area manager said that she had been advised that the company had checked that the radiator guards were appropriate in terms of health and safety. This information is required in writing. However replacement of these is still recommended to provide a more homely environment. A number of bathrooms required attention with regard to grouting. Several door frames and skirting boards were scuffed. Staff said that this was a result of wheelchairs catching and were often scuffed even when they had just been painted. This issue must be reviewed on a regular basis. Door locks were not provided for all of the rooms. The inspector was advised that some service users had said that they did not want them and that some may not be able to Queens Meadow Care Home DS0000000181.V253969.R01.S.doc Version 5.0 Page 16 use them. This must be recorded in the care plan. A risk assessment must be undertaken with regard to this and discussed with the service user and their relative or significant other. The care plan must also contain evidence that a risk assessment is undertaken where a service user has behaviour problems because of their dementia and as a result frequently damage furniture and pull off wallpaper etc. Frequent audits of these areas are required and alternative items of furniture considered if they are damaged on a regular basis. Where someone wants to keep an item of their own furniture which is damaged a risk assessment must also be undertaken and the issue discussed with the family and service user. Again this must also be recorded in the care plan. There were no apparent odours on the day of inspection. Queens Meadow Care Home DS0000000181.V253969.R01.S.doc Version 5.0 Page 17 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 There are sufficient staff on duty to meet the need’s service users. Appropriate recruitment procedures are in place. EVIDENCE: Examination of duty rotas indicated that there are 6 staff on duty throughout the day on the upstairs unit and 4 staff on the downstairs unit. There is a minimum of 1senior supervisor in the home throughout the day and there is a supervisor on each unit throughout the day. At night there is a supervisor and a carer on each floor with a carer floating between the two floors. Staff spoken to confirmed that this is adequate. The home had staff files in place, which provided evidence that the appointment of a new staff member is made through proper recruitment processes. This includes the vetting of staff through the use of references, POVA first checks and Criminal Record Bureau (CRB) checks. There is a commitment at the home to having a trained workforce with 17 out of the 32 care staff having completed NVQ level 2 or 3 training in care. Staff said they found the training helpful in improving their day-to-day practice. Recent training has included fire safety, care planning, administration of medication, health and safety, risk assessments and food hygiene. The acting manager advised that training in abuse, dementia and challenging behaviour is planned. Queens Meadow Care Home DS0000000181.V253969.R01.S.doc Version 5.0 Page 18 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 36 & 38 Health and Safety practices in the home may potentially place service users at risk. EVIDENCE: The home has an acting manager in place who has made application to be registered with the CSCI. She has previously managed a care home in another setting and has commenced an appropriate management qualification. She had only taken up post and therefore a full assessment of Standard 31could not be undertaken. The CSCI are aware that the acting manager is currently well supported by the area manager who visits on a frequent basis and carries out regular audits. These audits must be recorded and the CSCI must be provided with a Regulation 26 visit report. Queens Meadow Care Home DS0000000181.V253969.R01.S.doc Version 5.0 Page 19 There was an open, friendly culture between the management team and the staff at the home, and staff said they now felt very well supported in their work Relatives spoken to felt that the acting manager was very approachable and has made significant improvements within the home. Although staff said they are supervised on a regular basis, they were unsure about formal supervision. The acting manger had only recently commenced working at the home but could produce evidence to confirm that this had commenced, and all staff should have their first session within the near future. There are no outstanding issues from environmental health inspections. However there was one outstanding issue following the fire and rescue services inspection. This resulted in an immediate requirement notice being issued, which meant that the home had to have the work done within 28days of the notice. In addition staff spoken to on the dementia unit were not aware of the alternative action that they needed to take until the work was completed. The procedure to follow was put in place that day and the area manager told the inspectors that all staff would be advised of this at the beginning of each shift. At the second visit, it was confirmed by the acting manager that the work had been completed and she had advised the fire service of this. Records with regard to checks were available from September 2005. However the previous handyman had left the home and records before September could not be located. The policies and procedures have recently been reviewed by the company and are currently being updated. Queens Meadow Care Home DS0000000181.V253969.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 X X X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X 2 X 1 Queens Meadow Care Home DS0000000181.V253969.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3OP4OP 7OP8 Regulation 14(1)(b) 15(1)(2) 17 & Schedule 2 Requirement 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). (Previous requirement-timescale of 30/09/05 not met). The care plans must contain evidence that service users have been consulted with regard to their care. The home must consult service users on an individual basis with regard to the size of food portion preferred. The Registered Person must ensure that all staff receive training on abuse and the correct reporting procedure to follow (Previous requirement -timescale of 30/09/05 not met). The programme of refurbishment must continue to provide an adequate standard of accommodation for all service users. Timescale for action 31/12/05 2 OP7OP14 15 31/01/06 3 OP15 16 04/10/05 4 OP18OP30 12(1) & 13(6) 31/01/06 5 OP19OP24 13, 16 & 23 31/01/06 Queens Meadow Care Home DS0000000181.V253969.R01.S.doc Version 5.0 Page 22 6 OP19OP26 13, 16 & 23 7 OP30 13 8 9 OP33 OP36 26 18(2) 10 11 OP38 OP38 17 & Schedule 4 13 12 OP38 23 13 OP38 23 Where service users have behaviour problems and damage furniture on a regular basis, a plan must be in place to ensure that this is repaired or removed immediately. All service users must be provided with locks on bedroom doors. Information must be available within care plans to confirm where a service user has requested not to have one. Where a discussion has taken place and a service user is considered to not able to use one, this information must also be contained in the plan. Staff training with regard to dementia and challenging behaviour must be implemented. (Previous requirement-timescale 0f 30/09/05 not met) The CSCI must be provided with Regulation 26 reports on a monthly basis. A formal system for staff supervision must be implemented. (Previous requirement-timescale of 31/10/05 not met) The Registered Person must ensure that maintenance records are available for inspection. The review and update of the policies and procedures must be completed.(Previous requirement-timescale of 31/10/05 not met) To make safe cavity barrier as instructed by the fire officer. Immediate requirement notice issued. To ensure staff and resident safety via amendment to current evacuation procedure. Immediate requirement notice issued DS0000000181.V253969.R01.S.doc 31/01/06 31/01/06 31/12/05 31/12/05 31/01/06 31/01/06 01/11/05 04/10/05 Queens Meadow Care Home Version 5.0 Page 23 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 24 Good Practice Recommendations It is recommended that the home replace the radiator guards to provide a more homely environment for service users Queens Meadow Care Home DS0000000181.V253969.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Darlington Area Office 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. 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