Inspection on 16/08/05 for Radcliffe Meadows Mental Nursing Home

This inspection was carried out on 16th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Radcliffe Meadows Mental Nursing... 30/04/09

Radcliffe Meadows Mental Nursing... 30/04/08

Radcliffe Meadows Mental Nursing... 03/01/08

Radcliffe Meadows Mental Nursing... 26/02/07

Radcliffe Meadows Mental Nursing... 27/02/06

Radcliffe Meadows Mental Nursing... 04/02/05

Radcliffe Meadows Mental Nursing... 22/07/04

Radcliffe Meadows Mental Nursing... 08/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Radcliffe Meadows Nursing Home Off Twiss Green Lane Culceth Warrington Cheshire, WA3 4DJ Lead Inspector Anthony Cliffe Unannounced 16 August 2005 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Radcliffe Meadows Nursing Home F51 F01 S5156 Radcliffe Meadows V231063 160805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Radcliffe Meadows Nursing Home Address Off Twiss Green Lane Culceth Warrington Cheshire WA3 4DJ 01925 765550 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) Warrington Community Living Ms June Gilbody Care Home 12 Category(ies) of LD - Learning Disability (12) registration, with number MD - Mental Disorder (1) of places Radcliffe Meadows Nursing Home F51 F01 S5156 Radcliffe Meadows V231063 160805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 The home is registered for a maximum of 12 service users to include: * Up to 12 service users in the category of LD (learning disability excluding dementia). * Up to 1 named service user may be category of MD (mental disorder). 2 Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection. The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 3 Date of last inspection 4th February 2005 Brief Description of the Service: Radcliffe Meadows is a purpose built home providing nursing care for twelve younger adults who have a learning disability. The home is situated close to the local village and is within a short walking distance of a bus service. The philosophy of the home is to enable residents to lead an independent and fulfilling lifestyle by providing opportunities to exercise their rights, and to enjoy the same range of options available to all members of society.The home is a single storey building that provides twelve single bedrooms, three lounges, two dining rooms, a games room, Snoezelun, two bath and shower rooms, four toilets, a laundry, kitchen, and large enclosed gardens to the rear of the property. Radcliffe Meadows Nursing Home F51 F01 S5156 Radcliffe Meadows V231063 160805 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken by a regulatory inspector due to concerns reported in a Regulation 26 visit report undertaken by the registered provider. The report indicated concerns about the protection of vulnerable adults. The concerns raised were not founded and the content of the report was confirmed as being inaccurate. The inspection took place over five hours and feedback was given to the manager at the completion of it. It included inspection of records, observation of staff practice and discussion with residents and staff. What the service does well: What has improved since the last inspection? What they could do better: Provide staff with guidance on the circumstances in which information given in confidence may have to be shared with others. Provide a timescale for the completion of complaints and reassure complainants they will not be victimised. Radcliffe Meadows Nursing Home F51 F01 S5156 Radcliffe Meadows V231063 160805 Stage 4.doc Version 1.30 Page 6 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. Radcliffe Meadows Nursing Home F51 F01 S5156 Radcliffe Meadows V231063 160805 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Radcliffe Meadows Nursing Home F51 F01 S5156 Radcliffe Meadows V231063 160805 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 Residents are fully assessed before moving into the home to ensure the home can meet their identified needs. EVIDENCE: The records of one resident who recently moved into the home were examined. A detailed a pre admission assessment and detailed assessment of need regarding the resident’s associated mental health needs and learning disability was completed. This was supported by a comprehensive assessment and care plan from the resident’s recent admission to hospital for assessment. There was detailed information for other health and social care professionals obtained by staff from Radcliffe Meadows as part of the admission assessment. The information related to the physical and mental health of the resident. There was detailed information and supporting care plans on how the resident’s mobility needs would be met through provision of equipment. It also detailed that the resident had some swallowing problems and advice from a speech and language therapist was present to guide staff on the resident’s nutritional needs, and was supported by a risk assessment. The staff from the resident’s previous accommodation provided information and this was incorporated into the person centred plan. The resident had a planned admission into the home that included visits to the home for meals and overnight stays. The resident was also able to choose the colour scheme and furnishings in her bedroom. Radcliffe Meadows Nursing Home F51 F01 S5156 Radcliffe Meadows V231063 160805 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7, 9 and 10 Residents are consulted about their care plans and their decisions about their lives are acknowledged and not restricted because of risks. Residents’ health and safety needs do not hinder them leading an independent lifestyle. The policy on sharing information with family, friends and professionals needs to be clear in the circumstances confidential information can be shared. EVIDENCE: The purpose of the inspection was discussed with the manager as a serious incident had been identified as part of a Regulation 26 report sent to the Commission. The manager was able to comprehensively demonstrate that an incident had occurred when one of the residents had been physically posturing but not aggressive as a result of staff not acceding to the resident’s demand. As part of a strategy agreed with the police they were informed of the incident and attended the home. No further action was taken and the manager later discussed the incident with the police as part of a plan agreed with them to enable the resident to have safe access into the community. Radcliffe Meadows Nursing Home F51 F01 S5156 Radcliffe Meadows V231063 160805 Stage 4.doc Version 1.30 Page 10 Residents’ care plans contained comprehensive risk assessments and risk management plans to manage residents’ health and social care needs. Risk assessment strategies were in place regarding a residents’ mental health and physical health needs taking account of assessment and information from other professionals involved in the residents’ care. There was evidence that a speech and language therapist had assessed residents. Person centred plans recorded the level of support and supervision that residents needed when accessing leisure and community activities. Where a resident required the supervision of one staff member at all times, there was clear guidance for staff on the level and type of activities the residents could participate in safely, taking account of risks to the resident. An example of this was that a resident was identified as having ‘limited understanding of common dangers when out and about’. The resident was identified as becoming excited when going out in the community, which led to her becoming agitated and walking at speed and being at risk of falling. To support this staff had completed an activities risk assessments and management plans, as there were specific behaviours and risks linked to certain activities. This allowed staff to plan activities with the resident and identify additional resources or staff. The home has a policy relating to confidentiality that complies with the Data Protection Act 1998. The manager stated that residents are verbally informed of the confidentiality policy. Records were kept securely locked in the staff office. Staff job descriptions have a standard statement regarding confidentiality of information. The policy on sharing information with family, friends and professionals remains unclear in the circumstances confidential information would have to be shared. For example if allegations of abuse were made by a resident. This had not been revised as recommended at previous inspections. See Recommendation 1. Radcliffe Meadows Nursing Home F51 F01 S5156 Radcliffe Meadows V231063 160805 Stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12 and 16. Residents are able to participate in the and take responsibility in the running of the home and their responsibilities recognised. EVIDENCE: The manager actively sought the permission of residents to talk about living in the home and some wished to show how they had personalised their bedrooms. Residents were comfortable in discussing their experience of living in the home. A resident introduced himself and asked about the purpose of the inspection visit. He said he was very proud of how he had personalised his bedroom and showed the electrical items he had purchased. His bedroom contained a stereo, television with video and tabletop fridge. The resident said he now liked his bedroom as he could lie on his bed and watch his television and videos. Another resident who works at the home was polishing furniture. She said that she had suggested she have a uniform and chosen one. She said that she still worked in the laundry as well. Another resident asked if he could empty the waste paper bins and them made arrangements to accompany staff to go into the village and purchase food he could prepare for lunch. Radcliffe Meadows Nursing Home F51 F01 S5156 Radcliffe Meadows V231063 160805 Stage 4.doc Version 1.30 Page 12 Residents confirmed that they had keys to their bedrooms. A resident said’ I keep my bedroom clean and polish it sometimes. My mum helps me when she visits or the staff do it’. Staff explained how a resident liked to spend time in her bedroom as it is quiet and she can become easily agitated by other residents. Staff frequently knocked and entered the resident’s bedroom and spent time with her. The hairdresser was visiting and talked about her involvement with residents. She said she had been visiting the home for six years and had developed lasting relationships with the residents. She said she enjoyed visiting and working at the home and this had prompted her to do her nurse training. She was very knowledgeable about the residents and gave examples of how she worked with residents who are learning disabled. She gave an example of how she supported a resident to choose her own hairstyle, which was normally done by her mother. She said she liaised with staff and used her relationship with the resident to let her decide when she wanted her hair done. She said ‘I know when she agrees to do something you have limited time and your timing must be right. I know when the time is right or staff will tell me. If she doesn’t want her hair done I leave it, it’s up to her’. Radcliffe Meadows Nursing Home F51 F01 S5156 Radcliffe Meadows V231063 160805 Stage 4.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 Residents are supported to maintain their health and welfare. EVIDENCE: Residents’ health and emotional needs are met with staff support. There were examples of residents being referred to specialist NHS services and treatment and advice from staff in the local Primary Care Trust. A resident’s health deteriorated and blisters developed on his skin. The advice and guidance from the tissue viability nurse and district nurse were sought. The district nurses initially treated the blisters following advice from the tissue viability nurse. A care plan was in place from the district nurse and as the blisters improved staff from the home were dressing them in accordance with it. A wound management chart was also being used to detail how the blisters were improving. Another resident required eye surgery and there were details of how the resident was supported to attend consultation for the operation. Staff were available to support the resident during the treatment. A resident who is severely physically disabled and cannot communicate his needs developed an autoimmune disease and secondary infection. Records demonstrated that the skill mix of staff at the home was able to support the resident during this period. The resident’s general practitioner monitored the resident’s health. Staff continue to monitor the resident’s temperature, as this is the indicator if he is unwell, as he cannot communicate to staff. The resident was referred to the dietetic services due to weight loss associated with the condition. Another resident is diabetic and has problems with eating. Radcliffe Meadows Nursing Home F51 F01 S5156 Radcliffe Meadows V231063 160805 Stage 4.doc Version 1.30 Page 14 The speech and language therapist is involved in the resident’s care. Staff continue to monitor the resident’s diabetes. The community mental health services are involved with several residents who have associated mental health problems. There were details of routine contact with the psychiatric services. Consent for staff to administer medicines, monitor blood sugar and routine blood tests are sought from residents their relatives or representative. Radcliffe Meadows Nursing Home F51 F01 S5156 Radcliffe Meadows V231063 160805 Stage 4.doc Version 1.30 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 The complaints policy needs to inform complainants that complaints will be promptly acted upon and complainants will not be victimised. EVIDENCE: The complaints policy has not been amended as recommended at previous inspection visits. The complaints policy place does not have a timescale for the resolution of a complaint or assure residents and their families they would not be victimised for making a complaint. See recommendation 2. Radcliffe Meadows Nursing Home F51 F01 S5156 Radcliffe Meadows V231063 160805 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25, 27, 29 and 30 Residents live in a comfortable, clean and safe environment, which is equipped to meet their needs and promote their independence. EVIDENCE: Three domestic staff were on duty. The building and several bedrooms were looked at. The building was clean and hygienic. The environment has been improved to benefit residents’ comfort and safety. Four bedroom doors have been replaced. These are fire doors are fitted with free swinging closures and open outward in case of emergency. Access to a bathroom and toilet has been improved for wheelchair access with a full and half door fitted. The layout of a bathroom has been altered to allow easier access. This was re tiled and a raised toilet fitted. Grab rails in a contrasting colour had been fitted along with a new Gainsborough bath with hydraulic bath chair. The television room had been decorated along with the main corridor. A patio door had been replaced from a sliding to an opening door to allow wheelchair access. Passive infra red detectors had been fitted in toilets and bathrooms and the shower room. These activate the lights at night, so if a resident walks into these areas the lights come on automatically. The manager said this has been successful in reducing accidents at night, as residents going into these areas are nit at risk of falling. Radcliffe Meadows Nursing Home F51 F01 S5156 Radcliffe Meadows V231063 160805 Stage 4.doc Version 1.30 Page 17 This has helped a resident to go to the toilet independently at night. Previously he did not switch the light on and was at risk of falling. He now has the confidence to use the toilet independently. Radcliffe Meadows Nursing Home F51 F01 S5156 Radcliffe Meadows V231063 160805 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 A competent and appropriately trained staff team cares for residents. EVIDENCE: The registered manager confirmed the figure for the annual training budget. The registered provider had a core-training programme in operation that included health and safety and first aid. The home use an induction checklist and staff register for the Learning Disability Award Framework (LDAF). Once registered staff are supervised through the LDAF by an assessor. The home had an agreement with a training provider for the LDAF. Once completed staff are then registered for an NVQ. Staff had an appraisal and development plan. Staff training was recorded. Between September and November 2004 staff attended the local authority adult protection procedure. There is a lead nurse in the home for adult protection and completed cascade training to staff on 8th May and 9th August 2005. Further training was planned for September 2005. Radcliffe Meadows Nursing Home F51 F01 S5156 Radcliffe Meadows V231063 160805 Stage 4.doc Version 1.30 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 and 38 There is leadership guidance and direction in the home to ensure residents receive consistent quality care. EVIDENCE: Staff interviewed were positive about the standard of care that residents receive and the management of the staff team. The visiting hairdresser said ‘ I am part of the staff team when I visit I get an update on residents I am involved with to make sure I am aware of any safety issues’. Radcliffe Meadows Nursing Home F51 F01 S5156 Radcliffe Meadows V231063 160805 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x x x x Standard No 22 23 ENVIRONMENT Score 2 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x 3 x 3 3 Standard No 11 12 13 14 15 16 17 3 3 x x x 3 x Standard No 31 32 33 34 35 36 Score x x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Radcliffe Meadows Nursing Home Score x 3 x x Standard No 37 38 39 40 41 42 43 Score 3 3 x x x x x F51 F01 S5156 Radcliffe Meadows V231063 160805 Stage 4.doc Version 1.30 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 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. 2. Refer to Standard YA10 YA22 Good Practice Recommendations The policy on confidentiality should include guidance to staff on when a confidence may be shared. The complaints policy should be amended to include a timescale for the resolution of a complaint and to assure residents and their families they will not be victimised for making a complaint. Radcliffe Meadows Nursing Home F51 F01 S5156 Radcliffe Meadows V231063 160805 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Unit D, off Rudheath Way Gadbrook Park Northwich Cheshire, CW9 7LT 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 Radcliffe Meadows Nursing Home F51 F01 S5156 Radcliffe Meadows V231063 160805 Stage 4.doc Version 1.30 Page 23 - 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. 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