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Inspection on 27/02/06 for Radcliffe Meadows Mental Nursing Home

Also see our care home review for Radcliffe Meadows Mental Nursing Home for more information

This inspection was carried out on 27th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

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

Radciffe Meadows encourages residents to participate in the daily running of the Home through an Action Group. Efforts are made to make residents feel part of the local community, using local facilities and attending local events. Staff help residents to maintain family relationships and the Registered Manager stated that intimate relationships would be supported appropriately. The food provided is varied and appealing, with new tastes and textures regularly introduced. Personal care is offered in a discreet and dignified manner. Medication procedures are appropriate and records up to date and accurate. Staff are trained appropriately regarding adult protection and residents are further protected by the use of clear and appropriate procedures and access to advocacy services. Staff are recruited following appropriate procedures and residents are encouraged to give feedback on potential recruits. Staff are formally supervised at Radcliffe Meadows and supervision is linked to the appraisal process. Health and Safety procedures at Radcliffe Meadows are in good order.

What has improved since the last inspection?

Reviews are taking place of policies and procedures, including complaints and confidentiality policies.

What the care home could do better:

The Service User Guide could be improved so that it is more accessible to residents. Although the medication procedure is in good order, discussion should take place with regard to introducing a monitored dosage system.The quality assurance procedure should be further developed so that residents are able to contribute their views appropriately. An annual development plan should be completed.

CARE HOME ADULTS 18-65 Radcliffe Meadows Mental Nursing Home Off Twiss Green Lane Culcheth Warrington Cheshire WA3 4DJ Lead Inspector Jayne Telfer Unannounced Inspection 27th February 2006 09:00 Radcliffe Meadows Mental Nursing Home DS0000005156.V262168.R01.S.doc Version 5.0 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 Radcliffe Meadows Mental Nursing Home DS0000005156.V262168.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 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. Radcliffe Meadows Mental Nursing Home DS0000005156.V262168.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Radcliffe Meadows Mental Nursing Home Address Off Twiss Green Lane Culcheth Warrington Cheshire WA3 4DJ 01925 765550 01925 767636 june@radcliffemeadows.com 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) Warrington Community Living Ms June Gilbody Care Home 12 Category(ies) of Learning disability (12), Mental disorder, registration, with number excluding learning disability or dementia (1) of places Radcliffe Meadows Mental Nursing Home DS0000005156.V262168.R01.S.doc Version 5.0 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). 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. 4th February 2005 2. 3. Date of last inspection 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 Mental Nursing Home DS0000005156.V262168.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a short, unannounced inspection. It looked at standards which were not examined during the previous detailed inspection. A tour of the home was completed, files and other documents examined. Staff and residents were both observed and spoken with. Discussions took place with the Registered Manager What the service does well: What has improved since the last inspection? What they could do better: The Service User Guide could be improved so that it is more accessible to residents. Although the medication procedure is in good order, discussion should take place with regard to introducing a monitored dosage system. Radcliffe Meadows Mental Nursing Home DS0000005156.V262168.R01.S.doc Version 5.0 Page 6 The quality assurance procedure should be further developed so that residents are able to contribute their views appropriately. An annual development plan should be completed. 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 Mental Nursing Home DS0000005156.V262168.R01.S.doc Version 5.0 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 Radcliffe Meadows Mental Nursing Home DS0000005156.V262168.R01.S.doc Version 5.0 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 the following standard(s): 1 The Statement of Purpose and Service User Guide provide information to prospective residents, but need to be reviewed and presented in a more accessible way. EVIDENCE: The Statement of Purpose and Service User Guide contain all information required in the standards. It is recommended that the Service User Guide be reviewed so that it is accessible to all residents. The Registered Manager stated that she had started to look at producing some information in pictorial form and this would be a good way of presenting information. See Recommendation 1 Radcliffe Meadows Mental Nursing Home DS0000005156.V262168.R01.S.doc Version 5.0 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 the following standard(s): 8 Residents are encouraged to participate in the day to day running of Radcliffe Meadows. EVIDENCE: Residents are encouraged to become part of Radcliffe Meadow’s Action Group and attend their meetings. The group meets regularly to discuss the running of Radcliffe Meadows and gives residents a forum to voice opinions, have information shared and make decisions. Residents are asked for feedback about staff during the recruitment process. Residents are encouraged to participate in their own plan of care and reviews. Where limitations have been imposed, residents have a clear understanding of the reasons and what the limitations are. Residents are seen to access the Registered Manager and other staff, as they need to, to discuss issues of concern to them. A recommendation in the previous inspection regarding confidentiality is being addressed when the directors of Radcliffe Mews meet to discuss policy review. Radcliffe Meadows Mental Nursing Home DS0000005156.V262168.R01.S.doc Version 5.0 Page 10 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 the following standard(s): 13, 15 and 17 Efforts are made to help residents become part of the local community. Staff help individual maintain appropriate relationships. Food offered at Radcliffe Meadows is healthy, varied and appetising. EVIDENCE: Radcliffe Meadows is located in a small village community. The residents are able to access local facilities, for example, shops and pub. The Registered Manager stated that residents attended any events taking place in the village, for example village fetes and parades. An activities co-ordinator is employed at Radcliffe Meadows and accompanies residents on shopping trips for the Home, as well as developing activities such as fishing, bowling and walking. Some residents attend a lunch club in a local pub. Radcliffe Meadows has an open visiting policy; although visitors are asked to contact the Home prior to arriving to make sure the resident is there. One resident is helped by staff to maintain a relationship with his elderly mother. She has been invited to Radcliffe Meadows for meals and staff at the Home organise transport for her. Staff are willing to accompany residents and their family members on trips if necessary in order to help with potential behaviour Radcliffe Meadows Mental Nursing Home DS0000005156.V262168.R01.S.doc Version 5.0 Page 11 problems. Good practice was noted when a barbeque was organised to introduce family members to each other, so that the relatives of a newly admitted resident could ask questions discuss any concerns. The Registered Manager stated that efforts had been made to organise a relative support group and that plans to hold more ‘get togethers’ were in place. No residents are in intimate relationships at Radcliffe Meadows. The Registered Manager stated that relationships had happened in the past and these had been supported through discussion and information giving by the staff team. Residents said that the food at Radcliffe Meadows was good and they had enough to eat. Residents are encouraged to prepare their own breakfast within the dining/kitchen. Other meals are prepared by the cooks in the main kitchen. Menus are on a three weekly rolling system, and the food provided is varied and appealing. Choices are offered to residents. Staff try to encourage residents to try different foods, textures and tastes. A weekly ‘Theme Night’ gets residents to try food from different countries, and a ‘Cook’s Special’ night could produce anything from a new dish to an old favourite. Some use is made of local takeaways if residents wish. Special diets are catered for at Radcliffe Meadows. Two residents require some form of pureed diet. Other residents need some help with food due to chewing and swallowing difficulties, this has been assessed and recommendations sought from the Speech and Language Therapist. Radcliffe Meadows Mental Nursing Home DS0000005156.V262168.R01.S.doc Version 5.0 Page 12 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 the following standard(s): 18 and 20 Residents receive personal care in a respectful and dignified way. Medication procedures are appropriate and safe. EVIDENCE: Resident’s personal care needs are detailed within their individual Care Plans. Individual needs are described by including both what needs to be done and how. Personal care needs are linked to health needs where appropriate, for example, one resident who has frequent urinary tract infections requires regular toileting. Staff were observed to promote resident’s dignity and privacy when offering personal care. Residents were dressed in their own clothes, whose styles reflected personal choice. Medication procedures at Radcliffe Meadows were appropriate and records clear and in good order. Medication is ordered from a local pharmacy and stored securely. Staff sort medication for individuals and night staff are responsible for counting medication to ensure the right amounts are left at the end of the day. It is recommended that the Registered Manager discuss a monitored dosage system with staff and the pharmacy, as this will make medication dispensing safer and less time consuming. Controlled drugs are stored, dispensed and recorded appropriately. The Registered Manager is in the process of organising a waste disposal system for leftover medication in line with the new Medication in Nursing Homes Guidance. See Recommendation 2 Radcliffe Meadows Mental Nursing Home DS0000005156.V262168.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 23 Residents are protected from abuse, neglect and self-harm at Radcliffe Meadows through robust policies and appropriate staff training. EVIDENCE: The policies and procedures regarding protection of vulnerable adults at Radcliffe Mews are appropriate and linked to the procedures of the local authority. The Registered Manager has experience of the process and this was dealt with appropriately. Staff are trained to recognise potential abuse and respond in accordance with procedures through access to training with the Local Authority. In addition, one staff member has had detailed training regarding protection, abuse and other issues in this area, such as ‘The Ethics of Touch’, and leads in-house workshops for the staff team. A recommendation from the previous inspection regarding the complaint policy is being addressed when the directors of Radcliffe Mews meet to discuss policy review. Radcliffe Meadows Mental Nursing Home DS0000005156.V262168.R01.S.doc Version 5.0 Page 14 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 the following standard(s): All standards were inspected at the previous inspection. EVIDENCE: Radcliffe Meadows Mental Nursing Home DS0000005156.V262168.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 and 36 Radcliffe Mews has appropriate recruitment procedures. Staff are supervised regularly and appropriately. EVIDENCE: The recruitment process at Radciffe Meadows is clear and appropriate. The Registered Manager invites potential recruits to look around prior to interview and they get an opportunity to meet with residents at this time. Interviewees get to meet residents again on the day of interview, and feedback from residents is sought as part of the employment process. All relevant checks and documentation is obtained by the Registered Manager, including Criminal Record Bureau disclosures, prior to a new staff member starting in post. All staff receive regular documented supervision. The Registered Manager supervises Registered Nurses. Other staff are supervised by one of the registered nurses. Staff set objectives and goals in their supervision and these are linked to the appraisal process. The Registered Manager sees supervision as very important and is conducting teaching sessions with staff about supervision and how to get the most out of the process. Staff said they felt supported at Radcliffe Meadows and that the supervision process helped them to do their job. Radcliffe Meadows Mental Nursing Home DS0000005156.V262168.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 and 42 Radcliffe Mews has a basic Quality Assurance process which needs to be expanded. Health and Safety issues are promoted and appropriate. EVIDENCE: Quality Assurance is completed through the use of questionnaires. These are distributed to residents, staff, relatives and other visitors to Radcliffe Meadows. Information from these questionnaires is sent to the Chief Executive of Warrington Community Living (the provider). It is required that the Quality Assurance process be expanded so that information is collected and collated in a manner appropriate to the residents. An annual development plan should be completed using information gathered through the Quality Assurance process. Radcliffe Mews’ Health and Safety policies and procedures are in good order. Risk assessments are appropriate and up to date. Fire safety is appropriate and includes regular drills, fire lectures and equipment safety checks. Radcliffe Meadows Mental Nursing Home DS0000005156.V262168.R01.S.doc Version 5.0 Page 17 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 Score X 4 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X 3 X X Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X X X 3 X 4 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X 3 X Standard No 37 38 39 40 41 42 43 Score X X 2 X X 3 X Radcliffe Meadows Mental Nursing Home DS0000005156.V262168.R01.S.doc Version 5.0 Page 18 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 YA39 Regulation 24(1) Requirement A Quality Assurance System and Annual Development Plan should be further developed. Timescale for action 30/04/06 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 YA1 YA20 Good Practice Recommendations The Service User Guide should be reviewed to make the document accessible to all residents. The use of a monitored dosage system should be reviewed. 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