Inspection on 05/08/08 for River Meadows

This inspection was carried out on 5th August 2008.

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

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

Other inspections for this house

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/10/2008.

CARE HOMES FOR OLDER PEOPLE River Meadows Warwick Road Kineton Warwick Warwickshire CV35 0HN Lead Inspector Jo Johnson Unannounced Inspection 5th August 2008 08:45 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 River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service River Meadows Address Warwick Road Kineton Warwick Warwickshire CV35 0HN 01926 640827 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) Prime Life Ltd Mrs Melanie Oliver Care Home 41 Category(ies) of Dementia (41), Old age, not falling within any registration, with number other category (41) of places River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 41 2. Dementia (DE) 41 The maximum number of service users to be allocated is 41. Date of last inspection Brief Description of the Service: River Meadows is a purpose built care home, situated in the village of Kineton. River Meadows can accommodate up to 41 older people including older people in the dementia care category. The home offers long and short-term accommodation. The accommodation is on three levels. Each floor has bedrooms, lounges and bathrooms. The dining area and kitchen are on the ground floor. The garden is secure and accessible. River Meadows is registered to provide personal care services only. The visiting district nurses treat residents needing nursing care. All placements at River Meadows are contracted through Warwickshire Social Services. Information about the home is available in a variety of formats. River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The focus of inspections undertaken by us is upon outcomes for people who live at the home and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. This report uses information and evidence gathered during the key inspection process, which involves a visit to the home and looking at a range of information. This includes the service history for the home and inspection activity, notifications made by the home, information shared from other agencies and the general public and a number of case files. The manager supplied the commission with an AQAA (Annual Quality Assurance Assessment). Information from this has been used to make judgements about the service, and have been included in this report. This was the home’s first key inspection of 2008/2009. The inspection visit was unannounced (we did not let the home know that we were coming) and took place on 5th August between 8.45 and 3.30 pm. We undertook a random inspection on 26th June 2008 following a safeguarding referral relating to the admission of one person to hospital who subsequently died. This inspection report is available on request and the requirements made at that inspection were assessed during this inspection. Because people with dementia are not always able to tell us about their experiences, we have used a formal way to observe people in this inspection to help us understand. We call this Short Observational Framework for Inspection (SOFI). This involved us observing up to five people who use services for two hours and recording their experiences at regular intervals. This included their state of well-being, and how they interacted with staff members, other people who use services, and the environment. The inspection involved; • • Speaking with seven people who live at the home and one relative. Their views have been included in the report. Observations of and generally talking with the people who live at the home and the staff on duty, senior carer and the manager. River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 6 • • Four people were identified for close examination by reading their care plan, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’, where evidence is matched to outcomes for people. A tour of the environment was undertaken, and home records were sampled, including staff training and recruitment, health and safety, and staff rotas. We would like to thank the people who live at the home, the manager and staff for their hospitality and cooperation during the inspection visit. What the service does well: What has improved since the last inspection? All of the requirements and the recommendation made at the random inspection on 26th June have been met. Accurate daily records are now completed for each individual and include details of the care, support and nutrition provided as identified in their care plan. They now include specific details for any areas of risk that have been identified. This is so that the home can be sure that people are being provided with the care and support they have been assessed as needing. River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 7 Proper provision for the care, treatment, education and supervision of people living at the home has been made. This means that their needs are met as required. Staffing levels are now maintained at the levels identified and assessed by the manager. This makes sure that there are sufficient staff to meet the personal, physical, social and psychological care and support needs of the people at the home. Staff are now deployed to work with specific people living at the home. This makes sure that every individual living at the home receives the care they have been assessed as needing. This is also means that staff know whose care and daily records they are responsible for when they are on duty. The manager is now supernumerary and is not included in the numbers of care staff on duty. This means that they can consistently assess, monitor and improve the quality of care and service provided to people living at the home. The manager has undertaken a competency assessment to assess that staff that have been previously trained can administer medication. What they could do better: The auditing of care records should be included in the quality assurance or monitoring systems. This is so any discrepancies can be picked up and any changes can be made in the care records. A wheelchair should be purchased for the home so that people can be safely transported in the home whilst they are personally assessed for a wheelchair. The manager will need to develop ways of monitoring and assessing whether there is sufficient staff to meet the needs of people once they start admitting new people. The manager and senior carer should plan any new admissions carefully making sure that staff have time to get to know and understand the new people that move in. They should carefully consider whether it is appropriate to admit up to three people a week as agreed with the local authority contract monitoring team. A formal system of monitoring the quality of the care and service should be developed. This is so the manager can develop and produce an annual improvement plan for the home. River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 9 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 River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 Quality in this outcome area is good. People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager told us that people and or their families come and visit the home before making a decision about moving in. Appointments are now made to ensure that the manager or senior carer are available to accompany prospective people and or their relatives. River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 11 The service user guide has been updated and is now supported by pictures and photographs. The manager has approached a local organisation to make the guide available on audio tape. The manager told us that feedback from people about the guide had been positive and that she would continue to consult with people. The care records of the four people who have moved into the home since it opened on 25th April 2008 were seen. All of the referrals to the home are made through local authority social workers or care managers. The manager told us that they will now undertake assessments before people are offered a place at the home. This will include people who are referred for emergency short stays as well. The manager told us that the home will not be accepting any people direct from the community who have not been seen by their GP before their admission into the home. All of the people had their needs assessed before they moved into the home for a trial stay. There was a copy of people’s care management and in some cases a health assessment. There was a letter in peoples records to them and their relative confirming that the home was able to meet their assessed needs. The letter detailed the date of admission and some guidance on bringing personal possessions and named clothing into the home. Peoples’ initial assessments covered the following areas: Mobility, transferring, washing and dressing, nutritional intake, fluid intake, elimination, medication, nocturnal needs and communication. Initial risk assessments were completed in relation to skin, level of orientation and falls. Since the random inspection, the manager has considered that people may have partners and or different important relationships in their lives. This information is now sought at the initial assessment. From these initial assessments a care plan was developed. River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8,9,10 Quality in this outcome area is good. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans seen were of a good quality and detailed how staff were to meet peoples’ needs. They included assessments for any areas of risk and the action staff need to take to minimise these and the how often to monitor for any changes. Risk assessments were completed for falls, tissue viability, mobility, and nutrition. People were weighed on admission to the home and this was recorded in their plans. There was additional information available on medical conditions. River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 13 Care plans had been reviewed on a monthly basis and as and when people’s needs have changed. • One person’s care plan and moving and handling risk assessment had been changed following a deterioration and fluctuation in their mobility. The care records told us that appropriate medical intervention had been sought as soon as the person showed signs of discomfort and pain. One person had recently been diagnosed with Type 2 Diabetes. Their care plan had been amended so that staff knew what care and support the person needed to manage their diabetes. However, their personal profile and missing person’s information had not been updated to give this new medical condition. The manager took immediate action and amended the profile and missing person’s information. One person who is nutritionally at risk has been weighed every month. They have lost one kilo over the last month. They have been referred to the GP regarding their weight loss. There is a food and drink diary where staff have recorded exactly what the individual has eaten and drank including nutritional supplements. However, the monthly care plan review for nutrition stated that the individual had ‘gained one kilo’. Following discussion with the manager, she acknowledged that it should have been ‘lost one kilo’. She took immediate action to change the care plan review. • • The auditing of care records should be included in the quality assurance or monitoring systems. This is so any discrepancies can be picked up and any changes can be made in the care records. Since the random inspection, the standard of record keeping about people has improved. The manager and senior carer now monitor all recording on a daily basis to ensure that staff are recording accurately about the people that they are responsible for. All of the care staff have had an individual supervision session with the manager to go through the importance and expectations around record keeping. Staff who previously failed to record information about people have all been the subject of disciplinary action. Staff spoken with were confident of the information that they need to record and said that it was better now they knew who they were responsible for caring for on that day. People were well groomed and cared for. On the day of inspection, a hairdresser was at the home. A majority of the women living at the home chose to have their hair set. A relative spoken with said that staff always take care to make sure their relative is well dressed and their appearance is cared for. River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 14 People’s preference of gender of carer for personal and intimate care is sought during the assessment process. Their preferences are then detailed in the care plan. Discussion with the manager, staff, and observation of care plans and daily records tell us that people living in the home have access to health professionals such as GP, dietician, dentist and specialist consultants and chiropodist. The medication systems and administration at the home are well managed. Medication policies and procedures are safe, with medication being stored safely, labelled correctly and administered safely. All of the medication records seen were correct. One person’s medication had been dropped and a new prescription had been ordered from the GP for the two tablets. The medication storage room continues to be too warm. An air conditioning unit has been provided but this does not reduce the temperature. The manager told us that the additional fans and cooling systems are being fitted within the next few weeks to resolve the problem. Since the last inspection, the manager has assessed the competency of the staff who had previously been medication trained. This means that more staff are now able to administer medication and people are not reliant on the manager and senior carer being at the home to administer any medication. The manager told us that any people who have previously prescribed sedative type medications are having theses reviewed with the local GP to try and reduce their use where possible. Staff observed had good relationships with the people living at the home and were patient and encouraging. People with dementia freely approached staff and staff gave them reassurance when needed. Staff respected people’s privacy and dignity, by knocking on their doors and offering personal care discreetly and in private. Staff spoken with had a good understanding of recognising people as individuals, respecting their privacy and dignity and they were knowledgeable about them as a person. Staff were observed to be relaxed with people. They reassured people by talking quietly, touching and holding them when they were upset. Staff and people laughed and chatted together and clearly enjoyed each other’s company. River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. People living in the home are supported to maintain their independence, contact with important others and lifestyle, which enhances their quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People spoken with said that their visitors were made to feel welcome whenever they visited. During the inspection one relative was spoken to they spoke very highly of the flexibility of the visiting and that the staff make them feel welcome. The visitor told us that they have their meals with their partner and that the staff respect their need for time alone as a couple and their privacy. The home provides a programme of activities with at least one planned group activity each day. On the day of the inspection, people participated in the River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 16 following activities, giant snakes and ladders, playing cards, reading the newspapers, foot spa and a quiz. People spoken with and observed got up and spent their time how and where they chose. One person and their spouse have their bedrooms on the ground floor and choose to spend their time during the day in a lounge on the first floor, as it is quieter. The manager told us that they have arranged for people to be able to worship if they choose to. As the home is new, the manager is still developing links with ministers from different denominations. The two-hour observation session started towards the end of the morning and covered lunchtime. One the whole staff interacted in a positive way with people and in return, people’s moods were relaxed and positive. The people observed, were a majority of the time, engaged in activities either with staff, other residents or by themselves. The full cooked meal of the day is served in the early evening and there is a light lunch of sandwiches, salads or hot snacks. People were given verbal or visual choices when they were asked what they wanted to eat. Staff observed supported people in a quiet and sensitive way; they all sat down and ate with people. One person who needs lots of encouragement was supported throughout lunch by a number of staff. They sat with them, ate their lunch with them, and gently prompted them to eat or choose something different. Staff changed over occasionally to see whether the individual would respond better to a different person. Another person decided half way through their lunch that they wanted to sit somewhere else and staff supported them to move to another table. There is fridge with a glass door with cold drinks, crisps and other snacks in. There are also bowls of fresh fruit around the home. River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. Complaints procedures make sure that peoples, relatives and representatives concerns and complaints are listened to and acted upon. A staff team who have a good knowledge of how to respond to any suspicion of abuse and to keep people safe from harm support the people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a formal complaints policy which is accessible to people and their families. People are encouraged to raise their concerns with the manager. One visitor spoken with knew how to complain and who to speak to if they had any concerns. One person who lives at the home told us that they know how to complain, they said, “ I would talk to xxx (manager) or xxx (senior carer) and they would sort it out, I’ve not got any problems”. Staff spoken with told us that they know what to do if a service user or relative or friend has concerns about the home. River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 18 There has been one complaint made about the home directly to the local authority. The complaint related to the safety of one individual who had attempted to climb over the back fence and the lack of supervision of people living at the home. The organisation investigated the complaint and copies of the response to the complainant and local authority were sent to us. The back fence is now six foot and there have been no further issues. Staff have attended training in the Protection of Vulnerable Adults (POVA) so that they are aware of the different ways vulnerable people are at risk of abuse, and would know how to respond. They have to complete a workbook to demonstrate their understanding. Staff spoken with had a good understanding of how to recognise and report any allegations of abuse. Since the home was registered at the end of April 2008 there has been one safeguarding investigation following the admission of an individual into hospital that subsequently died. The manager and provider have co-operated fully with the police, local authority and us over this matter. The local authority contract monitoring team is working closely with the manager and provider to monitor the quality of the service provided and the health, safety and well being of the people living or staying at the home. The manager told us that staff are completing a Warwickshire Quality partnership workbook on the Mental Capacity Act. This means they can understand the importance of the new legislation and the impact that it will have on the people living at the home who may have previously been assessed as not having capacity to make decisions about their lives. River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22, 26 Quality in this outcome area is good. The home is maintained and furnished so that people live or stay in a homely, clean, comfortable environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is purpose built and has only been registered for just over three months. The accommodation is over three floors. Each floor has bedrooms, one or two lounges, bathrooms and toilets. The main dining room is on the ground floor as is the main kitchen. The lounges are light and are comfortable with a mix of sofas and armchairs. River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 20 All of the bedrooms have ensuite toilet, showers and basins. Each bedroom has a fridge and drinks making facilities for those people who have been assessed as safe to use kettles etc. People’s bedrooms seen were personalised and people had bought in their important personal things from home. At the time of the random inspection, people were accommodated throughout the home. This made it difficult for the staff to safely monitor all of the people living at the home. Since then, the individual who was accommodated on the top floor has moved to the ground floor. The manager told us that people would not offered any rooms on the first floor until the ground floor was full. No one will be offered a room on the top floor until the ground and first floor are full. There is an accessible secure garden with a six foot fence. One person is growing tomatoes in the garden. People were observed to walk all around the home and garden quite freely. People socialised with other people and staff whenever they chose. Some people chose to spend their time in their bedrooms. We observed staff using a wheeled shower chair to transport one person to the hairdressing salon. This was because the individual has fluctuating mobility and did not feel able to mobilise that day. The individual is tall and their feet were dragging on the floor. This presented a risk of injury to the individual. From discussion with the manager, there is not a wheelchair with footplates at the home for general use in such circumstances. A suitable wheelchair should be provided at the home so that people can be safely transported in the home whilst they are personally assessed for a wheelchair. The manager confirmed the day following the inspection that she had managed to borrow a wheelchair. A wheelchair should still be purchased for the home so that this wheelchair can be returned. Systems are in place for the management of dirty laundry and control of infection. The laundry is in the basement and staff are responsible for the laundering of people’s personal clothing. A contractor launders all of the linen and towels. The manager told us that a member of laundry staff has been appointed. Protective clothing such as plastic gloves and aprons were available and handwashing facilities were available. River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. The people living in the home are protected by robust recruitment practices and supported by a skilled, competent and managed staff team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of inspection, 13 of the 41 bedrooms at the home were occupied. The staffing rotas were seen for the month leading up to and including the week of the inspection. 8am to 2pm is 4 care staff 2pm to 8pm is 3 care staff 8pm to 8am is 2 care staff Since the random inspection, the way that the staff are deployed has changed. At the start of each shift staff are allocated to work with people in specific bedrooms. From discussion with staff and the manager, this seems to be working better with staff knowing whom they are responsible for. These daily River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 22 planning records were seen and the manager said that it was assisting with monitoring care practices in the home. During the inspection, there were enough staff to meets the needs of the 13 people living at the home. The manager told us that the staffing will increase when more people are admitted into the home. The manager will need to develop ways of monitoring and assessing whether there is sufficient staff to meet the needs of people once they start admitting new people. It is strongly recommended that the manager and senior carer plan any new admissions carefully making sure that staff have time to get to know and understand the new people that move in. They should carefully consider whether it is appropriate to admit up to three people a week as agreed with the local authority contract monitoring team. Since the random inspection, the manager and or the senior carer are always supernumerary to the care rota. This means they are able to spend time completing assessments, dealing with visitors, undertaking the day-to-day running of the home and monitoring practices without it having a negative impact on the care provided to people. Four staff files were seen including the most recently recruited staff. The files were well organised. Files included evidence of CRB (Criminal Records Bureau) checks and PoVA (Protection of Vulnerable Adults) checks for those staff that had started work at the home. One staff member was undertaking induction whilst waiting for CRB and POVA checks to be returned. The manager has sought references that cover the staff’s last five years of employment. This means that for staff there were up to 5 references. This is good practice. From the AQAA (Annual Quality Assurance Assessment) completed by the manager, the training programme and discussions with staff there is a comprehensive training programme in place that focuses on mandatory training and the specific needs of the people living at the home. Staff training matrix shows that staff complete an induction programme and receive mandatory training including food hygiene, Equality and Diversity, fire safety, first aid, and adult protection, Control of Substances Hazardous to Health (COSHH) and moving and handling. All staff complete a dementia awareness training course. The manager told us that the local District Nurses have agreed to provide training on diabetes and catheter care. River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good. People benefit from living in a new home that is now starting to establish some good practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been a manager for approximately five years for the same organisation. She transferred to manage this new home from another home in the area. She has completed the registered manager’s award and is an experienced home manager. River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 24 There were clear lines of accountability in the home, the management team comprises the manager and senior carer. During the visit staff appeared confident in their roles, the home was relaxed and people appeared at ease and comfortable. Staff spoken with commented positively about the style of management and leadership from the manager, their job role and the people living at the home. Systems are in place to safeguard the finances of the residents in the home. Four peoples financial records were seen and they balanced with the monies kept in the safe. All of the requirements and recommendation from the previous inspection have been met. As previously stated the home has been working closely with the local authority contract monitoring team to ensure that the service is safe and that there are suitable monitoring systems in place. The manager gave us a copy of the action plan they have developed to meet the requirements of both the local authority and the commission. The manager is now supernumerary and is now able to start monitoring the quality of the care and service provided to people as well as plan new admissions into the home. From discussion with the manager and senior carer they are looking at implementing a number of quality audits such as; relatives and professional surveys, monitoring falls and accidents, auditing of medication and monitoring of care records. A senior manager from the organisation completes a Regulation 26 visit once a month. These visits were seen and detailed actions to be taken by the manager to improve the service. The manager told us that she is talking to relatives about setting up a relatives group so they can contribute their views about the home. A relative spoken with confirmed that they had been approached about this. The three relatives surveys that have already been returned were very positive about the home. The organisation does not undertake its own quality assurance assessment so this means that the manager needs to develop a formal system of monitoring the quality of the care and service, so that she can develop and producean annual improvement plan for the home. River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 25 Information provided before the inspection, by the acting manager in the AQAA (Annual Quality Assurance Assessment) shows that relevant Health and Safety checks and maintenance are being carried out at the home. As a majority of the equipment is new it will not need servicing yet. The manager told us that there are systems in place to ensure all equipment is serviced as required. Staff spoken with and records seen showed that staff are supervised. The manager has a schedule of staff supervisions. A number of Health and Safety records were checked, including the fire safety log. These records showed that health and safety matters are well managed. The local Environmental Health Officer has recently visited the home to complete a health and safety and contact dermatitis inspection. The home has taken action to meet all of these requirements. Staff spoken with said they attended fire drills and have been trained in health and safety procedures. River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 26 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 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x 3 x x x 3 STAFFING Standard No Score 27 3 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 3 River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The auditing of care records should be included in the quality assurance or monitoring systems. This is so any discrepancies can be picked up and any changes can be made in the care records. A wheelchair should be purchased for the home so that people can be safely transported in the home whilst they are personally assessed for a wheelchair The manager will need to develop ways of monitoring and assessing whether there is sufficient staff to meet the needs of people once they start admitting new people. It is strongly recommended that the manager and senior carer plan any new admissions carefully making sure that staff have time to get to know and understand the new people that move in. 2 3 OP22 OP27 4 OP27 River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 28 5 OP33 They should carefully consider whether it is appropriate to admit up to three people a week as agreed with the local authority contract monitoring team. A formal system of monitoring the quality of the care and service should be developed. This is so the manager can develop and produce an annual improvement plan for the home. River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI River Meadows DS0000072134.V369461.R01.S.doc Version 5.2 Page 30 - 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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