Inspection on 16/04/09 for Stambridge Meadows

This inspection was carried out on 16th April 2009.

CQC found this care home to be providing an Adequate 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

Stambridge Meadows 01/04/10

Stambridge Meadows 05/10/09

Stambridge Meadows 09/10/08

Stambridge Meadows 04/05/08

Stambridge Meadows 09/01/08

Stambridge Meadows 23/08/07

Stambridge Meadows 15/01/07

Stambridge Meadows 03/05/06

Stambridge Meadows 31/01/06

Stambridge Meadows 28/09/05

Stambridge Meadows 01/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/06/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Stambridge Meadows Stambridge Road Great Stambridge Rochford Essex SS4 2AR Lead Inspector Michelle Love Unannounced Inspection 16th April 2009 10:00 DS0000015554.V374990.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Stambridge Meadows DS0000015554.V374990.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Stambridge Meadows DS0000015554.V374990.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stambridge Meadows Address Stambridge Road Great Stambridge Rochford Essex SS4 2AR 01702 258525 01702 258229 stambridge.meadows@ashbourne.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited 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) Manager post vacant Care Home 49 Category(ies) of Old age, not falling within any other category registration, with number (49), Terminally ill (2) of places Stambridge Meadows DS0000015554.V374990.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Terminal illness to include persons over the age of 55 Date of last inspection 9th October 2008 Brief Description of the Service: Stambridge Meadows is a care home for up to 49 older people. The home is situated approximately three miles from Rochford Town Centre and is set in pleasant country surroundings. The home has 40 single bedrooms, 33 with ensuite facilities and 5 double bedrooms, 2 of which have en-suite facilities. The home has three lounges, one of which has a designated dining area. The home also benefits from a visitors lounge area/reminiscence on the ground floor. The spacious grounds are maintained, with several paved areas. The home is in good decorative order with high quality accommodation for residents. Inspection reports are readily available for visitors to the care home and are displayed in the main reception area. Upon request, prospective residents and/or their representatives can have a copy of the last report and this can also be provided on audiocassette. The range of fees as confirmed by the administrator are £680.00 for those residents receiving residential care in a bedroom without en-suite facilities, £749.00 for those residents receiving residential care in a bedroom with ensuite facilities. A shared bedroom without en-suite facilities is £525.00 per week per person and with en-suite facilities is £595.00 per week per person. A large room is charged at £800.00 per week and a large room with en-suite facilities is charged at £850.00 per week. Respite/Short Term Care is charged at £140.00 per day and after 7 days this reduces to £110.00. Additional charges to residents include chiropody, hairdressing, newspapers and magazines, personal toiletries and telephone charges. Stambridge Meadows DS0000015554.V374990.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 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key inspection. The visit took place over two days by one inspector and lasted a total of 11 hours, with all key standards inspected. Additionally, a pharmacist inspector examined medication practices and procedures. Progress against previous requirements from the last key inspection were also inspected. Prior to this inspection, the manager had submitted an Annual Quality Assurance Assessment (AQAA). This is a self-assessment document detailing what the home does well, what could be done better and what needs improving. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. A partial tour of the premises was undertaken, residents and members of staff were spoken with and their comments are used throughout the main text of the report. At the time of the inspection, surveys (relatives, staff and healthcare professionals) were handed to the manager for distribution. At the time of writing this report, we had received no responses. The manager and operations manager and members of care staff, assisted us during the site visit. Feedback on the inspection findings were summarised at the end of the inspection. The opportunity for discussion and/or clarification was given. What the service does well: People who use the service are able to raise concerns and there is an effective complaints procedure in place. Visiting arrangements in the home ensure that people, who live at Stambridge Meadows, get to see their relatives and/or friends at any reasonable time. Visitors to the home stated they are made to feel welcome and both the management team of the home and care staff, are friendly and welcoming. The quality of meals provided to people living at the care home remains excellent. Positive comments were noted from residents and these are recorded within the main text of the report. Stambridge Meadows DS0000015554.V374990.R01.S.doc Version 5.2 Page 6 The storage facilities provided for people’s medication, is secure and temperature controlled. This ensures medication is safe and of suitable quality. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Stambridge Meadows DS0000015554.V374990.R01.S.doc Version 5.2 Page 7 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Stambridge Meadows DS0000015554.V374990.R01.S.doc Version 5.2 Page 8 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 Stambridge Meadows DS0000015554.V374990.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who come to live at the home can be confident that their needs will be assessed. EVIDENCE: There remains a formal pre admission assessment format and procedure in place, so as to ensure that the management and staff team are able to meet the prospective resident’s needs. Records show that in addition to the formal assessment procedure, supplementary information is provided from individual resident’s placing authority and/or hospital. Formal assessments are also completed in relation to dependency, moving and handling, pressure area care, nutrition and continence. Three staff spoken with stated they are given sufficient information about new people admitted to the care home and this is, provided by senior members of staff at ‘handovers’. Stambridge Meadows DS0000015554.V374990.R01.S.doc Version 5.2 Page 10 At this site visit, the care files for the 2 newest people admitted to the care home were examined. Records showed that a pre admission assessment had been completed for both people, prior to their admission to Stambridge Meadows. In general terms the information recorded within both pre admission assessments was seen to be informative, however care must be taken to ensure that all information as required on the pre admission form is completed. For example, the assessment for one person in relation to their medication was not completed, yet the assessment from their placing authority, made reference to them having a ‘complex medication regime’ as a result of their specific healthcare needs. The records for one person showed they were given the opportunity to visit Stambridge Meadows, prior to their admission. The person was able to spend the day at the home, have a meal and meet staff and other people who live at the care home. Although there were no records to evidence whether or not the other person had had the same opportunities, from discussion with them, we were advised that their representative visited Stambridge Meadows on their behalf. One person confirmed that the admission process had been smooth and they had been made to feel welcome since their arrival. Written confirmation that the home can meet the individual person’s needs following assessment was available for both people. A copy of both the Statement of Purpose and Service Users Guide was readily displayed within the home’s reception area and included a copy of the last key inspection report. Both documents have been reviewed and updated to reflect that since the last key inspection (October 2008), the category of registration has been changed and the home no longer accepts people who require specialist nursing care. The AQAA details that a brochure about Stambridge Meadows is given to all prospective residents and/or their representatives. The home does not provide intermediate care. Stambridge Meadows DS0000015554.V374990.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the care home can expect to have a plan of care, which identifies their care needs and how these are to be met. EVIDENCE: There remains a formal corporate care planning system in place to help staff identify the care needs of individual residents and to specify how these are to be met by staff who work in the care home. As part of this site visit the care files for 2 people were examined (1 respite and 1 permanent care file). Evidence at this inspection showed that continued effort and progress has been made by the management team of the home to sustain improvements in relation to the care planning and risk assessing processes and to ensure there is a record detailing individual’s care needs and how these are to be met by care staff. Stambridge Meadows DS0000015554.V374990.R01.S.doc Version 5.2 Page 12 Of those people case tracked, each person was noted to have a plan of care. The general recording was observed to be informative with some aspects being person centred and providing a good basis to staff so as to ensure that care provided was reflective of individual’s care needs. However, this would be enhanced by the involvement of the resident and/or their representative in the development and review of the care plan. Whilst we recognise the above improvements, further development of individual’s care files and associated documentation is required. On inspection of the daily care records for one person, these recorded the person as not receiving their pain relief medication as a result of it not being available. On inspection of their plan of care, little information was recorded as to how the management of pain for this person should be monitored and/or treatment required. The communication book for staff was also examined and this showed several entries whereby staff had recorded that a prescription for the person’s pain relief medication had been faxed to the doctor’s surgery, however there was little evidence of urgency by staff to follow this up. This resulted in the resident not receiving pain relief on 13 occasions. The daily care records recorded that as a result of missed doses the resident experienced pain in their legs and was upset at staff for not having their pain relief available. The resident confirmed this during discussions and stated, “oh, my legs were so painful”. As a result of the above, the manager and operations manager were advised to refer the above as a safeguarding issue. Another care file detailed the person was diabetic, may have difficulty chewing their food and may need assistance on some occasions. The daily care records showed that on occasions they could refuse both drinks and meals and sometimes did not eat much. Nutritional records were completed each day, however there was little evidence to show that alternatives to the menu were offered or that food was offered later and/or supplements provided. Records showed that over a 5 week period, the person lost approximately just over 5KG in weight. The care plan was not reviewed and updated to reflect the above and no risk assessment was devised. The AQAA details under the heading of, ‘what we could do better’, “care plans to be continually updated as care needs change and more person centred” and “a comprehensive audit trail to ensure care plans are regularly updated and reviews are carried out”. The same care file made reference to the person having their lighter kept securely by staff. The rationale for this decision was not clearly recorded and there was no evidence to suggest that the person had agreed to the above restriction. Where restrictions and/or limitations are in force, records must clearly detail that these have been agreed with the resident and the rationale for the decision. Stambridge Meadows DS0000015554.V374990.R01.S.doc Version 5.2 Page 13 The care file for one person recorded them as having Parkinsons Disease. Although there was a plan of care, this aspect of their care file was not person centred and it was unclear as to how their Parkinsons Disease specifically affected their ability to carry out activities of daily living. Additionally there was little information recorded specifying the person’s strengths and where they were independent and where they required support from staff. Records showed that people living at Stambridge Meadows have access to a range of healthcare professionals and services as and when required, both at the care home and within the local community. These include, GP, attendance at hospital appointments, Optician, Dentist, District Nurse Services etc. Of those people case tracked, professional visitors records were available depicting appointments. In some instances additional information is recorded detailing outcomes. Staff, spoken with confirmed that residents would receive treatment from a healthcare professional in their own bedroom to protect their privacy and dignity. Staff interactions with residents were observed to be much improved and positive. Where support and assistance was provided by staff in relation to individual’s personal care, this was conducted with respect and sensitivity. Residents spoken with were complimentary regarding the care and support provided at Stambridge Meadows. From discussions with 5 members of staff, all were able to demonstrate a good understanding of residents care needs and how people like to be supported. The storage facilities provide for medicines is secure and adequately temperature controlled so that people’s medication is safe and of, suitable quality. The home has developed a checklist to regularly record when medicines are checked against the records but when discrepancies are found there is no record of the action taken only that it was “incorrect”. We looked at the medication and medication records for several people and the records made when medicines are received into the home, when they are given to people and when they are disposed of are of a reasonably good standard so that medicines are accounted for. But there were some people whose medication is prescribed as “one or two tablets” but the record made when the medicine is given didn’t always show how many were given. This could lead to people being given too much or too little medication. Also when people are prescribed medication “when required” there wasn’t always clear guidance for staff on what the medication was needed for and how much to give. One person was given such a medicine but there was no record in the care plan or daily notes of the reason why. There were hand-written changes and entries on medication records but no indication of when this change was made or by whom. We watched medicines being given to some people at lunchtime and this was done well, with regard to people’s needs, dignity and personal choice. Medicines are only given to people by trained care staff but in some cases this training is basic and in the training files seen there was no record that they had been assessed as competent to do so. Stambridge Meadows DS0000015554.V374990.R01.S.doc Version 5.2 Page 14 For people who have diabetes, the care plans state that there should be “blood sugar monitoring” but in some cases this did not indicate how frequently this should be done or who was responsible for doing it. Prior to the site visit, we were made aware through notifications submitted to us that since the last inspection (October 2008), there had been 2 medication errors. We discussed these with the management team of the home and were advised that one was “just a human error” (resident administered a double dose of Perindopril) and the second error (resident administered a double dose of Valproate) led to the member of staff being supervised as to their continued competency, however this had not been recorded within the person’s supervision and/or training records. We were advised that further training was planned for the member of staff. Stambridge Meadows DS0000015554.V374990.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the care home can expect to receive a varied diet, however they can not always be assured they will have their social care needs met. EVIDENCE: An activities co-ordinator is currently employed at Stambridge Meadows for 22.5 hours per week, Monday to Friday, however this is flexible to cover events held during the evenings and at weekends. As the numbers of people who live at the care home increase, the hours for activities need to be increased, so as to meet individual’s social care needs. It was of concern that we were advised that the activities co-ordinator did not provide any activities to residents on 2 days the previous week, as a result of undertaking care duties. We were advised that they have been in post as the activities co-ordinator for the past 6 weeks and previous to this they, were a carer at the home. It was Stambridge Meadows DS0000015554.V374990.R01.S.doc Version 5.2 Page 16 clear from discussions with this person that they have a good knowledge and understanding of current residents’ support needs. It was also evident that they are enjoying their new role and are finding it very rewarding. A list of activities for the week is displayed on the notice board in the main reception area. There was also evidence to show that a copy of the activity plan is provided to each resident. A copy of the past 4 weeks activity programme was inspected and this showed that people living at Stambridge Meadows are provided with a varied programme of activities. These include, sing-a-long, bingo, arts and crafts, quizzes, manicures, board games, carpet skittles, television and film afternoons, making cakes, gentle exercises, external entertainers etc. Although each person is provided with a copy of the activity programme, at the time of the site visit, people still had the previous week’s plan on display and not the most up to date programme. A list of events for 2009 (April-December) was provided to us and this included, Easter Bonnet Parade, St George’s Day (Pie, Mash, Liquor and Eels Supper), National Cake Bake Day, Flower Show, and Summer Bazaar. We were advised that it is hoped that arrangements will be made by the registered provider to enable the activities co-ordinator and other staff, the opportunity to take people out in the local community and for raised flower beds to be made at Stambridge Meadows. The AQAA details that within the next 12 months it is hoped that links with the local community will be established. Consideration should be given to ensure that the activity programme is provided in an appropriate format, so as to enable residents to make an informed choice. This refers specifically to only 2 weeks of the programme being in a written/pictorial format. A newsletter is compiled once monthly and advises people as to what is going on at the care home. To date, 2 newsletters have been issued. An activities diary is kept to record activities undertaken by individual residents. Additionally an ‘activity preference sheet’ is completed, identifying individual’s preferences relating to media entertainment, games and pastimes, past history, exiting hobbies and interests etc. Of the 2 people case tracked, an, ‘activity preference sheet’ was completed for only one person. No care plan was devised pertaining to individual’s social care needs. There remains an open visiting policy whereby visitors to the home can visit at any reasonable time. All residents spoken with said their visitors were welcomed and one person confirmed that their family come and go as they please. Information relating to advocacy is available within the main reception area. Residents spoken with confirmed that they do have some control over their lives and are enabled to make choices. This refers to choosing whether or not to spend time in their own room or in the main lounge, whether or not they Stambridge Meadows DS0000015554.V374990.R01.S.doc Version 5.2 Page 17 join in activities or pursue their own interests and where they choose to eat their meals. The menu for the day was displayed for residents. There remains a rolling 4 week menu and this showed that people who live at the care home receive a varied diet. Alternatives to the menu are readily available. Dining tables were attractively laid with tablecloths, small vase of flowers, serviettes, cutlery and condiments. The dining experience for people at Stambridge Meadows was observed and this was seen to be positive. Throughout the day people were provided with drinks and meals provided to residents were seen to be plentiful and attractively presented. Where people require assistance to eat their meal support was provided by staff with respect and sensitivity. Comments from residents regarding meals provided were positive and these included, “the food is good, I have no complaints”, “its not bad” and “yes, the meals provided are very good”. Stambridge Meadows DS0000015554.V374990.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect their concerns to be listened to and acted upon and to be safeguarded by staff’s knowledge and supporting policies and procedures. EVIDENCE: The complaints procedure was displayed within the main reception area and within the Statement of Purpose and Service Users Guide. Formats are available to record both formal and informal complaints. The AQAA details that the manager has an ‘open door’ policy and residents, staff, relatives and others can report any concerns. Residents spoken with said that they would feel able to tell staff if they were worried or concerned. We were advised by the manager that since the last key inspection (October 2008), the home has received 2 complaints, relating to lack of stimulation/entertainment for residents and the de-registration of nursing beds at Stambridge Meadows. Records evidenced that all issues were dealt with appropriately by the management team of the home and the complainants were satisfied with the outcome of the home’s investigation. Several records of compliments were readily available and included, “to the manageress, will you please thank your two care workers who came to [name Stambridge Meadows DS0000015554.V374990.R01.S.doc Version 5.2 Page 19 of resident] funeral, and for the beautiful flowers. [name of resident] was very content at Stambridge Meadows and thought of it as their home. Thank you again” and “To all staff, thank you for all the care and attention you have given me during my stay at Stambridge Meadows”. We are aware of 2 safeguarding referrals and investigations since the last key inspection of October 2008. Both issues were raised by the home and referred to Essex Safeguarding Team. Both issues have been investigated thoroughly by the home and the outcome is that one safeguarding matter was not upheld and one has been upheld. Staff spoken with, demonstrated a good awareness and understanding of safeguarding procedures and advised that should an issue arise, information would be passed to the person in charge of the shift and/or the manager and deputy manager. The staff training matrix showed that 24 out of 26 staff have up to date safeguarding training. Stambridge Meadows DS0000015554.V374990.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the care home can be assured that the home environment will be safe, homely and comfortable to meet their needs. EVIDENCE: A partial tour of the premises was undertaken throughout the day of the inspection. Since the last key inspection, the large lounge/dining area has been decorated and refurbished and a number of unoccupied bedrooms are in the process of being redecorated. A random sample of residents’ bedrooms were inspected and all were seen to be personalised and individualised. The newest resident admitted to the care home confirmed they were able to bring in their own personal items. Stambridge Meadows DS0000015554.V374990.R01.S.doc Version 5.2 Page 21 Residents spoken with confirmed they were happy with their personal space and found them to be comfortable. All areas of the home were noted to be clean and odour free. A maintenance person is employed at the home Monday to Friday between 08.00 a.m. and 16.30 p.m., however these hours are flexible to cover weekends and evenings. There is a maintenance programme within the home so as to ensure that the home environment and equipment is well maintained. A random sample of safety and maintenance certificates showed that equipment in the home has been serviced and remains in date until their next examination. The training matrix details that the maintenance person has up to date training relating to fire safety, fire drills, moving and handling, COSHH (Control of Substances Hazardous to Health), health and safety, safeguarding and infection control. Stambridge Meadows DS0000015554.V374990.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the care home can expect to be cared for by a stable staff team, who are robustly recruited and who have the skills and knowledge to provide good care. EVIDENCE: At the time of the inspection there were 17 residents living at Stambridge Meadows. We were advised that staffing levels for the current number of residents are 1 senior member of staff and 3 members of staff between 08.00 a.m. and 20.00 p.m. and 1 senior member of staff and 2 members of staff between 20.00 p.m. and 08.00 a.m. each day. The manager’s hours are supernumerary and the deputy manager receives 1 supernumerary shift per week. In addition to the above, ancillary staff are utilised at the home (chef, kitchen assistant, administrator, laundry person, housekeepers). On inspection of 4 weeks staff rosters, records showed that staffing levels as detailed above have not always been maintained. We have not received any Regulation 37 notifications advising us of the staffing shortfall and measures undertaken to deploy staff to the home. On the day of the site visit the deployment of staff within the home was better than at previous inspections to the home, however there were occasions when Stambridge Meadows DS0000015554.V374990.R01.S.doc Version 5.2 Page 23 staff were not obviously present and/or available and people were calling out for assistance. The rota available reflected accurately the staff on duty on the day of the site visit. Residents spoke positively of staff and comments included, “oh, the girls are lovely, they do their best” and “on the whole, the staff are really good”. The AQAA details, “we have continued to maintain relevant staffing levels and skills for the dependency and continuity of our service users”. The AQAA also details that within the next 12 months it is hoped to develop a ‘staff bank’ system, so as to provide continuity of care for the people who live at the care home. The staff files for 3 people newly employed since the last key inspection were examined. Records show that robust recruitment procedures are in place so as to ensure that residents are safeguarded. Records showed that each member of staff received a comprehensive and detailed induction. The AQAA confirms there is a “rigorous recruitment programme” in place at the care home. It remains of concern that no records relating to the manager’s recruitment were available. This has been highlighted and discussed at previous inspections to the care home. NVQ information provided to us, show that 6 members of staff have attained NVQ Level 2 (3 of whom also have NVQ Level 3) and 8 members of staff are currently undertaking NVQ Level 2. On inspection of the training matrix, records showed that since the last key inspection, staff received training relating to core subject areas. These refer specifically to fire safety, fire drills, food hygiene, moving and handling, COSHH, health and safety, safeguarding, infection control, nutrition, pressure area care, customer care, care planning and dementia awareness. Staff spoken with, were able to demonstrate a reasonable awareness of the care needs of each person discussed. Stambridge Meadows DS0000015554.V374990.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 and 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to benefit from developing management systems that will promote positive outcomes for the people who live at Stambridge Meadows. EVIDENCE: Since the last key inspection the registered provider has appointed a new manager to manage the care home. The manager has been in post for 5 months. The manager has over 19 years experience within the private healthcare sector working with older people and adults who have a learning disability and/or challenging behaviour. Stambridge Meadows DS0000015554.V374990.R01.S.doc Version 5.2 Page 25 Additionally the manager has extensive managerial experience. The manager has attained NVQ Level 4 and the Registered Managers Award. Since the last key inspection, the registered provider has submitted an application to amend the home’s registration. In October 2008 it was formally agreed that the nursing category at Stambridge Meadows be removed. We were advised at this inspection by the Responsible Individual and Managing Director, that an application will shortly be submitted to us, requesting that people who have a diagnosis of dementia be admitted to the care home. The manager advised that the current ethos of the service is to ensure there is stability for the existing staff team, that there is an “open culture” between the management team of the home and the staff team and that staff feel supported to carry out their role effectively for the benefit and wellbeing of the people who live at Stambridge Meadows. The manager stated that she has noted that the staff team are working more cohesively, there is a better atmosphere within the home and communication is improving daily. The manager is aware that much progress needs to be made to raise the home’s profile and that there have been many changes over the past 12-18 months, which has been unsettling for staff, residents and their families. We were advised that an ‘open day’ is to be shortly conducted at Stambridge Meadows so as to enable people the opportunity to meet the new management team of the home, staff and to have a look around the premises. Residents and staff spoken with confirmed that the manager is approachable, proactive and a good listener. One person stated, “the manager is absolutely fantastic”. Staff spoken with stated that staff morale within the home is much better and “there is a better atmosphere since the registered nurses have left”. The manager has as yet to submit an application to be formally registered with the Commission. We were advised that an application would be forwarded to us within the next two weeks. It is evident from this inspection that progress has been made to address previous identified shortfalls and concerns. While improvements to the service are noted, including pre admission assessments for all prospective people admitted to the care home being in place and continued development of the care planning processes, there is a need for further development in some key areas. As stated within the main text of the report, some aspects of care planning and risk assessing continue to require further development, staffing levels need to be maintained for the numbers and dependency levels of current people who live at the care home and some aspects of medication practices and procedures need to be improved. The management team of the home must ensure that progress achieved at this site visit, is maintained and sustained for the wellbeing of the people who live at the care home. Stambridge Meadows DS0000015554.V374990.R01.S.doc Version 5.2 Page 26 All sections of the AQAA were completed and the document returned to us when requested. Information recorded was informative providing a reasonable level of information about the service. The organisation, have several ways of monitoring the quality of the service provided. These include, monthly Regulation 26 visits, monthly audit undertaken by the manager and quarterly audits. Records relating to the above were readily available. The AQAA details that the manager carries out a daily audit and the results of this are reported directly to the operations manager. No quality assurance surveys for residents, relatives and other interested parties have been undertaken since November 2008. We were advised that no response was received. Records were available to show that staff meetings and resident/relatives meetings have taken place since the manager’s appointment. The staff supervision tracker for 2009 showed that 13 staff members received supervision in January 2009, 11 staff received supervision in February 2009 and other supervisions are planned throughout the year to December 2009. We were advised that a new supervision format is to be introduced, which will be more comprehensive and detailed ensuring that care practice issues and individual staff development issues are formally discussed. The previous supervision tracker for 2008 showed that supervisions have not been conducted in line with National Minimum Standards recommendations. One member of staff confirmed that in 2008, they had received only 2 supervisions. A health and safety policy was observed within the home. The majority of staff who work at the care home had received health and safety training. Stambridge Meadows DS0000015554.V374990.R01.S.doc Version 5.2 Page 27 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 X 3 Stambridge Meadows DS0000015554.V374990.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Care plans must fully depict a person’s care needs and how these are to be met. This will ensure that staff, have the information they need so as to enable them to provide appropriate care. Risk assessments must include details as to how the risk identified affects the individual person and what steps are to be taken to minimise the risk. Previous timescale of 8.8.08 and 14.10.08 not met. Where people are prescribed medicines on a “when required” basis or in variable doses there must be clear guidelines for the use of these medicines. This will ensure people receive the medicines prescribed for them. Staff, who administer medicines to people must be suitably trained and assessed as competent to do so. DS0000015554.V374990.R01.S.doc Timescale for action 15/06/09 2. OP7 13(4) 15/06/09 3. OP9 12 and 13 30/04/09 4. OP9 13 and 18 31/05/09 Stambridge Meadows Version 5.2 Page 29 5. OP9 13 6. OP27 18(1)(a) This will protect people from harm. There must be adequate supplies of medicines for the continued treatment of residents. This will ensure people are not put at risk of not receiving their medicines as prescribed. Ensure there are sufficient staff on duty at all times. So as to ensure peoples’ safety and wellbeing. Previous timescale of 1.10.07 to 14.10.08 not met. Ensure that staff, receive regular supervision so that they feel supported. Previous timescale of 1.7.07 to 14.10.08 not met. 30/04/09 15/05/09 7. OP36 18(2) 01/06/09 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 OP9 Good Practice Recommendations Hand-written changes or additions to medication records should be signed and dated by the person making the entry and checked for accuracy by a second person, who should also sign the record. Consider devising the activities/event summary in larger print and/or pictorial format so as to enable people to make an informed choice. 2. OP12 Stambridge Meadows DS0000015554.V374990.R01.S.doc Version 5.2 Page 30 Care Quality Commission Eastern Region Care Quality Commission Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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