Inspection on 04/05/08 for Stambridge Meadows

This inspection was carried out on 4th May 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Stambridge Meadows 01/04/10

Stambridge Meadows 05/10/09

Stambridge Meadows 16/04/09

Stambridge Meadows 09/10/08

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Stambridge Meadows Stambridge Road Great Stambridge Rochford Essex SS4 2AR Lead Inspector Michelle Love Unannounced Inspection 4th and 8th May 2008 09:15 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 Stambridge Meadows DS0000015554.V362633.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. Stambridge Meadows DS0000015554.V362633.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.V362633.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 January 2008 Brief Description of the Service: Stambridge Meadows is a care home with nursing 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 en-suite 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 on the ground floor. The spacious grounds are well 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. The range of fees as confirmed by the operations manager remain at £630.00 for those residents receiving residential care in a bedroom without en-suite facilities, £680.00 for those residents receiving residential care in a bedroom with en-suite facilities, £650.00 to £750.00 for those residents receiving nursing care. A shared bedroom without en-suite facilities is £525.00 per week per person and with en-suite facilities is £550.00 per week per person. A large room is charged at £695.00 per week and a large room with en-suite facilities is charged at £800.00 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.V362633.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 0 star. This means the people who use this service experience poor quality outcomes. This was an unannounced key inspection. The visit took place over two days and lasted a total of 15.5 hours, with all but one of the key standards inspected. Additionally, the manager’s progress against previous requirements from the last key inspection was also inspected. For part of this inspection, a specialist pharmacist inspector accompanied the inspector. Prior to this inspection, the registered provider had submitted an Annual Quality Assurance Assessment. 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. Additionally 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 site visit, surveys for relatives were left at the home for people to complete and return to us. Where surveys have been returned to us, comments have been incorporated into the main text of the report. The manager, project manager and operations manager and other members of the staff team assisted the inspector and the specialist pharmacist inspector on both days of the inspection. Feedback on the inspection findings were given throughout and summarised at the end of the day with both the project manager and operations manager. The opportunity for discussion and/or clarification was given. As a result of concerns relating to medication practices and procedures and complaint management, two Immediate Requirement Notices were issued on 8/5/08. The main text of the report highlights a number of shortfalls, which have been emphasised at previous inspections to Stambridge Meadows. As a result of concerns relating to care planning/risk assessing and the health and welfare of residents, a Code B notice of the Police and Criminal Evidence Act 1984 was issued on 4/5/08 and a number of documents relating to the above issues were photocopied and provided to the Commission for Social Care Inspection. The Commission for Social Care Inspection may take enforcement action in relation to the outstanding shortfalls. Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Practices and procedures for the safe handling, administration and recording of medicines must be improved to protect residents from harm. Further development is required in relation to care planning and risk assessing processes so as to ensure that individual plans of care are comprehensive, up to date, reflective of people’s current care needs and ensure that care provided to residents, meets their specific requirements. The social care needs for those people who have poor mobility or who spend the majority of their time in bed needs to be improved. The deployment of staff at the home needs to be reviewed so as to make sure that all residents needs are met at all times. Routines within the home need to be improved so that these are resident led rather than staff orientated. Further training and personal development is required for staff to ensure that they have the skills and competence to meet resident’s needs and to deliver good care. Complaint management and referrals relating to adult protection matters need to be more robust so that people feel assured that any concerns raised will be dealt with appropriately. Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 7 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. Stambridge Meadows DS0000015554.V362633.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.V362633.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a formal assessment process in place, however people who may use the service may not always have their needs assessed or be provided with sufficient assurance that their needs can be met. This means that people could be moving into a home that may not be suitable for them. EVIDENCE: There is a formal pre admission assessment format and procedure in place, so as to ensure that the management team are able to meet the prospective resident’s needs. As part of the assessment process, formal assessments are completed relating to dependency, moving and handling, pressure area care, nutrition and continence. In addition to the formal assessment procedure, supplementary information is sought from the individual resident’s placing authority and/or hospital. Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 10 Two care files for the newest residents admitted to the home were examined and evidenced that the management team of the home completed a preadmission assessment prior to admission for only one person. The project manager advised the inspector that a, pre admission assessment had been completed by the newly appointed manager, however this was unable to be located at the time of the site visit. Additionally, confirmation from the manager to the resident and/or their representative verifying that it can meet the person’s needs must be available as it was unavailable for one person case tracked. The management team must ensure that new people are admitted only on the basis of a full assessment and that they are able to demonstrate that they can meet the person’s needs. The Annual Quality Assurance Assessment details, “a pre admission assessment is carried out, for all potential new service users, to ensure the home can meet their needs”, “a letter informing service user, the home can care for their needs, is sent, and a copy is kept in the care plan” and “pre admission assessments held on all residents care plans”. Both the project manager and operations manager were advised to ensure, that as part of good practice procedures, where a prospective resident is admitted on the same day as the pre admission assessment is undertaken, the rationale for the decision is clearly recorded. Care must also be taken to ensure information, as detailed within the placing authority assessment (COM 5), and pre admission assessment, is transferred to the person’s care plan. This will ensure that the care plan has all necessary information relating to the individual’s needs and provides care staff with sufficient information so as to deliver care in line with those needs. The information provided by one placing authority recorded that the resident required regular blood pressure monitoring and was prone to depression. This information was not transferred to the individual’s care file. The Annual Quality Assurance Assessment under the heading of `what we could do better` details, “ensuring that information provided by the social work assessment team is incorporated into care planning for the potential new resident”. The project manager advised that prospective residents and their relatives are afforded the opportunity to visit the home prior to admission. Information relating to this was not evident for either person. Following the inspection, the inspector spoke with one resident’s relative and was advised that their member of family had previously been admitted to the care home and chose to return. The relative was not aware of either of them being offered an opportunity to visit the home prior to their admittance. The Improvement Plan addressing the requirements and recommendations following the last key inspection detailed, “all residents and relatives will be invited to visit the care home prior to admission, this will be documented on care file and enquiry file via a letter of invite” and “letters will be kept on file of invite to visit home prior to admission”. This is important as it enables the prospective resident and/or their representative to have the opportunity to meet care staff, other residents and to make an informed decision as to the facilities and suitability of the Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 11 home. Additionally there was no information evidencing that the resident and/or their representative had been involved in the pre admission assessment process. The Annual Quality Assurance Assessment details under the heading of ‘what we could do better’, “ensuring that all residents and their relatives are involved in the care planning process”. The home does not provide intermediate care. Stambridge Meadows DS0000015554.V362633.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 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents can be sure they have an individual plan of care in place, however significant shortfalls in care planning, risk assessing and medication practices means that residents cannot be assured that their needs will always be met or that their health and wellbeing will be maintained or proactively managed. EVIDENCE: There is a formal comprehensive 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 care staff. Additionally formal assessments are to be completed in relation to dependency, manual handling, falls, pressure area care, continence and nutrition. As part of this inspection 4 care files were examined and each individual was observed to have a plan of care. Care records show that further development of the care planning and risk assessment process is required to ensure that individual plans of care are detailed, include the actions to be taken by care Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 13 staff, covers all aspects of individual’s health, emotional, personal and social care needs and proactively promotes and maintains people’s health and welfare. Care plan recording was seen to be inconsistent with some elements recording giving a good level of detail and other areas being basic and not person centred. Staff, must ensure that individual resident’s needs are fully recorded, and include the interventions required so as to ensure the appropriate delivery of care. Care records must be regularly reviewed to reflect individual resident’s changed needs and how this affects their daily life. For example, prior to the inspection, we had been notified by a member of the public that a resident had been found wandering outside of the home close to the main road. On inspection of their care file, there was evidence to indicate that there were several occasions when the resident had left the building undetected by staff. It was of concern that no care plan had been devised for the resident pertaining to wandering/leaving the building unescorted, especially in light of them being assessed at high risk of falls. The manager confirmed to the inspector that no care plan was available. It was also of concern that a risk assessment had only been completed recently. It is of concern that failure to devise and implement a care plan/risk assessment sooner has potentially placed the person at risk and harm and evidences that preventative measures should have been in place much sooner to protect the resident. Additionally, records evidence that staff failed to follow their own, `Missing Service User` policy and procedure. This details that the named nurse/team leader is responsible for planning, implementing and evaluating care. It further states, “A risk assessment must be carried out and documented to identify those service users who may be prone to wandering. A care plan should be formulated with appropriate interventions planned”. The procedure further states, “An ongoing record of events must be entered in the service users care file. The service users assessment, risk assessment and care plans must be reviewed and updated as appropriate following the event”. It is evident that the above did not take place following the first incident. The care plan for another person was examined as a result of issues expressed by their concerned relative. Concern was expressed that care staff were unable to meet the resident’s needs relating to their challenging behaviours, their refusal of medication and poor nutritional intake. No care plan and/or risk assessment had been devised in relation to the resident’s challenging behaviours, yet daily care records as far back as December 07 evidenced that at times the person was unsettled, appeared confused and was un-cooperative. A medication care plan was in place, however this failed to make reference to the resident refusing their medication on several occasions. The last entry on the care plan was dated 18/1/08 and recorded, “Staff to ensure [the resident’s name] is given their medication on time, and ensure fluids are available”. Medication Administration Records (MAR) were requested for inspection in line Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 14 with concerns expressed by the relative. It is concerning that MAR records for specific dates were not able to be located. A care plan was devised in relation to the person’s poor nutritional intake, however both this and the risk assessment had not been reviewed regularly to reflect the person’s current care needs e.g. refusal of food on occasions. From inspection of fluid/nutritional records, there was little evidence to indicate that other food items were offered to the resident or food encouraged later in the day. It is evident that failure to devise, implement and acknowledge a change in the person’s needs has resulted in them not receiving care appropriate to their specific care needs. It is evident that preventative measures and consultation with healthcare professionals should have been implemented sooner so as to enable appropriate care to be provided to the resident and/or an alternative placement to be found. As a result of the care provided, the relative moved their member of family to an alternative placement. There was also evidence to indicate that some staff do not have the necessary skills to meet the assessed needs of individual residents. For example, following the site visit, an adult protection referral was made from healthcare professionals to the local authority in connection to concerns relating to one person’s poor pressure area care. It is evident from discussions with healthcare professionals that care staff/qualified staff, were slow to respond and failed to adopt appropriate preventative measures in relation to the person’s pressure area care. At the time of the healthcare professional’s involvement, the wound was in a poor state. Additionally this was not recorded within the individual’s care file. Of those care plans inspected there was little evidence to suggest that these had been devised with the resident and/or their representative. During both days of the inspection staff, were observed to interact positively with individual residents however routines at the home are task based and not person led. During the second day of inspection, one resident was observed to have a lack of individual support and attention from staff throughout the day as a direct result of staff focus being on routines of the day. The resident was observed to be left for long periods of the day in their bed and staff when questioned confirmed that they do not have sufficient “quality time” to spend with individual resident’s as they would like. Staff surveys returned to us also recorded that only “sometimes” was information given to staff about the needs of the people in the home and “very rarely in handovers are we told the right information and enough in detail”. One staff survey recorded, “it is frustrating that I can’t meet the needs of residents, everything is rushed or we tell residents one minute, already carrying out 3 jobs at once, people would be mobilising more (those that can walk slowly with 2 staff for assistance) but using a wheelchair is an easy option”. Two relative surveys returned to us recorded on most occasions they felt that sufficient support was provided by staff to meet the differing needs of people Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 15 at the home. In contrast one relative survey recorded under the heading of ‘do you feel that the care home meets the needs of your friend/relative’, “at first but it soon lapses”. The Improvement Plan from the registered provider addressing the requirements and recommendations following the last key inspection recorded, “ All care plans to be revisited and evaluated. Clear and comprehensive details which will reflect the needs of the service user and how they will be supported. The care plan will be evaluated monthly and service user and relatives will be part of the care planning process through reviews. All care plans will be reviewed by 31st March”. It is evident from the inspection findings that this did not occur. The Annual Quality Assurance Assessment details under the heading of `what we do well` (Management and Administration), “Care plans are audited by the acting home manager for residential, and the project manager audits the nursing care plans”. There was evidence to suggest that care plan audits had been undertaken, however these had failed to pick up on the above issues as described. Records showed that residents have access to a range of healthcare professional services such as chiropody, optician, District Nurse services and GP as and when required. However, records relating to professional visits are inconsistently completed and do not always include details of the outcome from the visit. This needs to be improved so as to evidence healthcare interventions provided to individual residents. A specialist pharmacist inspector examined the procedures for the use of medicines. Residents are protected by having secure storage for medicines but the temperature of the storage room and the fridge used to store medicines need to be maintained at a safe level since they were recorded as being outside the recommended range on 8 out of 16 occasions since the 1st May 2008. The medication audit conducted by the previous manager and operations manager on 18/1/08 detailed that fridge/storage room temperatures did not always comply with recommended safe levels. No action plan to detail how this was to be improved and/or addressed was evident and this was highlighted at the previous inspection to the home. The failure to store medicines at the correct temperatures may result in residents receiving medicines, which are not effective. The cupboard used to store controlled drugs does not comply with the relevant Misuse of Drugs (Safe Custody) Regulations but records of the use of controlled drugs are well maintained. Supplies of medicines in use were kept to a reasonable level but there was some medicine being retained beyond their prescribed period of use. The home use an agreed list of available medicines to treat residents’ minor ailments but the medicines in use did not concur with the agreed list and some prescription only medicines were kept after the dispensing label had been removed. It is unacceptable to retain medicines prescribed for one person for Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 16 the treatment of another and to use medicines to treat minor ailments, which are not on the agreed list, could put residents at risk. Clear records are kept of when medicines come into the home and when they are disposed of providing a reasonably good audit trail. Records made when medicines are administered to residents need to be improved upon. Particularly when medicines are prescribed in variable doses (e.g. “one or two tablets”) where the actual quantity given is not always recorded and this could result in residents receiving too little or too much medication. Some medicines prescribed for residents in a short course (e.g. for five days only) had continued to be given after this period and there were other examples of where the prescriber’s instructions were not followed and where special instructions for medicines were not followed which could put residents at risk of harm. An immediate requirement notice was served to ensure that residents are protected from harm by being administered medication safely, in accordance with the prescriber’s instructions and special instructions for medicines must be followed. Additionally the record made when medicines are given to residents must be made immediately after they are taken otherwise this could result in medication being duplicated or omitted unnecessarily. A member of staff was called in and completed the records for two residents, which had been omitted more than 3 hours earlier. One resident advised the inspector, that on occasions medication is not always administered in a timely manner and that they have had to wait for their medication for up to 30-60 minutes. When staff, have been questioned as to why the medication is late, the explanation given to the resident has been “ we were busy upstairs”. The resident confirmed on occasions that their medication has been administered incorrectly, however they have corrected staff and taken the correct medications due. Additionally, the inspector was advised by the resident that not all members of staff ensure that they administer the medication to them and on occasions they stated that this had been left for them to take. The resident advised that they find this task difficult to undertake as a result of their physical condition. Following the last key inspection, we were notified as part of Regulation 37 that staff could not find medication for one resident. Following discussion with the previous manager the inspector was advised of actions taken to address the shortfall/issue and informed that an investigation would be carried out. No information relating to the investigation was available at the time of the site visit. The list of those staff deemed competent to administer medication to residents was out of date. It is disappointing that the qualified nurse on duty did not know that this was inaccurate and required updating, as when asked by the inspector, confirmed that the list was correct. Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 17 Training records indicated that all but one member of staff employed at the home (not agency) had up to date medication training, however no records were available for one person. We recognise that the person is a qualified nurse, however in light of recent concerns and history of non-compliance with safe medication practices and procedures, it is recommended that further training relating to the safe administration of medication be undertaken as part of good practice procedures. Additionally, competency assessments were not evident for some people. Under the heading of `what we do well`, the Annual Quality Assurance Assessment recorded that staff who administer medication, “have 3 monthly competency assessments”. The project manager confirmed to the inspector that these had not been undertaken as detailed above. At a meeting on 31/1/08 between Southern Cross Healthcare and us, the then manager confirmed that regular competency assessments would be undertaken to ensure staff’s capability and proficiency. The manager also advised that weekly audits relating to the home’s medication records, practices and procedures would be undertaken. At the site visit, audits were requested from January 08 to May 08. No weekly audits relating to medication were evident, other than the medication audits conducted on 18/1/08 and 9/4/08. (evidence of monthly manager’s audits and the operation manager’s validation audits were available from January 08 to May 08). Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 18 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 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Shortfalls in the activities programme at the home for those people with complex needs, means that some residents do not have their social care needs met. People can be assured of receiving a varied diet. EVIDENCE: An activities co-ordinator is employed at Stambridge Meadows for 25 hours per week, Monday to Friday. Both the project manager and operations manager advised the inspector that the co-ordinator’s hours are flexible so as to include special activities undertaken in the evenings and at weekends. The Improvement Plan from the registered provider addressing the requirements and recommendations following the last key inspection details that an additional 12 hours for activities is being advertised. At the time of the site visit, this post remained vacant. As detailed at the last inspection the activities co-ordinator has joined NAPA (National Association for Providers of Activities for Older People) and is completing a distance-learning course. Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 19 On inspection of the recreational activities record folder and diary, there was evidence that some residents had participated in quiz night, PAT Dog visits, clothes party, religious observance, arts and crafts, reminiscence, indoor bowling, darts, bingo, listening to music, external entertainers, visited by the hairdresser and television/video afternoons. As stated previously, there remains little evidence to indicate that those people who remain in their room or who have poor cognitive development are supported to have their social care needs met. Additionally, access within the local community was seen to be limited, with the last outing undertaken in December 07. Under the heading of ‘what we could do better’ this details, “accessing activities for those residents with more complex needs or who are bedridden”. It also states under the heading of ‘our plans for improvement in the next 12 months’, “identification of links for activities for those residents with complex needs e.g. RNIB and various societies as the Parkinson’s Society”. Residents spoken with confirmed that they have the option as to whether or not they participate. No adverse comments were made by residents in relation to the activity programme, however two residents advised that they wished they could be taken out for a cup of tea/cake etc. Of those care plans inspected, not all were noted to have sufficient information recorded detailing resident’s preferences relating to their social care needs, past/current interests and hobbies. Both the project manager and operations manager confirmed that improvement needs to be made so as to ensure that those people who remain in bed or who have poor cognitive development/poor communication are also given the opportunity for stimulation through a varied programme of recreational activities which meet their individual needs. On the day of the site visit it was positive to note that a VE Day display had been set up within the main lounge/dining area and in the evening residents enjoyed an external entertainer singing songs of that era and an elaborate buffet tea had been provided. Residents spoken with confirmed that the above was very successful and enjoyable. An up to date event summary was displayed within the main reception area and this had been circulated to individual residents. As detailed at previous inspections to the home, the management team of the home should consider devising this in larger print and/or pictorial format so as to enable the majority of residents to make an informed choice. There is an open visiting policy whereby visitors to the home can visit at any reasonable time. A four-week rolling menu is in operation at the care home. The head chef advised the inspector that a new system of nutritionally balanced meals had recently been introduced at the home (NUTMEG), however at the time of the site visit, he had not received training relating to the new system. Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 20 The menu for the day was displayed within the main dining room, however some residents when asked, were unable to say what was on offer. As stated previously, the management team of the home should consider devising a larger/simple print and/or pictorial menu so that the majority of residents are enabled to make an informed choice. The menu continues to indicate there are two choices of main course and dessert available, plus alternatives to the menu are always available (sandwiches, omelette, soup and jacket potato). Dining tables were attractively laid with tablecloths and condiments and a choice of drinks were readily available. For those people who choose to have their meals in the dining room, the dining experience was observed to be positive and appropriate. Where residents required assistance from staff to support them to have their meal, this was done with respect and sensitivity. Meals provided to residents were attractively presented and portions of food seen to be plentiful. Comments relating to food from residents were noted to be positive, “oh yes the food is lovely”, “the chef is a good cook”, “its not too bad” and “its lovely, I never have any complaints”. It was disappointing that for those people who have their meals in their room and who require assistance from staff, meals provided were considerably later than for those people who receive their meal in the dining room. For example, one resident was observed to not receive their meal until 13.50 p.m., some 50 minutes after other people. Staff, were questioned as to the rationale for this, and the inspector was advised that they are required to assist people in the dining room first and then people in their room. Currently there are 5 residents who require assistance by staff to eat their meal (ground floor), however there are only 2 staff available to undertake this task. This is seen as unsatisfactory and means that some people do not get their meal until quite late in the day. The project manager and operations manager were advised to look at how the above could be improved. Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 21 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 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although there is an appropriate complaints procedure and system for logging complaints, people who use the service are not confident that their concerns are taken seriously and acted upon. EVIDENCE: The management team has a corporate complaints policy and procedure, which is detailed within the Statement of Purpose and Service Users Guide and displayed within the main reception area. It is evident that relatives and others are aware of how to make a complaint and the complaint process. Two relative surveys returned to us commented that usually the home responds appropriately if concerns have been raised about their relatives care. Another relative survey returned to us advised that “yes” they were aware of how to make a complaint but “usually it is taken up and always the care staff are blamed”. Prior to the inspection we received a number of concerns and complaints from relatives in relation to inadequate staffing levels, poor standards of care for their member of family, insufficient hoisting equipment in the home for the numbers and needs of residents and the impact this has had on care delivery and concerns from a member of the public in relation to one resident’s safety, health and wellbeing. Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 22 Complaint records were requested from the project manager/operations manager. On inspection of the complaint log, this evidenced that since the last inspection there have been six recorded complaints. However, not all complaints that we are aware of were detailed and included within the complaint log or responded to within a 28 day, period. The Annual Quality Assurance Assessment details under the heading of `what we do well`, “All complaints are now recorded and followed through to completion/outcome. All complaints are responded to within a 28 day period”. Under the heading of `How we have improved in the last 12 months`, this stated, “Complaints are recorded appropriately and a log kept in the folder of all complaints”. Additionally, it is of concern that following an incident in January 08 one resident’s concerns were not dealt with by the previous manager and at the time of the inspection, they had not received any feedback from the organisation as to the outcome of the issues raised. The resident advised they were given assurances by the manager that, the matter would be looked into and notified of the outcome. The resident advised that the reason for writing to Social Services was as a result of not having faith in the manager/organisation to deal effectively with their concerns. At the last key inspection, it was of concern that out of 11 complaints logged, records were only available for 4 complaints. At the time, both the manager and operations manager concurred with the inspector’s findings and assurances were given to ensure that records would be maintained in accordance with regulatory requirements and Southern Cross Healthcare’s own policy and procedures. The Improvement Plan addressing the requirements and recommendations from the last key inspection stated, “There is now in place a complaints and compliments record that details the original complaint, the investigation and outcome. Complaints monitored each month by operations manager via Regulation 26 and all complaints and responses forwarded to operations and head office”. Several complaints made since the last key inspection relate to only one hoist being available within the home for a period of time. Records inspected evidenced that the hoist first became non operational on 24/12/07 and that an engineer visited the home and informed the management team that the charger required replacing. However, records indicate that the charger was not received at the home until 8/2/08 and unfortunately this too was faulty. Another charger was provided on 15/2/08, however this too was faulty and could not be used. The complaint log does not provide evidence as to when the home had sufficient working hoists in operation and neither, the project manager or operations manager could advise as to the specific date. The complaint log was seen to be inaccurate on two occasions as issues relating to the `lack of hoists` was recorded as being “resolved” on 1/2/08, however it was not until after 15/2/08 that the home had sufficient working hoists in the building. From discussion with staff, correspondence from relatives and from talking with one resident, it is apparent that the lack of hoist’s in the care home have Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 23 had significant impact on care delivery for residents. One resident spoken with advised that they had to wait for up to 1 hour/1 hour 30 minutes to have support with their personal care. One relative advised in their letter of complaint that their member of family had to wait for 1 hour 30 minutes before a hoist became available. Staff commented/confirmed that it was very stressful with only one hoist as residents, were having to wait to be hoisted to use the toilet and in some instances people could not wait and this led to beds requiring to be changed, people being bathed/washed and clothes changed. This impacts negatively on a person’s dignity. Additionally some residents were not got up from their bed until later in the day. Staff also advised that they found it difficult providing an appropriate rationale to relatives as to why there was only one working hoist. We are concerned that action by the registered provider to address the areas of concern as detailed above, was slow and ineffectual and the quality of life for some residents was made worse by the lack of response by the registered provider. As a result of the above concerns an immediate requirement notice was issued to ensure that residents, relatives and other interested parties are confident that their complaints will be listened to, taken seriously and acted upon. Additionally to ensure that any complaints raised are investigated in line with the registered provider’s own policy and procedures and meet the regulatory requirement. Issues, as highlighted above, were forwarded to the local authority safeguarding team and an adult protection meeting was undertaken on 20/5/08. The findings of the meeting were that the registered provider had failed to proactively deal/raise issues under safeguarding procedures and incidents were poorly managed and not satisfactorily resolved. The registered provider confirmed that they had failed to safeguard people within the home and to provide appropriate interventions in line with meeting people’s needs. Policies and procedures relating to safeguarding are readily available within the home. Staff spoken with demonstrated a basic 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. The staff training matrix evidenced that 82 of staff have attained safeguarding training and 71 of staff have received training relating to challenging behaviour. Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 24 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although residents live in a safe and well-maintained environment, shortfalls were identified in relation to residents having the specialist equipment they require and ensuring positive outcomes for residents. EVIDENCE: A partial tour of the premises was undertaken throughout both days of inspection. On both days, the home was noted to be odour free and the cleanliness of the home continues to be maintained to a high standard. A random sample of residents’ bedrooms were inspected and all were seen to be personalised and individualised with many personal items on display. The ambience is homely and residents spoken with continue to enjoy their surroundings and the facilities provided. Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 25 Although there were no health and safety issues highlighted at the time of the site visit, both the project manager and operations manager were advised that a number of fire doors within the home, were observed to be `propped’ open. As stated previously, concerns relating to sufficient equipment (hoists) being available for residents has also been an issue. This is discussed in more detail within the Complaints and Protection section of this report. At the time of the inspection, there was sufficient items of equipment e.g. hoists, wheelchairs, grab rails etc. so as to ensure residents safety and wellbeing. The maintenance person at the home is employed for 40 hours per week and there is a continuing programme of maintenance and decoration in progress. On inspection of the maintenance book, this highlighted on several occasions that the call alarm facility within some areas of the home have intermittently not been working. One resident advised the inspector that they sustained a fall in January 08 and used the call alarm facility, however they consequently learnt from staff that this did not register in the hallway and resulted in staff not being alerted to the fact that they required assistance. The impact for the resident was that they remained on the floor for a period of approximately 5 hours. The registered provider must ensure that the home’s call alarm facility is regularly checked to ensure that it is working properly and if problems continue to persist that appropriate measures are undertaken so as to ensure residents safety and wellbeing. The operations manager advised the inspector following the site visit that the call alarm system was serviced. The training matrix evidences that the maintenance person, housekeeper, laundry person, domestic and gardener have 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. Following discussions with the maintenance person and from inspection of maintenance records, a new `check it` system has been introduced since February 08 in relation to the maintenance of bedrails, shower heads, window restrictors, wheelchairs etc. The record of hot water temperatures was available and indicated that the hot water temperatures emitting from some resident’s wash hand basins was luke warm (38°). A random sample of safety and maintenance certificates showed that the passenger lift, fire systems within the home, fire alarm/emergency lighting testing and fire drills were serviced/tested regularly. Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 26 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 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The level of staffing/staff deployment restricts the ability of the service to deliver person centred care and to ensure that people’s needs, can be met and that they are safe. Shortfalls in training means that residents are not safeguarded and staff working at the care home may not have the necessary skills to meet the assessed needs of residents. EVIDENCE: The project manager and operations manager advised the inspector that staffing levels at the home have reduced to 1 Senior/1 RGN or 2 RGN plus 4 members of care staff between 08.00 a.m. and 20.00 p.m. each day as a result of the numbers of residents currently living at Stambridge Meadows (28). The inspector was advised that the waking night staffing levels remain unchanged at 1 RGN and 3 members of care staff between 20.00 p.m. and 08.00 a.m. each day. Since the last inspection we have been notified on 13 separate occasions of staff shortages, whereby the management team of the home have been unable to cover the staffing shortfall with existing staff, unable to get cover from an external agency or only partially managed to cover the shift with agency staff. On inspection of six weeks staff rosters these evidenced that on all but 3 occasions, the above staffing levels were maintained. From inspection of Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 27 notifications received by us, there are 3 dates whereby we had not received a Regulation 37 notification advising us of the staffing shortfall and measures undertaken to deploy staff to the home. Since the last inspection several residents’ relatives have expressed concern to us in relation to inadequate staffing levels within the home and feel that the level of care provided to their member of family has been poor. Following discussion with staff, the inspector was advised that although the numbers of residents within the home has decreased, the dependency levels of some residents remain high, with some resident’s requiring significant input from staff in relation to personal care tasks, two staff to hoist and some people requiring assistance to eat their meals. Staff advised that where there have been shortfalls, this has resulted in some residents not receiving care in a timely manner, people not receiving personal care in line with their care needs and in some instances people left in bed until later in the day. One resident advised the inspector that they have overheard staff complaining of staff shortages and on occasions have had to wait for personal care to be provided, for incontinence pads to be changed, to be assisted to use the commode and for their position in bed to be changed. One relative survey returned to us, recorded, “The staff are usually cheerful and willing to help. They all appear to want to help and have a friendly approach to the residents”. Staff surveys returned to us commented, “there is never enough staff, we are always short and nothing ever seems to be done about it” and “sometimes to short on shift to look at care plans, especially after handover, buzzers start and people are asking for breakfast and to be washed”. During the first day of inspection, there were two occasions when call alarm facilities were not answered promptly and as previously stated, occasions during both days of inspection when those people who are immobile/left in bed were left without appropriate staff support for long periods of time. The operations manager was requested to provide us with dependency levels/statistics relating to how staffing levels at the home are determined. The inspector was advised that there are no figures/information compiled to provide a rationale as to how the above staffing levels are established. It is evident as already highlighted within other areas of the report that routines within the home are task orientated/routine based and on occasions staffing levels/deployment of staff has not met the needs of the people who use the service and this has resulted in some individuals having their health and welfare adversely affected. A random sample of staff files were examined including those for newly recruited staff. It was positive to note that the majority of records as required by regulation had been received, however the recruitment file for the manager and a bank member of staff had to be faxed from head office. Not all files were observed to have a recent photograph of the employee or a job description. In relation to the latter, the file for the deputy manager contained a copy of a job description for `team leader` and not for deputy manager. The start date was Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 28 not recorded for one person and on inspection of one file the individual’s Nursing Midwifery Council (NMC) Pin Number had expired at the end of April 08. No evidence was available to indicate this had been renewed however when questioned by the project manager, they confirmed that this had been refreshed. From inspection of staff rosters, these evidenced that on occasions agency staff had been used at the home to cover staffing shortfalls. Profiles and induction records were requested for those people used during a six-week period (8). The majority of people were noted to have a profile confirming that the external agency had undertaken recruitment checks in line with regulatory requirements and detailing training courses completed. Additionally there was evidence to support that they had received an induction at Stambridge Meadows, however a profile/induction was not available for 2 people. Of 8 staff files examined, a record of induction was only available for 4 people. None of the induction records seen were in line with Skills for Care. The training matrix provided to the inspector showed at the time of the key inspection 61 of staff had training relating to food hygiene, 84 had manual handling training, 66 had COSHH training, 74 nutrition, 21 customer care, 43 care planning, 71 challenging behaviour, 16 dementia awareness, 3 had received training relating to safe use of bed rails and 23 members of staff had up to date first aid training. As highlighted at previous inspections to the home, there was little evidence to indicate that staff have received specific training around those conditions associated with the needs of older people e.g. pressure area care, parkinsons’ awareness, falls management etc. As stated previously within the Health and Personal Care section of the report, there was also evidence to indicate that some staff do not have the necessary skills to meet the assessed needs of individual residents. Additionally it was of concern that from inspection of one newly employed staff member’s file and from evidence of the staff training matrix the only training undertaken since their appointment (March 08) was in relation to manual handling. This was confirmed by the member of staff. The project manager and operations manager confirmed that they were aware of some gaps in the training programme for staff and hope to deal with this area in time. One staff survey returned to us recorded, “although training is given, it would be nice to have advice when needed, instead of being told I’ll get back to you, but it never happens”. Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 29 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, 32, 33, 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Management arrangements in the home are unsatisfactory and the shortfalls identified throughout this report adversely affect outcomes for residents. EVIDENCE: Since the last inspection there have been management changes within the home, resulting in a new manager being appointed in April 08. At the time of the inspection the manager had been in post for approximately 2 weeks, however following the inspection we have been advised by the registered provider that they have terminated their employment. It is of concern that the home is, once again, without a manager and although we recognise the attempts made to appoint a new person in the management role, it is unclear as to why people appointed do not stay for long. Currently the home is being Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 30 managed by a project manager and they are being supported by an operations manager, however there remains little evidence to indicate that requirements/recommendations as highlighted at previous inspections are being addressed and improvements sustained over a period of time. Over the past 18 months there have been 6 changes in the management/running of the home. Emphasis must be undertaken by the registered provider to secure a permanent manager for Stambridge Meadows, who has the qualities and qualifications required to manage the care home effectively, provide stability and ensure positive outcomes for the people who live there. It is evident from this inspection that progress highlighted at the previous inspection to the home has declined. Areas which continue to require further development relate to care planning/risk assessments, proactive management in meeting individual resident’s care needs, providing a range of activities which meets people’s social care needs, ensuring medication practices and procedures in the home are safe, staffing levels appropriate to meet residents dependency needs, sustained training and development of staff particularly around those conditions associated with the needs of older people and developing consistent staff supervision. The management team at the home must demonstrate a proactive approach to addressing and sustaining good practice, so as to ensure residents continued safety, wellbeing and positive outcomes. The Annual Quality Assurance Assessment details, “As a company and individual care home within that company it is vital that the issues raised in the last inspection are recognised, categorised and improvements channelled to ensure the home moves forward in a logical, comprehensive and continuous format” and “the home is now moving forward, and addressing the issues”. We recognise that improvement was made at the last key inspection (January 08), however this has not been sustained and within a relatively short period of time many areas, once again, require significant improvement. Staff spoken with advised that they felt the project manager was approachable and doing her best, however they felt that the numerous changes in management at the home was having a detrimental affect on the overall performance of the service and not providing stability and reassurance to either themselves or residents. As stated previously staff were concerned with the high dependency levels of residents and lack of staff on occasions to meet individual resident’s needs. Staff surveys returned to us recorded, “there is no support for the staff or appreciation for the work we do”, “there is a lack of communication between managers and staff” and “because of problems keeping a manager at Stambridge Meadows, a staff/manager relationship never happens”. One relative survey returned to us recorded positive comments by stating, “It isn’t “home” but in most cases it’s a pretty good comfortable substitute”. In contrast another relative survey returned to us recorded, “This last year we Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 31 have had 4 managers who are under pressure from their head office. All this is very bad for staff moral each manager wants different things so there have been lots of changes. For the residents it is there home, they pay a lot of money to be there and are not getting the time with carers to get quality time. For the law maybe they have enough staff, but not enough to give quality care. They must get their act together as the reputation has gone so far down I will not put my relative in this home again. I have known this home since the days of [previous owners name] and it’s nowhere near the standard”. The survey further states under the heading of ‘how do you think the care home can improve’, “Listen a bit more to the staff and take into consideration that the nursing residents take longer to wash or bath and needs 2 carers to do this as most of the residents are not able to help at all”. All sections of the Annual Quality Assurance Assessment were completed. We recognise that the assessment form was completed and submitted to us in December 07, however the information recorded does not give an accurate account of the current situation within the service. Aspects of the document as detailed within the main text of the report are aspirational and there is little and/or no evidence to support the claims made within it. On inspection of a random sample of supervision records for staff it was evident that formal supervision, is not happening as frequently as it should. Records indicated that over the past year, some people had received between three and four supervisions. On inspection of the staff supervision planner, this did not include evidence of formal supervision being planned for all qualified members of staff. A list of those people who require supervision was handed to the inspector and the number of people listed totalled 20 staff members. The project manager confirmed that there were shortfalls. The Annual Quality Assurance Assessment details, “Regular supervision of staff is maintained”. The project manager advised that surveys to seek residents, their relatives and others views are to be forwarded in the future, however no planned date to do this was available. The operations manager advised that comment cards are available for people to complete and these are located in the main reception area of the home. The operations manager also advised that the previous manager held weekly surgeries so as to talk to relatives and others should they wish to and although the manager has left the employment of the home, it is hoped for these to continue with the project manager. Records of staff meetings since the last inspection were not available. The project manager advised that these have occurred and a meeting was planned for the following week. The last resident’s/relatives meeting was conducted in October 2007 and minutes were available. The project manager advised that one was planned for the following week. Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 32 A health and safety policy was observed within the home. Accident records were inspected and these evidence that these mainly relate to people experiencing falls. Records were well maintained and included all necessary information. On inspection of the staff training matrix, this details that at the time of the site visit, only 53 of staff had undertaken fire safety training, 61 of staff had undertaken recent fire drill training, 66 of staff had received COSHH training within the last 12 months, 63 of staff had received health and safety training within the last 12 months and 74 of staff had received infection control training within the last 12 months. The registered provider must ensure that all staff, receive training in relation to the above, so as to ensure safe working practices. A random sample of safety and maintenance certificates, showed that some areas as previously mentioned had been serviced, and remain in date until their next examination. At the time of the site visit, no certificate was available to confirm that the home’s gas safety or electrical safety systems were safe and in full working order. Following the inspection the operations manager confirmed that neither certificate was available (head office) and servicing was requested to be undertaken. Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 33 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 X X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 2 X X 2 X 2 Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 34 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 OP3 Regulation 14 Requirement Prospective residents are admitted on the basis of a full assessment to ensure that their needs can be met. Care planning at the home must identify, and be effective in meeting all residents’ assessed needs and ensure that these are regularly updated/reviewed to reflect the most up to date information. Previous timescale of 1.7.07, 1.11.07 and 9.1.08 not met. Risk assessments must be devised for all areas of assessed risk so that risks to residents can be minimised. Previous timescale of 1.10.07 and 9.1.08 not met. Ensure that the health and welfare of individual residents is promoted and proactively managed. This refers specifically to ensuring that where people require support, records are updated, staff have the skills to recognise when to contact DS0000015554.V362633.R01.S.doc Timescale for action 14/06/08 2. OP7 15 20/06/08 3. OP7 13(4) 20/06/08 4. OP8 12(1)(a) 20/06/08 Stambridge Meadows Version 5.2 Page 35 5. OP8 17(1)(a), Schedule 3 (n) 6. OP9 12(1) 13(2) healthcare professionals and to provide appropriate interventions. Record information relating to 20/06/08 individuals pressure area care and any treatment/on-going care provided, so as to promote and maintain resident’s health and wellbeing. Residents must be protected 10/05/08 from harm by being administered medication safely, in accordance with the prescriber’s instructions and special instructions for medicines must be followed. An immediate requirement notice was served. Residents must be protected, by 31/05/08 having medication stored under suitable environmental conditions, in line with current legislation and not retained after they are no longer prescribed. Records of medicines 31/05/08 administered to residents must be accurate, complete and made at the appropriate time. This will show that residents receive the medicines prescribed for them. Ensure that those people who 01/07/08 are immobile have their social care needs met. Previous timescale 1.7.07, 1.11.07 and 1.3.08 not met. Ensure that residents receive 14/06/08 their meals within a reasonable timeframe so as to ensure their health and wellbeing. Ensure that there is a clear audit 10/05/08 trail/records depicting complaints received, investigation, action taken and outcomes. This will ensure that residents and others are confident that their complaints will be listened to, DS0000015554.V362633.R01.S.doc Version 5.2 Page 36 7. OP9 13(2) 8. OP9 13(2) 17(1)(a) 9. OP12 16(2)(m) and (n) 10. OP15 16(2)(i) 11. OP16 22(2)(3) and (4) Stambridge Meadows taken seriously and acted upon. Previous timescale of 9.1.08 not met. An immediate requirement notice was issued. Ensure that appropriate measures are undertaken to enable residents to be protected from potential abuse and that all allegations and incidents are followed up promptly and referred to the appropriate agencies. Ensure that equipment provided at the care home is kept in a good state of repair and available for residents so as to ensure their care needs can be met and maintained. Ensure there are sufficient staff on duty at all times, and that the deployment of staff is appropriate to meet the needs of residents and to ensure their safety and wellbeing. Previous timescale of 1.10.07, 31.10.07, 13.11.07 and 9.1.08 not met. Ensure that robust recruitment procedures are adopted at all times for the safety and wellbeing of residents. Ensure that staff, receive appropriate training to the work they perform. This refers specifically to those conditions associated with the needs of older people. This will ensure that staff, have the competence, confidence and ability to meet resident’s care needs. Previous timescale of 1.5.08 not met. Ensure all staff receive a structured induction which is in line with Skills for Care. This will DS0000015554.V362633.R01.S.doc 12. OP18 13(6) 14/06/08 13. OP19 23(2)(n) 14/06/08 14. OP27 18(1)(a) 14/06/08 15. OP29 19 14/06/08 16. OP30 18(1)(c)& (i) 01/09/08 17. OP30 18(1)(c)& (i) 14/06/08 Stambridge Meadows Version 5.2 Page 37 18. 19. OP31 OP36 8(1) and 9 18(2) ensure that staff are enabled to undertake their job effectively. Ensure that a manager is appointed and that the care home is managed effectively. Ensure that staff, receive regular supervision so that they feel supported and residents know that staff are appropriately managed. Previous timescale 1.7.07, 1.11.07 and 9.1.08 not fully met. 01/07/08 14/06/08 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. 3. 4. 5. Refer to Standard OP3 OP4 OP12 OP15 OP38 Good Practice Recommendations Evidence should clearly depict where residents and their representatives are invited to visit the care home prior to admission. Evidence should be available in writing from the registered provider to confirm that residents needs, can be met. Consider devising the activities/event summary in larger print and/or pictorial format so as to enable people to make an informed choice. Consider devising the menu in larger print and/or pictorial format so as to enable people to make an informed choice. Ensure that the home’s gas and electrical systems are serviced/safe and that there is documented evidence to support this. Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Stambridge Meadows DS0000015554.V362633.R01.S.doc Version 5.2 Page 39 - 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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