Inspection on 05/10/09 for Stambridge Meadows

This inspection was carried out on 5th October 2009.

CQC found this care home to be providing an Adequate 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 16/04/09

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 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Stambridge Meadows Stambridge Road Great Stambridge Rochford Essex SS4 2AR Lead Inspector Michelle Love Key Unannounced Inspection 5th October 2009 11:07 DS0000015554.V377998.R01.S.do c Version 5.3 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.V377998.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.V377998.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.V377998.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 16th April 2009 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 £625.00 for those residents receiving residential care in a bedroom without en-suite facilities, £650.00 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 £575.00 per week per person. A large room is charged at £700.00 per week and a large room with en-suite facilities is charged at £750.00 per week. Respite/Short Term Care is charged at £140.00 per day and after 7 days this reduces to £110.00. If residents are funded by social services then a top-up fee for rooms may be applicable depending on the room chosen and will need to be discussed with the project manager/manager of the home. Additional charges to residents include chiropody, hairdressing, newspapers and magazines, personal toiletries and telephone charges. Stambridge Meadows DS0000015554.V377998.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 one day by one inspector and lasted a total of 8 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. There were 21 people living at Stambridge Meadows at the time of this inspection. As part of the inspection process a number of records relating to people who live at the home, care staff and the general running of the home were examined. A partial tour of the premises was undertaken, time was spent with residents, staff and information gathered from these conversations as well as from observations of daily life and practices at the home have been taken into account in the writing of this report. The project manager and Operations Manager were present during the site visit and assisted with the inspection process. The outcomes of the site visit were fed back and discussed with both the project manager and Operations Manager and opportunity given for clarification where necessary. As a result of concerns relating to some aspects of care planning and risk assessing, a Serious Concern Letter was forwarded to the registered provider. We have subsequently received a clear response from the registered provider confirming actions to be taken to address the shortfalls. What the service does well: The quality of meals provided to people living at the home remains excellent. Positive comments were noted from residents and these are recorded within the main text of the report. Several people told us that visitors are made to feel welcome at Stambridge Meadows. People who use the service are able to raise concerns and there is an effective complaints procedure in place. Stambridge Meadows DS0000015554.V377998.R01.S.doc Version 5.2 Page 6 The home environment is pleasantly decorated and furnished. Peoples rooms are personalised and individualised to reflect peoples lives and personal preferences. The staff carry out regular checks on medication and medication records to ensure people receive the treatment prescribed for them. 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. 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.V377998.R01.S.doc Version 5.2 Page 7 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.V377998.R01.S.doc Version 5.3 Page 8 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): 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 Stambridge Meadows can be confident that their needs will be assessed. EVIDENCE: No changes have been made to the services pre admission assessment documentation or assessment process since the last key inspection. As highlighted at previous inspections to the home there is a formal pre admission assessment format in place, so as to ensure that the management and staff team are able to meet the prospective persons needs. Records showed these are generally completed by the project manager or a senior member of staff. In addition to the formal assessment procedure, supplementary information is provided from individuals placing authority and/or hospital and formal assessments relating to dependency, moving and handling, pressure area care, Stambridge Meadows DS0000015554.V377998.R01.S.doc Version 5.3 Page 9 nutrition and continence are completed. Evidence shows that information recorded within the pre admission assessment, forms the basis of the persons plan of care. As part of this inspection, two care files for the newest people admitted to Stambridge Meadows were examined. Records showed that a pre admission assessment was completed for each person prior to them being admitted to the home. Whilst there is a formal assessment process in place, care must be taken to ensure that the information recorded on the pre admission assessment format is transferred to the persons care plan and where it states that the person is to be reassessed at the point of admission, this is carried out. For example one assessment made reference to the persons skin condition to be assessed on admission. The formal assessment relating to their pressure area care recorded them as being at high risk however there was no evidence within their current and archived records to evidence this had been undertaken. The project manager confirmed that written confirmation that the home can meet the persons needs following assessment is undertaken and kept on each persons file. There was little evidence to show that the pre admission assessment process had been conducted with the resident and/or their representative and this was discussed with the project manager at the time of the site visit. In addition it was unclear as to whether or not the prospective resident and/or their representative had visited the home prior to admission. However we are aware from previous inspections that people are offered the opportunity to visit Stambridge Meadows so as to look around the premises, to meet existing people who live there and to meet members of the staff team. Intermediate care is not offered at Stambridge Meadows. Stambridge Meadows DS0000015554.V377998.R01.S.doc Version 5.3 Page 10 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 Stambridge Meadows can expect to have a plan of care, however this may not fully identify all of their care needs and how these are to be met. EVIDENCE: There is a formal care planning system in place so as to help staff to identify the persons care needs and to specify how these are to be met. As part of this inspection the care files for 3 people were examined (2 in full and 1 in relation to a specific healthcare need as identified by the homes project manager). Records showed that each person had a plan of care and whilst some elements were observed to be detailed and informative, information recorded was not consistent. Information recorded for those people case tracked did not contain all of their specific care needs and the staff support and interventions required. In addition there was little evidence to Stambridge Meadows DS0000015554.V377998.R01.S.doc Version 5.3 Page 11 show that the care plan had been compiled with the resident and/or their representative. While we recognise that some elements of individuals care plans were detailed and person centred, further development of the homes care planning processes is required so as to ensure the care needs of people are clearly identified, recorded and that care staff have the information they need so as to provide good care. For example the care file for one person made reference to them having a diagnosis of mild dementia, suffering with angina, high blood pressure, having osteoporosis and on occasions having poor dietary needs. Records showed there was a detailed care plan relating to their nutritional needs, including evidence of a specific healthcare professional’s involvement for advice and appropriate intervention, evidence of weight loss and gain and where the persons needs had changed, the plan of care had been reviewed and updated to reflect this. Records also showed that the persons dietary needs were recorded each day and these were well maintained. However, there was no plan of care relating to their angina, high blood pressure, osteoporosis or how their dementia impacted on their activities of daily living. Medication Administration Records (MAR) showed the person was prescribed medication for the above medical conditions. In addition a formal falls risk assessment was observed to have been completed and this provided a score of 5. The assessment recorded falls risk scores of 4 and above must have a care plan. No plan of care was evident. Another care file made reference to the person being at high risk of poor nutrition, being breathless, having osteoporosis, having a sensory impairment, prone to chest infections and requiring oxygen. The draft care plan also made reference to the person being admitted to Stambridge Meadows with a small pressure sore. A plan of care was completed for the majority of areas and observed to be satisfactory however there was no plan of care relating to them being prone to chest infections or having a pressure sore in both their current file or within the archived records. Daily care records confirmed the person as having a pressure sore on admission and the intervention of a healthcare professional on several occasions to dress the wound. Records also made reference to the person experiencing constipation and pain for several days however their plan of care relating to this was not devised until 5 days after this was first noted. In addition there was no rationale as to why their nutritional plan of care was devised 2 days after they were admitted, yet they were deemed at high risk of poor nutrition prior to and at the time of admission and at risk of dehydration. Records also showed that the person should be weighed each week, however only one entry was recorded instead of two. The persons dietary needs were recorded each day and records well maintained. Records of fluid intake were inconsistent and provided poor evidence on some days that the person had received sufficient fluid. Stambridge Meadows DS0000015554.V377998.R01.S.doc Version 5.3 Page 12 The care file for one person recorded them as experiencing several falls in recent days as a result of their medical condition. Whilst records showed that the management and staff team had been proactive in alerting a healthcare professional to the persons change of care needs, they had failed to act swiftly on the healthcare professionals instructions. This was discussed with the project manager and they concurred with our findings, confirming that the instructions from the healthcare professional should have been conducted sooner. Risk assessments were not completed for all areas of assessed risk. As a result of concerns relating to shortfalls identified pertaining to some aspects of care planning and risk assessing we forwarded a Serious Concern Letter to the registered provider. We received a prompt response to our concerns detailing the actions taken to address the breaches of regulation. People at Stambridge Meadows have access to a range of healthcare professionals and services as and when required both at the home and within the local community. These refer specifically to GP, District Nurse Services, attendance at hospital appointments, Optician, Dentist, Dietician, Parkinsons Nurse etc. Records are maintained detailing records of appointments and/or visits and outcomes. Staff interactions with people were observed to be positive. Where support was provided to people by care staff, this was undertaken promptly and conducted with respect and sensitivity. People spoken with confirmed they are treated with respect by staff and that they know their care needs. One person spoken with stated the staff are wonderful, I have no complaints. Throughout the day staff, were able to demonstrate a good understanding of individuals care needs. On some occasion’s staff, were observed to not knock before entering a persons room or going into a bathroom. The majority of medicines are stored securely for the protection of residents but we found some medicines in a person’s shared room which were not locked away securely and could be accessed by other people. We also noted that there was no record of these medicines in the person’s medication records and the risks of this unsecured storage had not been assessed. We looked at the medication and medication records for several people in the home and, in general, these were in good order. They provide an account of medicines in use and demonstrate that people receive the medication prescribed for them. The home carry out regular checks of the medication records and this is good practice. Some people are prescribed medication on a “when required” bases e.g. to control pain, but care plans did not always carry guidance on the circumstances such medication is used. One person’s medication was given at a dose other than that prescribed and although we were told this was on the Stambridge Meadows DS0000015554.V377998.R01.S.doc Version 5.3 Page 13 instruction of a specialist nurse, there were no records made of this in the person’s care plan. For one person who was prescribed oxygen via a concentrator, the care plan did not carry verification of the rate of period of use and risk assessments had not been properly completed. Medication is only given to people by staff who have been trained and assessed that they are competent to do so. Stambridge Meadows DS0000015554.V377998.R01.S.doc Version 5.3 Page 14 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 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 home can expect to receive a varied diet, however they can not always be assured they will have their social care needs met. EVIDENCE: We were advised by the project manager that in recent weeks the home has been without an activities co-ordinator, however where possible an activities programme has been provided by care staff to people living at Stambridge Meadows. A new activities co-ordinator has been newly appointed for 40 hours per week Monday to Friday and is due to commence employment shortly and this will remain flexible to provide evening and weekend events on occasions. Activity planners in some peoples room were observed to be out of date (August 2009) and not reflective of activities being provided now. Out of 3 peoples care files case tracked, only 2 of them had a plan of care detailing the persons social care needs. Each person was observed to have a Recreational Activities Record in place detailing activities undertaken each month e.g. quiz, manicures, making bird boxes, arts and crafts, listening to Stambridge Meadows DS0000015554.V377998.R01.S.doc Version 5.3 Page 15 music, community based activities, bingo etc. Since the last inspection in April 2009, 2 cats have been purchased from the local Cats Protection League and these have proved very popular with people who live at the home. Concerns have been raised formally through the homes complaints procedure and the homes quality assurance surveys and questionnaires with regards to social activities at the home. Comments have included the notice board detailing resident’s activities not always correct, I would like more activities to be happening and perhaps some new ideas wouldnt go a miss and last week [name of staff] was away, everybody was just sitting there with nothing happening, the comment made to me was Im bored. A lot of things are advertised then nothing happens. On inspection of monthly Regulation 26 visit reports by the Operations Manager, there was evidence to show that similar comments were also made by residents. There remains an open visiting policy whereby visitors to the home can visit Stambridge Meadows at any reasonable time. People who live at the home confirmed their visitors are made to feel welcome and can come and go as they please. People have the choice to see their member of family and/or friend in the privacy of their own room or in the dedicated visitors lounge. People confirmed that they do have some control over their lives and are enabled to make choices wherever possible. This refers to choosing where they sit during the day, where they have their meals, whether or not they participate in activities and choice of meals. No menu detailing the choices of meal available on the day of inspection was displayed. We observed several table menus set to one side within the dining room, however this did not relate to the meal choices available. The project manager advised that steps are being taken to devise a pictorial menu so as to enable people who can no longer read the menu to make an informed choice. 2 people spoken with were unable to advise us of the meal choices available. The lunchtime meal was observed to be of a good quality, plentiful and attractively presented. The dining experience for people was observed to be positive and where people required assistance to eat their meal this was provided by staff with respect and sensitivity. Comments about the food were positive and included, its very nice, that was lovely and I have no complaints, [name of chef] is a good boy. Stambridge Meadows DS0000015554.V377998.R01.S.doc Version 5.3 Page 16 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 protected from harm and abuse. EVIDENCE: A copy of the complaints procedure is displayed within the main reception area and within the Statement of Purpose and Service Users Guide. People spoken with confirmed that they would feel able to raise any concerns or complaints within the home. The complaints log identified 1 complaint had been received since the last key inspection in April 2009. Concerns related specifically to some aspects of the persons personal care needs not being met as a result of alleged staff shortages, lack of social activities on occasions and concern that another manager had left Stambridge Meadows after only a brief time at the home. There was evidence to show that information relating to the complaint, details of the investigation and action taken were available and appropriate action taken by the management team of the home to address the issues. Records showed that some elements of the complaint were upheld. The project manager advised that the complainant was satisfied with the outcome of the complaint. Stambridge Meadows DS0000015554.V377998.R01.S.doc Version 5.3 Page 17 The project manager stated that there have been lots of verbal compliments however these have not been formally recorded. There was evidence of 1 thank you card and this recorded Thank you all very much for all your help and making my stay with you very enjoyable. Best wishes. Since the last key inspection there has been 1 safeguarding referral. This related to concerns relating to missed doses of medication for 1 person over a 2 day period. This was investigated and addressed by Essex County Council Safeguarding Team. The project manager advised us that all staff who administer medication have received updated medication training. 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 project manager. The staff training matrix recorded all staff as having up to date safeguarding training. Stambridge Meadows DS0000015554.V377998.R01.S.doc Version 5.3 Page 18 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 live in a safe, well maintained environment. EVIDENCE: At the time of the site visit there were 21 people living at Stambridge Meadows, all of whom are accommodated on the ground floor. A partial tour of the premises was undertaken with the project manager and independently throughout the day. We were advised by the project manager that once the major variation is agreed by the Care Quality Commission to admit people to Stambridge Meadows who have a formal diagnosis of dementia, people with dementia will be provided with accommodation on the first floor. The first floor has been newly decorated and appropriate signage is to be purchased and put up so as to aid peoples orientation. The proposed dining room on the first floor could potentially be too cramped for the numbers of residents and staff which Stambridge Meadows DS0000015554.V377998.R01.S.doc Version 5.3 Page 19 could utilise this space at any one time. This was discussed with the project manager. A random sample of residents bedrooms on the ground floor were inspected and all were observed to be personalised and individualised. The lounge/dining area to the front of the building has been newly decorated and new flooring laid. Residents spoken with confirmed they remain happy with their personal space and the communal areas. All areas of the home were observed to be clean, tidy and odour free. The cupboard by the staff desk on the ground floor was observed to be unlocked, yet there are signs which state danger high voltage and fire door keep shut and locked. Inside the cupboard was a tool box, step ladders, light bulbs and other items. No other health and safety risks were highlighted at the time of the site visit. A random sample of hot water from baths and wash hand basins were tested and the hot water temperature was seen to be satisfactory and within recommended levels. A maintenance person is employed at the home Monday to Friday between 08.00 a.m. and 16.30 p.m., however these hours remain flexible to cover evenings and weekends. There is a maintenance programme within the home so as to ensure that the home environment and equipment is well maintained. The training matrix details that the maintenance person has up to date training in fire safety, food hygiene, moving and handling, Control of Substances Hazardous to Health (COSHH), Health and Safety and Infection Control. Stambridge Meadows DS0000015554.V377998.R01.S.doc Version 5.3 Page 20 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 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: We were advised by the project manager that staffing levels for the current number of people living at the home are 1 senior member of staff and 3 care staff between 08.00 a.m. to 14.00 p.m., 1 senior member of staff and 2 care staff between 14.00 p.m. and 22.00 p.m. and 1 senior member of staff and 1 member of care staff between 20.00 p.m. and 08.00 a.m. (waking) each day. The project manager is supernumerary to the above figures. In addition to the above, ancillary staff are employed at the home (administrator, laundry person, housekeeper, kitchen assistant and chef). The project manager advised that she is looking to introduce an additional member of staff for a twilight shift each day and this will be from 17.00/18.00 p.m. to 22.00 p.m. A review of 5 weeks staff rosters showed that the above staffing levels are being maintained and the staff on duty on the day of the site visit were reflected accurately within the roster. Deployment of staff within the home was good and people spoken with said that staff, respond to call bells within a Stambridge Meadows DS0000015554.V377998.R01.S.doc Version 5.3 Page 21 reasonable time. Residents spoke positively of staff and comments included, the staff are so lovely and I cant fault them. Recruitment files were viewed for 2 people appointed since the last inspection. Records showed that they contained evidence of appropriate references and checks being undertaken in a timely manner to ensure that staff are suitable people to work with vulnerable adults. No record of induction was available for one person. The rationale provided to us was that they had transferred from another Southern Cross Healthcare home to Stambridge Meadows, however records showed that they had been employed at the home for 3 months at the time of the site visit and had received no formal induction to Stambridge Meadows. On inspection of the training matrix, this showed that since the last key inspection in April 2009 staff have undertaken training relating to fire safety, food hygiene, COSHH, health and safety, safeguarding, infection control, pressure area care and customer care. Consideration needs to be given to provide training for staff for those conditions associated with the needs of older people e.g. Parkinsons Disease, sensory impairment, Diabetes, dementia awareness, osteoporosis, dying with dignity, deprivation of liberty etc. NVQ information provided to us recorded that out of 13 members of care staff, 4 have NVQ Level 2, 2 have NVQ Level 3, 6 members of staff are currently undertaking NVQ Level 2 and 1 member of staff is undertaking NVQ Level 3. Stambridge Meadows DS0000015554.V377998.R01.S.doc Version 5.3 Page 22 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, 35, 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. People 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 in April 2009, the previous manager has left the employment of Stambridge Meadows and in the absence of no manager, the home has been managed by a project manager from Southern Cross Healthcare. The project manager advised us that a new manager, deputy manager (internal appointment) and administrator (to cover maternity leave) have been appointed and are due to commence employment at Stambridge Meadows on 12th October 2009. Stambridge Meadows DS0000015554.V377998.R01.S.doc Version 5.3 Page 23 A major variation to admit people who have a formal diagnosis of dementia has been submitted to us since the last key inspection. While we recognise continued improvements and sustainability in some areas, there are some areas identified in this report that require further development as these potentially effect the quality care outcomes for people living at Stambridge Meadows. This refers specifically to some aspects of care planning and risk assessing and ensuring that people are given the opportunity to participate in a range of activities. We were advised by the project manager that in July 2009 surveys and questionnaires were forwarded to all residents and their representatives so as to seek their views about the quality of care received and the quality of services and facilities provided at Stambridge Meadows. Records showed that 7 resident and 3 relative’s questionnaires were completed and returned. In general comments were positive and where negative comments were recorded, these related to a lack of activities and social stimulation for people. Comments included I am very happy living at Stambridge Meadows, The staff are so lovely and kind to me. I am well looked after, the food is good and the home is clean, food is very good and dont feel things need improving. The organisation, send a representative each month as required by Regulation 26 to undertake an unannounced visit to the service and write a report of their findings. The reports are detailed, record that staff and residents were spoken with to gain their views on the service and also review a number of records and health and safety issues. Reports in June and July 2009 by the Operations Manager recorded that some peoples care files required updating and care plans would benefit from being more person centred. In addition to the Regulation 26 reports, regular audits are conducted by the organisation to assess the homes performance in relation to the organisations own policies and procedures and regulatory requirements. Staff supervision records showed that staff, are receiving regular formal supervision. Aspects of health and safety were reviewed to ensure the health, safety and welfare of people living and working at Stambridge Meadows were promoted. A health and safety policy and procedure for maintaining safe working practices was readily available. Stambridge Meadows DS0000015554.V377998.R01.S.doc Version 5.3 Page 24 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 4 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 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 3 Stambridge Meadows DS0000015554.V377998.R01.S.doc Version 5.3 Page 25 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 13(4) Requirement 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, 14.10.08 and 15/6/09 not met. Care plans must fully reflect a person’s care needs and how these are to be met by staff working in the home. This will ensure that staff, have the information they need so as to enable them to provide appropriate care. Previous timescale of 15/6/09 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. Stambridge Meadows DS0000015554.V377998.R01.S.doc Version 5.3 Page 26 Timescale for action 05/11/09 2. OP7 15 05/11/09 3. OP9 12 and 13 30/11/09 4. OP9 13 Previous timescale of 30/04/09 not met. Variations to prescribed doses of medicines must only be done with the documented agreement of the prescriber. This will ensure people receive their medicines as prescribed. All people living at the home must receive regular opportunities to engage in a varied programme of activities which meet their social care needs. This will ensure that people have their social care needs met. 30/11/09 5. OP12 16(2)(m) and (n) 01/12/09 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. Staff should be respectful to people living at the home at all times. This refers specifically to staff knocking on people’s doors prior to entering. Consider devising the activities/event summary in larger print and/or pictorial format so as to enable people to make an informed choice. Ensure that the activity planner is up to date. Ensure that the cupboard next to the staff desk on the ground floor is locked at all times, so as to ensure people’s safety. 2. 3. 4. 5. OP10 OP12 OP12 OP19 Stambridge Meadows DS0000015554.V377998.R01.S.doc Version 5.3 Page 27 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA 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. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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