Inspection on 09/10/08 for Stambridge Meadows

This inspection was carried out on 9th October 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 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 30/01/2009.

CARE HOMES FOR OLDER PEOPLE Stambridge Meadows Stambridge Road Great Stambridge Rochford Essex SS4 2AR Lead Inspector Michelle Love Unannounced Inspection 9th October 2008 11:10 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.V372575.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.V372575.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.V372575.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 4th May 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.V372575.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, with two inspectors’ and lasted a total of 13.5 hours, with all key standards inspected. Additionally, a pharmacist inspector was also present to inspect the home’s medication practices and procedures on the first day of inspection. The manager’s progress against previous requirements from the last key inspection was also inspected. Prior to this inspection, the registered provider had submitted an Annual Quality Assurance Assessment (22/8/08). This is a self-assessment document, required by law, detailing what the home does well, what could be done better and what needs improving. Information given in this document has been incorporated into this report. 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. Prior to the site visit, surveys for relatives, staff and healthcare professionals were forwarded to the home for distribution and for people to complete and return to us. At the time of producing this report 6 surveys were returned to us from relatives. No surveys were returned to us from staff working at the care home. As a result of concerns highlighted at the previous key inspection, additional random inspections were undertaken on 26/6/08 and 8/8/08. What the service does well: Visitors to the care home are made to feel welcome. Food provided to people is of a good quality and comments from residents relating to meals provided, was positive. There is a varied menu and various alternatives are available if required. The care home provides people with a safe and homely environment that meets their needs. Residents continue to be satisfied with the home environment and their personal space. There is a safe system in place to safeguard residents’ monies. Stambridge Meadows DS0000015554.V372575.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Staffing levels and the deployment of staff at the care home must be maintained at all times, so as to ensure that people living in the home are kept safe and individuals have their safety and wellbeing needs met. 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 the care provided to residents, meets their specific requirements. Care plans must be devised for all residents. People living at the care home and/or their relatives should be more actively involved within the care planning process. Pre admission assessments should be devised for all prospective people admitted to the care home and information recorded used to inform the care plan. The social care needs for people at Stambridge Meadows needs to be improved. Please contact the provider for advice of actions taken in response to this Stambridge Meadows DS0000015554.V372575.R01.S.doc Version 5.2 Page 7 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.V372575.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.V372575.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 Standard 6 is not applicable to this service. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all prospective residents can expect to be assessed by the home prior to admission, and therefore are not assured that their needs can be met at this home. EVIDENCE: There remains a formal pre admission assessment format and procedure in place, so as to ensure that the management and staff team are able to meet the prospective resident’s needs. In addition to the formal assessment procedure, supplementary information is provided from individual resident’s placing authority and/or hospital. Formal assessments are also completed in relation to dependency, moving and handling, pressure area care, nutrition and continence. The care files for the three newest people admitted to the care home were examined (2 respite and 1 permanent). Records showed that a pre admission Stambridge Meadows DS0000015554.V372575.R01.S.doc Version 5.2 Page 10 assessment was completed for two people prior to their admission to the care home, however there was no evidence of a pre admission assessment having been undertaken for one person. The latter was confirmed by another regulation inspector and by the project manager. The project manager stated that a, pre admission assessment had been completed by another project manager. This person was contacted during the site visit, however no pre admission assessment could be located. This means that staff working within the care home may not have sufficient information about how to meet the needs of the prospective person admitted to the care home. In general terms the information recorded within both pre admission assessments was seen to be informative, however care must be taken to ensure that formal assessments are fully completed so as to give an accurate account of the person’s needs and that information recorded is transferred to the plan of care. The AQAA detailed under the heading of ‘what we do well’, “we have a thorough pre assessment tool to ensure all needs can be met”. Confirmation that the home could meet the individual person’s needs was documented within each of the care files examined. One resident spoken with stated that they did not visit the home prior to admission, however members of their family visited Stambridge Meadows on their behalf. The resident could not remember as to whether or not they or their representative had been provided with a copy of the services Statement of Purpose and/or Service Users Guide. As part of good practice procedures, the project manager/registered provider should consider recording the latter as part of the admission process. It was positive to note that the resident was complimentary regarding their admission to the care home and stated that they had been made to feel welcome. Stambridge Meadows DS0000015554.V372575.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. 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. People living at Stambridge Meadows cannot be safe in the knowledge that their individual care needs will be clearly recorded and met by support staff. EVIDENCE: There is a formal corporate care planning system in place to help staff identify the care needs of individual residents and to specify how these are to be met by staff who work in the care home. As part of this inspection 6 care files were examined (3 respite and 3 permanent care files). It was noted that following the last key inspection, care files for individual people have been audited, reviewed, updated and where appropriate rewritten. Evidence at this key inspection showed that efforts have been made by the management team of the home to improve the quality of the care planning processes and to record individual people’s care needs and how these are to be met by care staff. Stambridge Meadows DS0000015554.V372575.R01.S.doc Version 5.2 Page 12 The general recording within some people’s care plans was observed to be more detailed and informative, providing a good basis to staff so as to ensure that care provided was reflective of individual’s care needs, however this remains inconsistent and poor for some people. Care must be taken by staff to ensure that care needs highlighted within placing authorities assessments and from the pre admission assessment are recorded and transferred to individual’s care plans, so as to ensure that staff have the most up to date information about the individual person and the potential risks identified. This refers specifically to one person’s assessment recording that the person had chronic arthritis, had undergone knee replacements, had a crumbling spine and a heart condition, however the only elements completed within their care file related to nutrition and their social care needs. The formal moving and handling assessment recorded a score of 10 and the waterlow pressure area risk assessment recorded a score of 12. Documentation for both elements states that, “all clients must have a moving and handling care plan” and “risks with scores of 10 and above must have a care plan”. Neither of the above issues were detailed within the care plan and no risk assessments had been devised. Staff spoken with confirmed that no other records were available and information should have been recorded within the care file. Additionally on inspection of the person’s daily care records, records showed that these were not written for the first 3 days following their admission to the care home. We are aware that Southern Cross Healthcare’s policy regarding the latter is that daily care records are written daily and after every shift. The care file for one person who has a history of poor dietary intake and at high risk of developing pressure sores was examined. This showed that since the key inspection and additional random inspections, the care plan had been rewritten and updated. Although this is seen as positive, there was evidence to show that some aspects of the care plan are not being followed by care staff. This means that the resident is potentially placed at risk of not having all of their care needs and/or healthcare needs met. This refers specifically to the care file recording that the resident must be weighed weekly, fluids to be provided hourly and their position changed regularly during the day and night. Records showed the above as not consistently being undertaken by care staff. There was evidence to show that where appropriate healthcare professionals were providing advice and additional support to the care staff team. Another care file was examined in relation to the individual’s nutritional needs. There was evidence to show that there had been some improvement in the person’s dietary intake e.g. eating independently on occasions and their weight being stable, however their care plan relating to this particular care need had not been updated since August 08. Both the care plan and risk assessment recorded the person requiring to be weighed weekly, however records showed the last entry on the weight recording chart as 26/8/08 and the risk assessment had not been evaluated since the beginning of July 08. This was picked up by a project manager who was auditing a number of care files, Stambridge Meadows DS0000015554.V372575.R01.S.doc Version 5.2 Page 13 however there was no evidence to show that this had been addressed. The care plan also provided specific information relating to their posture requirements when seated at the dining table and encouragement to be provided by staff. Initially the above was not provided for the resident until the project manager intervened and prompted staff. Additionally there were occasions throughout the meal whereby the resident was noted to slide down the chair and to require further posture changes. Further interventions were provided by staff but only at the request of the inspector. At times the resident was observed to look uncomfortable and troubled prior to support being provided. During the site visit observations were conducted on both the ground and first floors of the care home by both inspectors. One person’s pre admission assessment made reference to the resident being a tablet controlled diabetic, at risk of developing pressure sores, having a urinary tract infection and being at risk of falls. The above was highlighted within the ‘service user enquiry’ sheet, however it was of concern that no formal manual handling risk assessment or care plan and/or risk assessments had been devised for the above areas. The above was verified and confirmed by another inspector and by the project manager. Observations during the morning showed that the resident was fully aware that they required frequent amounts of fluid throughout the day and stated to the inspector “I should be drinking a lot”. No jug of water and/or juice were readily available and records showed that fluid intake was not regularly provided. When questioned, staff spoken with advised the inspector that the reason for the person having a lot of fluid was, “ they’re diabetic, that’s the only reason as far as I know”. Lunch was observed on the first floor and the above resident was noted to be served non-diabetic desserts. From discussion with two members of staff, only one person was aware that the person was diabetic. Both members of staff confirmed they had not read all, of the person’s care plan. The chef was asked to confirm the number of people within the home who are diabetic. The inspector was given the names of 4 people, however this did not include the above named resident. As a result of the above concerns a Code B Notice was issued under the Police and Criminal Evidence Act 1984 and a number of documents relating to the above issues were photocopied and provided to the Commission for Social Care Inspection. Additionally an Immediate Requirement Notice was issued. As a result of the latter we received correspondence the following day, advising us that a care plan and risk assessments had been devised. The AQAA recorded, “residents wellbeing is now closely monitored and observed ensuring optimum care is delivered and where necessary appropriate professional advice is sought and documented appropriately to ensure all care needs are met”. The AQAA also recorded under the heading of ‘what we do well’, “we produce and maintain comprehensive and understandable care plans that are reviewed and audited regularly”. This did not concur fully with the inspectors’ findings. Under the heading of ‘what we could do better’ this Stambridge Meadows DS0000015554.V372575.R01.S.doc Version 5.2 Page 14 recorded, “care plans to be continually improved based on the principals of care and the person centred approach”. Improvement was noted in relation to the documentation of individual’s nutritional needs however there were some inconsistencies e.g. the records for one person showed there were occasions whereby individual nutritional intake records were not always completed throughout any given day e.g. nothing noted after breakfast etc. Daily care records for some people were generally informative, however these did not always record staffs interventions. For example the records for one person recorded an incident whereby the resident advised staff that they believed another person had taken their medication. No information was recorded detailing what action had been taken by staff to address the above or if this had been referred to a senior member of staff. The project manager advised that the matter had been addressed and dealt with, however there was no evidence to support this. Records showed that people living at the home have access to a range of healthcare professionals and services, as and when required e.g. GP, District Nurse services, Chiropody etc. Further development is required to ensure that records for individual people evidence advice/healthcare interventions. The daily care records for one person recorded they were noted to have blood in their underwear, however the only intervention recorded was “I asked [name of resident] to let me know if they had any more bleeding”. No further action and/or records were noted. Relatives surveys forwarded to us recorded mixed comments in relation to whether or not people felt that the care home met the needs of their member of family. These included, “always very helpful and show concern”, “my relative is completely immobile and always gets the care they require”, “getting my relative a regular bath is an uphill struggle”, “we are not entirely convinced that the lack of attention to detail in administration does not extend to the personal care of residents” and “usually” the home meets the needs of our relative “we think, but we have no way of knowing”. Residents spoken with confirmed that they liked living at Stambridge Meadows, however one person stated that staff are responsive at night to answering call alarms however during the day “this depends on who is on duty”. Another resident advised that since the last key inspection “some things have improved”, however “there are still occasions whereby I am not given personal care or got up until 11.00ish”. This person also confirmed that night staff are, responsive during the evening/night, however this is not consistent during the day and depends on which staff are on duty. The resident also advised that in their opinion staff attitudes are poor and stated, “its as if they are doing you a favour”. Staff interactions with residents on the second day of inspection were noted to be inconsistent. This refers specifically to some residents who were observed Stambridge Meadows DS0000015554.V372575.R01.S.doc Version 5.2 Page 15 to be calling out being ignored and dismissed by staff on duty. One resident was overheard to shout out, “want a doctor, help me, nurse help me”. The member of staff on duty was questioned by the inspector and they were advised, “she’s always doing that, I’ll come back later” and was noted to walk away. Another resident who was sitting in the lounge on the first floor asked the inspector to close the curtain as the sun was shining in their eyes. They advised the inspector, “I’ve asked the nurse twice to do it, but she’s not come back and I can’t see anything”. Another resident was noted to call out during the afternoon, “help me, help me”. The inspector observed a member of staff standing by the passenger lift, however they did not enquire as to the resident’s needs or provide support. The call alarm facility was observed to be tied up on the wall and not easily accessible for the person’s use. The resident was noted to call out again and the inspector intervened and rang the call alarm; staff attended after a short while. Additionally there were periods of time whereby staff, were not obviously present and residents on the first floor were left unattended. Interactions were generally observed to be task and routine orientated and there was little evidence to show that staff, are able to spend time with residents to sit and chat. One staff supervision record confirmed the above and stated, “we are very busy, I know they are lonely, they need me to stay with them, talk with them, but we usually haven’t any spare time, so I feel sorry”. A specialist pharmacist inspector examined practices and procedures for the safe handling, storage and recording of medicines. There have been some notable improvements in the handling and recording of medication over previous inspections. Facilities used for the storage of medicines are secure for the safety of residents and are temperature controlled to maintain the quality of medicines in use. There is a separate cupboard used for the storage of controlled drugs but we found one medicine that should have been stored there but was not. Neither was there a record of this in the relevant register as is required by the Regulations. It is expected that this will be managed by the home rather than a requirement made on this occasion. Records are kept when medicines are received into the home, when they are given to residents and when they are disposed of. These were generally of good quality and demonstrate that people receive the medicines prescribed for them. When district nurses attend to residents to administer injectable medicines e.g. insulin, this needs to be recorded but isn’t at the moment. There are regular audits of medicines in use carried out by the manager and senior staff and this is good practice. In tracking the medication in use only one discrepancy was found and this was discussed with the manager. People are given medicines by suitably trained care staff and certificates of attendance on training courses and competence assessments were seen in four staff files. When people are prescribed medication on a “when required” basis there are now written guidelines, held with medication record sheets, for staff to use and to protect residents. For one person whose needs have changed with respect to her medication needs, the care plan needs to be updated to reflect this. Stambridge Meadows DS0000015554.V372575.R01.S.doc Version 5.2 Page 16 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 poor. This judgement has been made using available evidence including a visit to this service. Shortfalls in the activities programme at the home, means that some residents do not have their social care needs met. People can be assured of receiving a varied diet and their nutritional needs being met. EVIDENCE: The project manager advised that since the last random inspection to the home, residents have been without an activities co-ordinator. We were advised that an existing member of care staff has shown an interest in undertaking this role, alongside their existing care hours and this is due to commence in 2 weeks. Since the last key inspection a newly created reminiscence room has been created, however on the second day of inspection this was not accessible as this was being used as a temporary dining room, whilst the main dining room was under redecoration. A list of activities for the week was displayed in the main reception area of the home. Consideration should be given to provide a larger print and/or pictorial format, so as to enable residents to make an informed choice. This has been highlighted at previous key inspections to the home. The activity programme Stambridge Meadows DS0000015554.V372575.R01.S.doc Version 5.2 Page 17 for week commencing 13/10/08 recorded activities available for residents as personal time, reminiscence, life stories, hairdresser, arts and crafts, games, residents meetings and general knowledge quiz. We were advised that activities undertaken by individual resident’s is recorded within an, ‘activity evidence folder’. Records showed that since the last key inspection a questionnaire had been completed for residents so as to identify their hobbies, interests and favourite foods (dated July 2008). On inspection of a random sample of 6 individual resident’s care files, records showed that 5 people case tracked did not have their social care needs identified. The care file for one person recorded, “[name of resident] is at risk of lack of socialisation”. It further stated that the aim of care was to “encourage optimum participation in the activity programme”, however the only reference made related to them listening to music, watching television and chatting to staff members. As stated at previous inspections to the home, there was little evidence to show that those people who have complex needs and/or poor cognitive development are provided with meaningful activities. The AQAA detailed under the heading of ‘how we have improved in the last 12 months’, “more 1-1 activity for those service users who are unable to leave their rooms to ensure interaction when wished”. This did not concur with the inspectors’ findings. Limited information was recorded detailing activities undertaken by individual people. The AQAA detailed under the heading of ‘our evidence to show that we do it well’, “service user care files record information of which activities a service user has attended and participated in”. This did not concur with the inspectors’ findings. Since the last key inspection, a newsletter has been devised. This recorded external entertainers at the home and future events e.g. quiz night with fish and chips and a rock and roll night. Residents’ comments relating to the activities programme provided at Stambridge Meadows were mixed. These included, “I get a bit bored sometimes”, “nothing much happens, I do this, do that, I’m here and there, I don’t know what to do sometimes, I just sit and sit”, “I get very down, no activities really, I stay in my room a lot, don’t know what goes on, not interested really” and “its not right, they (management) give the spiel about all the activities they’re providing, but it’s not happening”. Another resident advised they liked to paint and on the day of inspection they had requested staff to get their painting materials, however they had been waiting for this during the morning and by 2.00 p.m. these had not materialised. One relative survey returned to us recorded, “It would be nice to have activities everyday as my [relative] really enjoys taking part in anything”. There remains an open visiting policy whereby visitors to the home can visit at any reasonable time. Residents spoken with confirmed that they are supported and enabled to maintain friendships and contact with family members. The menu for the day was displayed for residents. Consideration should be given to provide a larger print and/or pictorial format, so as to enable residents Stambridge Meadows DS0000015554.V372575.R01.S.doc Version 5.2 Page 18 to make an informed choice. There is a rolling 4 week menu and this showed that residents have the option of 3 hot meals a day, including a cooked breakfast. Alternatives to the menu are readily available. The main dining room was not accessible on the second day of inspection as this was in the process of being redecorated. Alternative dining arrangements were evident and these were seen to be appropriate. People living at the home stated that they did not mind the current upheaval but looked forward to the dining room being completed within a reasonable timeframe. Dining tables were attractively laid with tablecloths, small vases of flowers, serviettes, cutlery and condiments. The dining experience for people living at Stambridge Meadows was observed on both the ground and first floors. People were observed to be offered a choice of drinks. Meals provided to residents were seen to be plentiful and attractively presented. On the ground floor, where individual people required assistance, staff were observed to undertake this with sensitivity and with due care and attention. Staff, were attentive to people’s needs and the meals were observed to not be rushed. Residents were also asked if they wanted second helpings and before plates were taken away, people were asked if they had finished their meal. Comments from residents regarding meals provided were positive and these included, “oh, the food is lovely”, “I tend to have the same, not a problem, they know what I like” and “its nice food”. In contrast on the first floor, 4 residents were noted to require assistance from staff to eat their meal. Support, was provided by 2 members of staff and whilst each staff member is providing support to individual resident’s, food is kept in a heated trolley. Staff advised that as a result of the above, residents could wait for up to 20 minutes before receiving their meal. When questioned as to why this is, a member of staff stated that mealtimes are arranged around staff breaks and what is happening on each floor at the time. Stambridge Meadows DS0000015554.V372575.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. Systems are in place to ensure that people living at Stambridge Meadows can be confident that any complaints raised will be listened to and acted upon. EVIDENCE: There is a corporate complaints policy and procedure in place and this was displayed within the main reception area of the home. On inspection of the document this made reference to Southend Borough Council contact details, but not Essex County Council or the London Borough of Newham. The project manager was advised that contact details for all placing authorities associated with those people living at Stambridge Meadows should be made readily available. Residents spoken with in general confirmed that if they had a concern and/or an issue, they would tell staff and/or their key-worker. One resident confirmed that they would raise issues with their key-worker, however they did not always feel confident about discussing issues with other members of staff. Not all residents spoken with were aware of the complaints procedure and the information recorded within it. Another resident advised that they would speak to the project manager and felt assured they would deal with any issues effectively. Out of 6 relative surveys returned to us, 3 confirmed they were aware of how to make a complaint. One recorded, “my [relative] has lived in the home for a number of years and I’m very pleased to say that I have only had to complain a couple of times and it was dealt with promptly”. Other Stambridge Meadows DS0000015554.V372575.R01.S.doc Version 5.2 Page 20 comments included, “have to ask several times but gets done eventually” and “communication/feedback is poor”. The AQAA detailed under the heading of ‘what we could do better’, “ensure all service users understand the complaint procedures and how to complain, ensuring any concerns are treated with urgency”. On inspection of the complaint log, this showed that since the last key inspection the management team of the home have received 4 complaints relating to poor care practices. Records evidenced the specific nature of the complaint, details of any investigation (where appropriate) and action to be taken. In addition to the complaint log the project manager compiles and completes monthly monitoring and audit forms. Not all complaints inspected had a clear outcome recorded. There was evidence of an email from the service’s operations manager in August 08 reminding the management team of the home to record outcomes/findings of all complaints and reinforcing the company’s complaint procedure to be followed. Since the last key inspection there has been one safeguarding referral, and this was referred by the Commission for Social Care Inspection to Essex Safeguarding Team. The outcome of the referral was that no action, was taken by Essex Safeguarding Team. Staff spoken with on both days of the site visit demonstrated a basic understanding and awareness of safeguarding procedures and advised that should an issue arise, information would be passed to the person in charge of the shift and/or the project manager. The training matrix provided by the administrator, showed that 72 of staff have attained safeguarding training in the last 12 months. Stambridge Meadows DS0000015554.V372575.R01.S.doc Version 5.2 Page 21 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 good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, well-maintained and comfortable environment, which ensures their safety and wellbeing. EVIDENCE: A partial tour of the premises was undertaken throughout the second day of inspection. Since the last key inspection to the home, the large lounge/dining room was in the process of being redecorated and we were advised that a new carpet is to be fitted within the next week. Additionally the project manager has newly created a reminiscence room for residents use. Other purchases include new bedding/towels for residents’ and new profile beds have been purchased. A random sample of residents’ bedrooms were inspected and all were seen to be personalised and individualised with many personal items on display. Stambridge Meadows DS0000015554.V372575.R01.S.doc Version 5.2 Page 22 Residents spoken with, confirmed they were happy with their personal space. All areas of the home were noted to be clean and odour free. In general terms the home was noted to be tidy, however some areas were observed to be cluttered with wheelchairs, walking aids and other items. The ventilation within the first floor was noted to be poor (hot and airless). The project manager confirmed that quotes for an air conditioning unit for the first floor had been sought. On the second day of inspection the sluice room on the first floor was observed to be unlocked. This is not good practice and potentially places people who live in the home at risk. A maintenance person is employed at the home Monday to Friday between 08.00 a.m. and 16.30 p.m. The training matrix details the maintenance person as having 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. There is a maintenance programme within the home so as to ensure that the home environment and equipment is well maintained. The AQAA details that the project manager undertakes a daily check of the environment and all staff working within the home are expected to identify areas requiring attention. A random sample of safety and maintenance certificates showed that the majority of equipment in the home have been serviced and remain in date until their next examination, however the gas safety and passenger lift certificate were noted to be overdue. Records showed that there is a fire risk plan for the home and that the fire alarms and emergency lighting are regularly tested. The record of fire drills showed these are regularly undertaken. Stambridge Meadows DS0000015554.V372575.R01.S.doc Version 5.2 Page 23 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 adequate. This judgement has been made using available evidence including a visit to this service. Whilst people living at the care home are protected by the home’s recruitment procedures, 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. EVIDENCE: The project manager confirmed that staffing levels remain at 1 RGN plus 5 members of staff between 08.00 a.m. to 14.00 p.m., 1 RGN plus 4 members of staff between 14.00 p.m. to 20.00 p.m. and 1 RGN and 3 members of staff between 20.00 p.m. and 08.00 a.m. each day. In addition to the above, ancillary staff are utilised at the home (chef, kitchen assistant, administrator, laundry person and housekeepers) and the project manager’s hours are supernumerary to the above. On the second day of inspection there were 27 residents living at Stambridge Meadows (3 people with nursing needs and 24 people with residential care needs). On inspection of 4 weeks staff rosters, records showed that staffing levels as detailed above have not always been maintained. The above staffing levels were evident on both days of the inspection, however the deployment of staff at times within the home was inadequate to meet individual resident’s needs. This refers specifically to lounge areas being left unsupervised for long periods Stambridge Meadows DS0000015554.V372575.R01.S.doc Version 5.2 Page 24 of time and some residents were observed to be calling out for staff on the first floor and staff were noted to be slow to respond in providing assistance. One resident spoken with advised that several days earlier, they had witnessed a resident sustain a fall and that no staff were present. The resident stated that they alerted staff to the incident. Following discussions with the project manager it was evident they were unaware of the above. Residents’ accident records did not record the above incident. The AQAA detailed under the heading of ‘our plans for improvement in the next 12 months’, “to maintain appropriate staffing levels”. Relatives’ surveys returned to us, recorded mixed comments about staff working at the care home and these included, “the staff are wonderful, but there should be more. They work very hard, but more weekend cover is needed”, the care home can improve by “better communication skills by the nursing staff”, “I have not had any problems with permanent staff over my [relatives] care as the carers are excellent”, “staff friendly, helpful but not always supervised as well as could be” and “the staff are very caring and try very hard to meet the residents demands”. The staff rosters did not always include the full names of agency staff utilised at the care home or record the names of staff undertaking an additional shift. The staff files for 3 people newly employed since the last key inspection were examined. Records showed that robust recruitment procedures are in place so as to ensure that residents are safeguarded. Each member of staff was noted to have completed a 2 day Southern Cross Healthcare induction and Skills for Care. Records evidenced that one new member of staff had no previous ‘care’ experience. The project manager and registered provider should consider as part of good practice procedures devising an induction to cater for those people with no previous and/or little ‘care’ experience. This will enable the newly employed member of staff to feel valued and to perform their role with skill and competence. The AQAA detailed under the heading of ‘our plans for improvement in the next 12 months’, “to set up a mentoring system for all new staff”. At the time of the inspection 3 members of staff had attained NVQ Level 3 and 2 members of staff had achieved NVQ Level 2. On inspection of the training matrix, records showed that some staff, have since the last key inspection, undertaken training relating to core areas such as fire safety, fire drills, food hygiene, moving and handling, COSHH, health and safety and infection control. Records also showed that 7 members of staff have attained training pertaining to pressure area care, 11 members of staff have undertaken training relating to customer care, 2 members of staff have received training in care planning and challenging behaviour, 18 members of staff have attained training relating to dementia awareness, 15 members of staff have received training relating to bed rail safety and 5 members of staff have achieved first aid training. The training records for one newly employed member of staff (August 08) only recorded training attained in 3 areas (fire safety, food hygiene and moving and Stambridge Meadows DS0000015554.V372575.R01.S.doc Version 5.2 Page 25 handling) and there was no evidence of further planned training. The above was confirmed by the member of staff. Stambridge Meadows DS0000015554.V372575.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst management arrangements in some areas are good, shortfalls identified could potentially affect positive outcomes for residents. EVIDENCE: Since the last key inspection the registered provider has appointed a project manager to manage the care home until an appropriate permanent manager is recruited and appointed. At the time of the inspection, the registered provider had submitted an application to us so as to deregister its nursing beds and this was being progressed. The project manager advised that she has over 34 years experience working within a care field setting with both adults and children’s services. The project Stambridge Meadows DS0000015554.V372575.R01.S.doc Version 5.2 Page 27 manager has attained NVQ Level 2 and 3, the Registered Managers Award, has a Diploma in Health and Social Care and achieved the ‘Train the Trainer’ qualification. An application to be formally registered with us has been submitted by the project manager and is being progressed. Following discussions with the project manager we were advised that the ethos of the home is to ensure the home is run in the best interests of the people living at Stambridge Meadows and that it is not run for the benefit of staff. The project manager confirmed that institutional practices have existed at the care home and work is ongoing to change staff practices and thinking. The project manager stated that the above will not happen overnight but continues to be a “work in progress”. Staff confirmed that the project manager is approachable and has made many improvements. Staff spoken with advised that they felt there was a “clearer sense of direction and purpose”. The project manager stated that staff morale within the home is much better and that staff have a much better understanding of their roles and standards that need to be achieved. The project manager advised that improvements have been made with regards to care planning/risk assessing, staff training and ensuring that medication practices and procedures remain safe and appropriate for people’s wellbeing and safety. Additionally the key-worker system has been reintroduced over the past 4 weeks. It is evident from this inspection that some progress has been made to address previous identified shortfalls/concerns and this is seen as positive (seeking advice from healthcare professionals, improving medication practices and procedures, ensuring robust recruitment procedures are adopted, recording of complaints and providing further training for staff). Further development is required to ensure that care planning/risk assessing processes and procedures are improved and that every person admitted to the care home has a detailed and comprehensive plan of care so that staff working within the care home are aware of individual’s care needs and how these needs are to be met. Additionally the staffing levels at the home need to be maintained for the numbers and needs of residents so as to ensure their safety and wellbeing. More emphasis must be placed in ensuring the social care needs of people at Stambridge Meadows are a priority. As stated at the previous key inspection to the home, the management and staff team must demonstrate a proactive approach to addressing and sustaining good practice, so as to ensure residents safety, wellbeing and positive outcomes. All sections of the AQAA were completed and the document returned to us when requested. Information recorded was informative providing a reasonable level of information about the service, however some information was noted to not give an accurate account of the current situation within the service. Supervision records were inspected for those people newly employed at the care home. Records showed that 2 out of 3 people had received formal Stambridge Meadows DS0000015554.V372575.R01.S.doc Version 5.2 Page 28 supervision. On inspection of a random sample of supervision records for staff and the staff supervision planner, evidence showed that not all staff had received formal supervision in line with National Minimum Standards recommendations. Although there are gaps, we recognise some improvement since the last key inspection. The project manager stated that she was supported by the registered provider and has regular supervision with both the operations manager and operations director. The financial accounting procedures for residents’ personal allowances were inspected. Records showed there is an itemised account balance sheet for each person and this includes a record of receipts. The regional manager conducts regular audits to ensure that systems remain appropriate and people’s monies are safeguarded. The project manager advised us that quality assurance surveys for relatives and staff were completed in August 08, however none have been returned. An annual report for Southern Cross Healthcare is compiled annually and the results are due within the next couple of months. In addition to the above regular audits are conducted by the registered provider, operations manager and manager. Evidence of these audits, were readily available at the time of the site visit. A health and safety policy was observed within the home. Accident records for residents were inspected and although these were well maintained, information recorded did not always include how the accident/incident had occurred or staffs interventions. Stambridge Meadows DS0000015554.V372575.R01.S.doc Version 5.2 Page 29 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 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 1 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 3 Stambridge Meadows DS0000015554.V372575.R01.S.doc Version 5.2 Page 30 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. Timescale for action 14/10/08 2. OP7 15 3. OP7 13(4) Previous timescale of 14.6.08 and 8.8.08 not fully met. Care planning at the home must 14/10/08 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. A plan of care must be devised for all residents in the care home. Risk assessments must include 14/10/08 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 not met. Ensure that all people who reside 14/10/08 at the care home have their social care needs met and these are clearly identified within their individual plan of care. This will DS0000015554.V372575.R01.S.doc Version 5.2 Page 31 4. OP12 16(2)(m) and (n) Stambridge Meadows ensure that people do not become bored. Previous timescale 1.7.07, 1.11.07, 1.3.08 and 8.8.08 not met. 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, 9.1.08 and 8.8.08 not met. Ensure that staff, receive regular supervision so that they feel supported and residents know that staff are appropriately managed. Previous timescale of 1.7.07, 1.11.07, 9.1.08 and 8.8.08 not fully met. 5. OP27 18(1)(a) 14/10/08 6. OP36 18(2) 14/10/08 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. Refer to Standard OP3 OP7 OP8 OP12 Good Practice Recommendations Information recorded within the pre admission assessment should be transferred to the person’s individual care plan. Daily care records should be written daily and after every shift to reflect how people living in the care home spend their day. Records relating to staffs interventions pertaining to healthcare, nutrition etc should be completed consistently so as to evidence care and support provided. Consider devising the activities/event summary in larger print and/or pictorial format so as to enable people to make an informed choice. DS0000015554.V372575.R01.S.doc Version 5.2 Page 32 Stambridge Meadows 5. 6. 7. 8. OP15 OP16 OP16 OP19 9. OP27 Consider devising the menu in larger print and/or pictorial format so as to enable people to make an informed choice. Contact details of all placing authorities for individual residents to be identified within the complaints procedure. All complaints logged should record an outcome. Servicing of the gas safety installation and passenger lift should be undertaken regularly to ensure they are safe and in good working order. Documented evidence should be available to support this. Staff interactions with individual residents should be improved. Stambridge Meadows DS0000015554.V372575.R01.S.doc Version 5.2 Page 33 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.V372575.R01.S.doc Version 5.2 Page 34 - 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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