Inspection on 13/01/09 for Streets Meadow

This inspection was carried out on 13th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Streets Meadow 31/08/06

Streets Meadow 28/11/05

Streets Meadow 28/06/05

Streets Meadow 08/03/05

Streets Meadow 17/06/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Streets Meadow Hanham Road Wimborne Dorset BH21 1AS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Peter Still     Date: 1 4 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Streets Meadow Hanham Road Wimborne Dorset BH21 1AS 01202884620 01202849906 marie.foden@dorsetcc.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Dorset County Council care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: One person in the category MD(E) may be accommodated to receive care. Staffing levels must be those determined in accordance with guidance recommended by the Department of Health. The home may from time to time, admit persons between the ages of 60 and 65 years of age. Date of last inspection Brief description of the care home Streets Meadow is a residential care home operated by Dorset County Council. Marie Foden manages the home. The purpose built premises were completed in March 2006. The staff provide personal care and support, the community nursing team carries out any nursing tasks. The home is close to the town centre of Wimborne and has good public transport links available nearby. The home consists of 4 units each accommodating a maximum of 15 residents. Two of the units are designed to accommodate people with specialist, dementia needs. The accommodation is provided on two floors. Each bedroom offers full en-suite including shower, each unit has its Care Homes for Older People Page 4 of 37 Over 65 60 60 0 0 Brief description of the care home own specialist bathroom, communal lounges and dining rooms. Two passenger lifts provide level access to the first floor. Weekly fees, at the time of the inspection, were 462 pounds. Care Homes for Older People Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Please note that this inspection was conducted by one inspector, however throughout this report, the term we has been used. This is to show that the evidence and judgements in the report are those of the Commission for Social Care Inspection. Prior to the inspection, we reviewed information, which had been sent to the Commission for Social Care Inspection, since the last inspection, including an Annual Service Review we had conducted. We also read the Annual Quality Assurance Assessment, which the home had kindly sent to us. This document had been comprehensively completed and provided valuable evidence for this report. We also analysed a significant number of surveys, which had been completed by residents, staff and external professionals and again, sent to us prior to the inspection. Care Homes for Older People Page 6 of 37 Since this is a large home, we conducted the inspection over two days. We talked to residents, relatives, staff and visiting professionals. We also had a telephone conversation with one external professional to confirm information and to check that their survey comments remained up to date. We made a tour of the building and also observed care being provided to residents in public areas. What the care home does well: What has improved since the last inspection? A new person centred care plan format has been introduced to provide clearer detail for staff, which was described as easier to read. The Brochure for the home had just been updated and was seen to provided good information. To promote closer working relationships and aid communication, the home has become a part of the induction process for new care managers at local hospitals. Sun blinds have been purchased to enable residents to enjoy meals in the garden, when the weather is warm enough; a number of bird feeders have been purchased to provide interest for residents, as well as a shed for bird watching; a volunteer is helping to promote computer sessions for residents; the home now has its own specialised bus so residents can go out on trips more easily. Care Homes for Older People Page 8 of 37 Five new specialised chairs have been purchased with money the home has raised, which help to improve dignity and enable people to be more involved in the daily life of the home. All staff have had training regarding the Mental Capacity Act. Ten staff have completed training concerning work with people who have dementia and four managers have completed NVQ level 3 in management. The home has carried out a full quality assurance exercise with residents, carers and staff. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 37 Care Homes for Older People Page 10 of 37 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 admitted to the home are given clear written information, so they are well informed and residents receive a written contract. People wishing to live at the home are fully assessed to ensure their needs can be met. Visits to the home prior to admission are encouraged and supported to help people with their decision making. The home does not provide a dedicated intermediate care facility at this time. Evidence: The files of four residents showed that a pre admission assessment had taken place. The Annual Quality Assurance Assessment completed by the home showed evidence that prospective residents visit the home. Where this is not possible, a manager will visit the person at their home or at hospital. Family members are encouraged to visit Care Homes for Older People Page 12 of 37 Evidence: prior to an admission and where necessary the home had arranged transport. An Occupational Therapist is always asked to visit whenever a person has a moving and handling need. Three files reviewed showed a contract of residency at the home and one did not. This was considered with the manager and it was explained that since the person had recently arrived, the manager was still awaiting a return of the contract, which needed to be signed. The home had recently completed a review and update of their Service User Guide and we found that it was well produced, providing clear information about the home.The guide comes within a welcome pack, which includes the Statement of Purpose of the home. It was noted that contact detail for the Commission for Social Care Inspection and that of other external agencies was clearly set out and up to date. The home ensures their admission criteria is met and also bears in mind the needs of current residents and staffing levels. The home is able to accommodate people for short stay care, dependent on availability of beds and during the inspection it was noted that one such request was declined. During the inspection, the admission of one resident was observed and also discussion with a visiting relative; a caring and sensitive approach was observed. The home demonstrates that it strives to develop new practice and is producing a picture album for managers to take out on pre-assessment visits to provide increased information about the home. The use of email to families has also increased during the last year. Two managers have attended courses on assessment skills and have cascaded their learning. Local hospital nursing staff have visited, to improve communication and consider information needed to support residents in the admission process. Comments within surveys sent to the Commission for Social Care Inspection from residents or relatives gave helpful feedback: Five people said they had not seen a contract and three said they were not sure. Other comments praised the home and the following are examples: My husband was taken to Streets Meadow for assessment and I was told after the initial period that he would be admitted. I cant tell you how lucky I felt and how relieved I was for both our sakes. I am thankful everyday for Streets Meadow and the wonderful staff there. Care Homes for Older People Page 13 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that important information needed to provide their care is recorded within the care plan. Whilst there was much evidence to show that the various methods of recording and of giving information to staff work well, there is other evidence to suggest that recording and communication should be reviewed further to protect residents. Risk assessments must be reviewed to ensure they are up to date, easy for staff to read and understand, to protect residents well being. Most evidence shows the home to be meeting residents health care needs very well. However since there is other evidence to suggest staffing levels may make it difficult to always meet residents needs, there should be a review to ensure that residents always have there needs met. Residents are protected by the homes policy and procedures for dealing with medication. Care Homes for Older People Page 14 of 37 Judgement: Residents are treated with respect and their rights are upheld. Staff are sensitive and respectful at the time of a residents death. Evidence: We reviewed the files of four residents, which showed good recording and care planning, a person centred approach was being taken. The home had recently implemented a new care plan format so that information and instructions to staff are clearer. The files reviewed held key information, which was easy to understand. One Key worker note made reference to a personal matter for a resident, which was sensitively recorded and would have helped staff to meet a need. Care plans were being reviewed monthly. The file for one resident contained an important point from a key worker about a risk of falls and that due to high risk, two staff were needed to support mobility. This was clearly set out within the care plan, however when we checked this with the separate Risk Assessment, it had not been reviewed for just over a year. We considered that since the risk was regarded as high, there should have been a review, in line with the care plan to avoid confusion. Another risk assessment reviewed had detail about the swallowing of medication and drinks, but no separate risk assessment about the risk of swallowing food, which was however well recorded within the care plan. We reviewed risk assessments on the files we had chosen to look at. One assessment was last reviewed in 2004 and when we considered this further, we found the risk assessment was no longer necessary. We looked at a care plan concerning an incident which had been reported about a person falling and hitting their head whilst being helped by a member of staff. The care plan said two staff were needed when the resident was walking. The incident report showed that only one member of staff was helping at the time. We could not see a detailed separate risk assessment although the care plan was clear. Daily recording sheets, completed for each resident were reviewed for four residents and most provided good and helpful information. The manager was already aware that improvement was needed in communication of key information to support staff and had taken steps to make improvements. Apart from daily individual recording sheets, the care file, which includes care plans and risk assessments, there was also a file of non confidential information, held within each Care Homes for Older People Page 15 of 37 Evidence: unit. This was reviewed in one unit and found to include helpful information. There was also a daily handover record, a typed and colour printed sheet of all key information concerning each resident. This was seen to be well recorded and was used for managers to provided valuable handover to staff and one such meeting was observed. Staff spoken with said they found the information helpful and that it gave confidence in relation to key points about each resident they were to work with. We spoke with a student starting a hundred day placement at the home and one placement project, the manager had instigated, concerning all aspects relating to care plans. The manager said that there is a real value of having a fresh pair of eyes to undertake an indepth review of the way the home manages this crucial aspect so that improvements can be made. Survey responses gave many positive comments about the care provided and the following is analysis with examples. Residents or relatives: Twenty said they always receive enough support; six said usually and one said never. Eleven said they usually get the medical support they need and one said never. Other comments: The staff are excellent Staff dont always come immediately but they do come to me. Staff listen generally, depending who is on duty. Doctors and nurses called promptly. There is a lack of understanding by a lot of staff regarding the working of hearing aids. Training would be useful. People with dementia especially need a lot of help with them. Examples of professionals comments giving praise: I have seen many examples where the health of residents has significantly improved following admission. All suggestions for enhancing care including pressure sore prevention have been adopted. I never fail to be impressed by the superb, sustained care of residents through to the end of their lives. I feel the attention to detail ensures optimum comfort for residents in the terminal stages of their lives and affords a level of care and comfort that could not be bettered elsewhere. I feel that the manager and her staff deserve to be congratulated on all their continuing care, hard work and dedication. Throughout the year there has been consistent high quality care and the attitude of staff to residents is excellent. One professional we spoke with said they had no concerns and that staff never make unnecessary requests for visits. Some external professionals raised concerns: Sometimes the information we relay does not always get received by all staff, therefore things are missed but it is not often. We know things are written down but they are not always communicated. We communicate with the care officer about needs of care plan for wound and skin care. The officer writes this down in a communication book but on numerous occasions Care Homes for Older People Page 16 of 37 Evidence: none of this information is or seems to be passed on and is evidenced by the patients care not having been adopted to. Patients with higher levels of care within the EMI unit, may not be getting the care they require due to understaffing. One professional spoken with just prior to the inspection, said that concerns expressed were continuing. Staff said: We do well providing a person centred environment. We have had people near the end of their life and with the special care they have received they are still with us, much stronger. One was so weak they could not talk, now we can hold conversations and laugh - just an example of what good care does. The most information I get is in handover between shifts - which I dont always get. We need to have adequate staff to give residents proper care. During the two days of inspection, we observed staff to be constantly working hard and meeting individual needs. Staff clearly knew residents well and responded in a caring and sensitive manner. There were a number of occasions within the units, when we found no staff with residents for periods of time, when they may have needed support. On one occasion a resident became distressed when they wanted to go to the toilet and had to wait. This also caused other residents concern. A resident who did not have dementia but who was dependant on staff, was asked if they had to wait to go to the toilet. The response to this question was a great deal of praise for the staff but that they did have to wait sometimes. Most of our observation found staff to be giving immediate and gentle response and also reassurance - staff were very observant. Staff also gave one to one, unhurried time, which was clearly making residents lives happier and there was sufficient staff to meet needs. It was particularly observed that staff made regular contact with residents who were quiet and not demanding of attention. Residents who were frail were seen to be very happy with the contact they had with staff and there was lots of fun and laughter. People with dementia were seen to be happy with the contact they received too. Appropriate physical contact gave reassurance and a number of residents were seen to have periods where they enjoyed good verbal communication as a consequence. It was considered that some residents could have been a challenge to the service but that the skill of staff was such that individual needs were met so that people did not need to express themselves in other ways. A member of staff was heard to give guidance to another member of staff to ensure observation was undertaken this was considered to be excellent practice and showed good communication, when it was required between staff. Fifteen people at the home were considered to need two staff for moving and handling and many residents needed individual support with their personal care, which included Care Homes for Older People Page 17 of 37 Evidence: full support with eating. It was observed in one unit that three staff was not sufficient at times. Many staff were spoken with and the consensus was that more staff were needed at key times to help with personal care tasks: when people get up, go to bed, and at meal times. At weekends staffing is also significantly reduced due to staff having time off. On the second day of inspection, the manager was interviewing for an additional senior officer post. A cleaner spoken with said that they are called to work as a member of the care staff team when there is a shortage, which they enjoy and it is good because they know the residents. Agency staff were seen working at the home on both days of the inspection. We spoke with relatives and their supporters and the following are examples of their comments: We are short of nothing, we get the attention. If we want a GP he is here in half an hour. Just yesterday I said I needed some help with shopping and I was taken immediately by a member of staff in her own time. Everything is wonderful. We had been to another home and lasted a week - the comparison is unbelievable. The arrangements for administration of medication was being managed robustly. Two staff hold key responsibility and ensure there is a double check of medication. The manager conducts weekly recorded audits of medication. The home has the benefit of a designated room, where it is possible for staff to concentrate on the complex task. This room was well organised and very clean. The medication of three residents was randomly checked and found to be correct. The administration of medication was observed within two units and was seen to be carefully managed. One external professional spoken with, said they had no concerns regarding the home and that matters concerning medication are always dealt with appropriately. All staff were observed to treat residents with great respect and ensuring their dignity was upheld. Where needed, specialist support chairs also enhance dignity for people who are highly dependent, which also means that some people are able to enjoy a quality of life with other residents. The file of one person, which was read to consider all aspects of their life and care, contained detail about wishes at the time of their death. The manager confirmed that this information is obtained if people wish it. A professional made a comment in their survey response that the home provides excellent care at the end of a persons life and we considered this to be in all respects. Care Homes for Older People Page 18 of 37 Care Homes for Older People Page 19 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. From our observation, records reviewed and comments received, it was clear that residents experience a lifestyle, which significantly enhances their lives. Families and people important to residents are encouraged to be as involved with residents and Streets Meadow as they wish or can. Residents are encouraged to make choices in their lives, Residents can be assured that the catering team provide a good and balanced diet and a mealtime experience that residents can enjoy. Evidence: During the two days of inspection, we observed a wide variety of activity available to residents. As we toured the four units, it was noticeable that staff ensured that activity was available. Where people have dementia, we observed that once staff had completed other tasks, they were spending time providing individual activity and contact. One member of staff, working on their own with residents in their lounge, was seen talking to a resident and encouraging conversation with questions. It was Care Homes for Older People Page 20 of 37 Evidence: particularly noticed that most of the other residents were listening and appeared to be gaining benefit too. At another unit visited, between two and three staff were engaged in a word game with most residents. The home has the benefit of volunteers and a carers group; four people were spoken with, they clearly enjoyed their visits, the mutual support, as well as working and spending time with residents. They were making a highly valuable contribution to the lives of residents. Staff showed appreciation and it was said they are a part of the Streets Meadow family. Two people were seen to be helping to feed residents and one person has a task of completing individual life story work (A social history), where residents wish to take part. Family members were spoken with and there was evidence to show that everyone important to a resident is made to feel very welcome at the home. A special Christmas meal had been arranged so that relatives and friends could all have a meal together with residents. One resident spoken with said they missed the day centre they used to attend, seeing their friends and the activity offered there, such as bingo and cards. Two other residents spoken with said there had not been much activity at Streets Meadow but that it was better now. One said that when they first came they just looked at the ceiling all day. The home did have a period when an activity organiser had left and it was difficult to maintain a programme, however the home currently has two activity managers. Each day a variety of activity is provided, with an alternating unit being used for the main activities and we observed one session. The activity provided was excellent as evidenced by the happy residents. Staff involved, varied but at times was as high as five . Residents were seen to be asked the day before about choices and what they wanted and residents came in from other units to take part. We observed the following examples of experiences for residents: restful, gentle music; facial massage; makeup; manicure; foot spar; hair care; life story work. Other residents were also returning having had their hair done. Two residents within a quiet area of the lounge were having a sleep. There was a lot of communication between residents who were very happy. Staff were very much engaged with residents and individual needs and wishes were well known - staff too were very happy giving individual attention. We spoke with the activities coordinators who were enthusiastic about their work. Activities are recorded on a notice board at the entrance to Units and we were given a sample activities chart, which included activity within each unit. Examples of activity include: Floor games; Bingo; sing-along; sensory work; Exercise; art and craft; days out and external entertainment. The home is very much a part of the local community and is fully involved in events locally. The home came 1st 2nd and 3rd in the wheel Care Homes for Older People Page 21 of 37 Evidence: chair section of the annual Pancake race around the Minster, Best ever result. The home has a computer for the use of residents and this is being encouraged and supported by a volunteer. The garden has raised flower beds and residents have been involved with planting. One visiting professional was spoken with and said they had no points to make about the home, they were meeting with staff to consider activity needs for a resident, which staff had taken note of. At the staff handover we attended, we had listened to an approach being suggested in relation to one resident, concerning activity and we were able to observe this being instigated by staff, which showed that communication had been understood to the clear benefit of a resident. One resident spoken with talked about the homes magazine and how much it is enjoyed. We were given a copy of the September edition, which was produced in large print. The home has its own adapted vehicle so that residents can be taken out easily. We met with the head and an assistant chef, we also observed a mealtime and reviewed the menu. Staff were enthusiastic about their work and the importance of good food for residents. They talked about the way they cook meat to ensure it is tender and also vegetables to retain nutritional value. The head chef has significant experience and talked about the high quality of food they source. catering staff have access to training and also to the County Council dietitian. One resident spoken with said The food is out of this world. Another relative spoken with talked about the difficulty of encouraging a good diet prior to admission to the home and spoke highly of the food and the way their relative had regained their weight. A chef talks to residents and uses records to ensure likes and dislikes are known. No fresh fruit was seen available for residents to choose when they wished and we were told that fruit is normally available and more was due to be delivered. We were told that fifteen people needed help to eat their food. We were told about the way residents are ensured of their own special birthday and party food is always provided. Other food on the menu is available too but that a special effort is made by catering staff, supported by the activity managers, to give residents a special day. Care Homes for Older People Page 22 of 37 Care Homes for Older People Page 23 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Streets Meadow can be assured their complaints will be listened to and taken seriously. Residents rights will be protected and promoted and staff will protect residents from abuse. Evidence: The home has complaints policies and procedures, which are available to residents and their supporters in a variety of ways. A How to complain leaflet is kept in each bedroom folder, which includes details of how to make contact with external agencies such as Social Services and the Commission for Social Care Inspection. We reviewed the compliments and complaints file and found many letters and cards of compliment but no complaints. One letter of thanks concerned the Christmas meal that families were invited to. Staff attend training in the protection of vulnerable adults, which includes whistle blowing. This training is arranged by the County Council who also maintain a record of when staff need to be formally updated with their training. We also reviewed staff meeting minutes since the deputy manager had said that Adult Protection is one of the themes at staff meetings. The November meeting of 2008 included a record that awareness of the protection of vulnerable adults was a topic, with various scenarios discussed. Care Homes for Older People Page 24 of 37 Evidence: One resident responding to our survey, said they did not know they could speak to a care assistant if they were not happy. We understood this to mean that they thought they could only communicate a concern to a senior member of staff. All other survey responses gave positive messages, mainly about the good care provided rather than any concern. It was particularly noted that 100 percent of staff responding said they knew what action to take if a resident or relative had a concern. The home communicated one safeguarding matter to the commission since the last inspection and the matter had been responded to by the local authority. Care Homes for Older People Page 25 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Streets Meadow provides a high quality environment, exceeding National Minimum Standards, which is clean and safe. Residents have equipment, which is suitable to their needs and which enhances their lives and promotes dignity. The alarm system, which enables staff to respond to residents immediate needs should be reviewed to ensure problems are overcome and that the system is able to meet residents needs whilst ensuring it is fully effective for staff to use. Evidence: Streets Meadow is a modern building and was designed to exceed the National Minimum Standards. Bedrooms are en-suite and have easy access shower areas. Corridors are wide to enable easy wheelchair access and also ensures some resident with slow mobility do not feel under pressure of holding people up - there is plenty of room for people to stop and chat. The home is very well equipped and has a professional kitchen. The home is divided into four units and each has its own dining room and lounge. Dining rooms are not vast and homely touches and their outlook enhance the Care Homes for Older People Page 26 of 37 Evidence: atmosphere. One lounge visited, had a central division, which enables people to have choice of area to sit. Activity was being carried on in one part of the lounge but the other part was much quieter. The home was very clean and there were no unpleasant smells. It was noticed that a member of staff was drawing beds away from the wall so that all areas could be cleaned. The member of staff said cleaning staff are well supported and listened to by senior staff. It was observed later that a loose headboard,had been reported and fixed immediately. The trolley used to Carry equipment for cleaning looked and was said to be easy to use. This member of staff was also noticed to make a very personal touch to the way a residents bed was left, which gave more evidence of the way staff know residents wishes well and that little touches can make a big difference to residents happiness. Residents have pleasant outside areas to use and during the last year many blinds have been installed to give shade outside and also inside the home. The Alzheimers Disease Society is being consulted in relation to plans for a sensory loss garden area. The home has encouraged residents to enjoy bird watching and has provided a shed for this and also to keep food and equipment. Through fund raising, the home has managed to buy five specialised chairs for residents, which enhances quality of life and promotes dignity. Initial problems with the building such as a shower, which flooded have been resolved and an issue with switches is being responded to. During the inspection, we noticed that the main call bell alarm in each unit was constantly sounding. We were told that whenever the alarm is used, it sounds in all units. It was observed that due to it constantly sounding, no notice was being taken, which presents a risk. Some staff in each unit carry a bleep alarm, this too was observed to sound frequently and it was noticed that staff would automatically stop their direct work with residents to check the alarm. This bleep alarm also contacts staff in all units and staff have to check if the alarm is for their unit or not. If there is an emergency,the alarm has a different sound, which staff immediately respond to. We considered that this system too is unsatisfactory, since unless there is an emergency, staff should concentrate on residents within their unit. One member of staff spoken with said there is a real difficulty during the early evening period, when a manager is needed and staff have to leave their unit and go around the Care Homes for Older People Page 27 of 37 Evidence: home to find the manager. The member of staff said that walkie talkies would save a lot of time. This was put to the manager, who said the home previously had walkie talkies but they had been stolen. She also said she would consider using the internal phone system. One resident spoken with, wished to raise a concern. This related to their view that glass table mats were slippery and dangerous. The manager responded immediately and the mats were taken away and replaced. Examples of comments about the environment from survey responses and those spoken with include: One resident said People should be allowed to walk through Streets Meadow to see how wonderful it is. I consider the standard of cleaning to be excellent. Its never dirty. Professionals said: Recently cleaners have been absent and they are really needed. Clients live in a nice homely environment, purpose built. There is a garden shed and people can potter about. Care Homes for Older People Page 28 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst at times staffing levels are good, at other times, due to the high level of personal care required, staffing levels do not fully ensure that residents needs can always be met, when needed. Residents can be assured that staff are trained and are committed to providing the best care they can. The homes recruitment policy and practice protects residents. Evidence: From our observation, we found times when staff levels were sufficient and times when they were not. Staff were observed to work with skill and enthusiasm and there was evidence residents were benefiting significantly from the way staff were providing care. We observed times when people had to wait for personal care such as help with their mobility when needing to go to the toilet. We also observed times when there was no members of staff with groups of residents. The home has many residents who need two to one staffing at times, which causes the lack of staff for other people at times. Care Homes for Older People Page 29 of 37 Evidence: We asked one external professional, who had raised concerns in their survey, if there had been improvement since they had sent us their survey response, concerning staffing shortage. They said there had been some improvement but more was needed and at weekends staffing was not adequate. This person also said that visiting professionals had to wait to gain access and gave an example of 20 minutes at a weekend before staff let them in. Another professional said that people with higher care needs within the EMI unit, may not be getting the care they require due to understaffing. We considered the concern about staff shortage at weekends and found this to be correct. Current staffing agreements result in staff having every other weekend off duty, which has an impact on staffing levels. Analysis of staff survey comments regarding staffing levels: One member of staff said there was always enough staff,11 staff said there usually is, 8 said sometimes and 3 said there was never enough staff. Examples of other staff comments: I would prefer that agency staff were not used so often as they dont know the residents so well and at times have found they are not so willing to work hard. (Not in all cases). The brokerage service for relief staff is an issue as some staff are not sufficiently trained. Sometimes staff do not have time to breath, so busy. Not always time and respect for staff. Very stressful - needs space, breaks. There are times when more staff would be useful on the secure unit. ie mealtimes and bed time. Make sure there are enough staff on the busy units to do the job properly. We spoke with a number of staff and the following are examples of their comments: There should be extra staff on Gold and Blue units to meet residents needs when they get up in the morning. There are not enough staff to help people to get up, have lunch and go to bed. This is particularly because so many residents need 2 staff to one resident. The staff lunch time break is silly because staff are sent off for their break at the busiest time and then staff from another unit have to come and help. Staff sometimes have to leave their unit to help out in another. On the Purple unit, only 6 residents do not need 2 staff to 1 resident and so 4 staff is not enough at certain times. Examples of residents survey responses: Sometimes staff are busy with someone else. Staff try to make time for me. Most residents responses gave high praise to staff and the home. During the inspection we spoke with residents about staffing levels and responses included: We do have to wait to go to the toilet (This was noted in the Health and Personal Care section of this report). The home definitely need more staff, girls are busy all the time. I can get up but a lot cant and have to wait. One relative spoken with said the staff are wonderful but there are not enough Care Homes for Older People Page 30 of 37 Evidence: staff sometimes - it is up and down. I do notice when there are no staff in the lounge with residents, there are times when residents do need things. The care is very good and so are staff. They work so hard, at times there could be more staff - at lunch there were only two staff and they could have done with more - they work so hard. We reviewed staff meeting minutes, which were well recorded. The record of the 22/09/08 meeting showed that staffing in Blue Unit was discussed and that management were aware of the considerable increase in workload. It was noted from a review of a number of staff meeting minutes that concerns raised by staff about staffing shortage had been raised and recorded. Many points made were similar to ones received in staff survey responses. We observed agency staff to be working at the home on both days of inspection. We considered the number of hours agency staff were used during December 2008, which was 342, although within this, 217 hours were recorded as special hours. These special hours were due to assessed needs of a resident, which had resulted in the manager providing extra hours to support the person. This demonstrates that the manager takes action to respond to staffing needs. The files of three staff were reviewed and it was found that correct recruitment practice had been followed by the home. Staff had received induction and supervision notes were correctly recorded. Staff are provided with good training opportunities and staff should complete their National Vocational Qualification training within 6 months of completing their induction. To support staff and improve communication, staff meetings had just been arranged twice a month for all staff. Four further meetings for the year are arranged in the evenings to make it easier for some staff to attend. The agenda for 15/01/09 was reviewed and it contained key agenda items and also encouraged staff to add items to the agenda. One member of staff spoken with said senior staff listen to their comments and issues. Another said that junior staff do not always feel they can speak up at staff meetings they will be disregarded because they are not senior staff they fear their jobs. Care Homes for Older People Page 31 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Streets Meadow can be assured the home is well managed by experienced staff who are committed in ensuring a high quality of care. The manager and staff team should consider the points of concern, which have been raised so they can take further steps to resolve issues. The annual check of portable appliances should be reviewed to ensure it is undertaken at correct intervals to protect residents. Evidence: The manager of Streets Meadow is highly experienced and demonstrated a very direct approach in all aspects of the running of the home. She was seen to be clear with staff on matters requiring attention and had the support of knowledgeable senior managers including a highly skilled deputy manager. The manager was aware of issues of communication and staffing shortage and had Care Homes for Older People Page 32 of 37 Evidence: taken a number of steps to make improvements and this report identifies many examples. It was observed that the managers central objective is the well being and best interests of residents and there is much evidence from residents, which shows appreciation for the care provided. Whilst there is much that is very positive and bearing in mind action taken to address issues, there are some key matters to be addressed, which have been identified through this report, which the provider will need to support the manager in addressing. The homes Annual Quality Assurance Assessment, provides evidence that a recent audit of finances, including that of residents as well of the home in general, were regarded to be managed in an excellent manner. We reviewed the cash records held for one resident and found it to be correct and well recorded, including evidence of receipts. The homes policies and procedures are robust and record keeping was good. We examined files concerning environmental checks to ensure the home is maintained and safe. These included the last gas and lift inspection checks. Weekly safety checks were also found to be in order. Portable appliances were looked at and the last date when they were checked, showed that the next annual check was due. The manager completed a comprehensive Annual Quality Assurance Assessment and sent a copy of this to the Commission prior to the inspection and has also completed a quality assurance survey, which had been sent to the local authority for analysis at the time of this inspection. She said she will respond to points emerging, once she is given the feedback to the survey, which was anonymous to encourage people to say whatever they wish. Care Homes for Older People Page 33 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 34 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 27 18 Ensure that at all times staff 31/01/2009 are working at the care home in such numbers as are appropriate for the health and welfare of service users. There are times when the current staffing arrangements do not provide adequate staffing levels to meet residents needs. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 7 7 Review systems of communication concerning the care plan so that information care staff need is provided effectively. Review the separate risk assessments about each identified risk to ensure they are up to date and do not lead to confusion with the main care plan. The various systems of alarm, which ensure residents have support when required, need a review so that changes can be made to resolve current problems. 3 19 Care Homes for Older People Page 35 of 37 4 32 The manager should consider points, which have emerged within this report about staff needing to feel they can say things easily and their contribution will be listened to and valued. It may help to consider other ways of gaining feedback from staff. Check the review date for portable appliances to ensure such equipment is checked annually. 5 32 Care Homes for Older People Page 36 of 37 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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