CARE HOMES FOR OLDER PEOPLE
Streets Meadow Hanham Road Wimborne Dorset BH21 1AS Lead Inspector
Trevor Julian Unannounced 28 June 2005 11:00 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 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. Streets Meadow D55 S32210 Streets Meadow V229093 270605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Streets Meadow Address Hanham Road, Wimborne, Dorset, BH21 1AS Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01202 884620 01202 849906 Dorset County Council Marie Foden Care Home 49 Category(ies) of OP - 34 registration, with number DE(E) - 15 of places Streets Meadow D55 S32210 Streets Meadow V229093 270605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Staffing levels must be those determined in accordance with guidance recommended by the Department of Health. One person, whose name and circumstances are known to the Commission, and who has mental health needs may be accommodated and provided with personal care. Date of last inspection 08 March 2005 Brief Description of the Service: Streets Meadow is a residential care home operated by Dorset County Council. Marie Foden manages the home.The purpose built premises date back to the 1970’s. Work was well advanced to replace the existing accommodation with a new home that will achieve national minimum standards. The registration allows for the accommodation of 34 older people and up to 15 older people with dementia. While the building work is in progress the home has restricted numbers to a maximum of 41. The staff provide personal care and support, any nursing tasks are carried out by the community nursing team. The home is close to the town centre of Wimborne and has good public transport links available nearby.The accommodation is provided on three floors. The bedrooms are all offered for single occupancy, communal lounges are sited on each floor. A passenger lift provides level access to each floor. A temporary garden, with seating, had been established at the rear of the property. Streets Meadow D55 S32210 Streets Meadow V229093 270605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on 28th June 2005 between 11:0017:30 and 20:15-22:10. The time taken for the report process including travelling time, preparation, site visit and report writing totalled 18 hours. The focus of the visit was to seek the views of residents and visitors and to see the home in operation during the evening and night shift. During the visit information was gathered through discussion with the manager, residents, staff and visitors. Further evidence was obtained through a tour of the premises and a review of records and procedures. For the purpose of this report the terms resident and service user are interchangeable. What the service does well:
Information was provided to prospective residents and their agents. All residents were referred for placement through the Authority’s care managers. Visitors confirmed that they had been provided with appropriate information about the services offered in the home. The files seen held details of the pre-admission assessment giving information on the individual’s care needs. The pre-admission assessments were the basis of the initial care plans. Staff said that they were advised of any changes in need at shift changeovers. Medical needs were addressed with referral to the community health teams via the individuals GP. The home’s medication was correctly stored, temperature sensitive items were held in a fridge with records of the operating temperature. Photographs were on the file to aid identification and there was information about any allergies to medication. Medication records seen were up to date. Only senior staff administered the medication. Residents and visitors were full of praise for the care and support provided by all the staff. All were described as kind and hard working. The home had an activity organiser who arranged activities, entertainment and excursions, funded through the home’s amenity fund. Visitors were welcome at the home at any time; during the evening a regular visitor was in the home. Streets Meadow D55 S32210 Streets Meadow V229093 270605 Stage 4.doc Version 1.30 Page 6 The chef attends monthly residents’ meeting to discuss any food issues. Residents said the standard and variety of food provided was very good. Portions were varied to suit individual preferences. The Authority’s complaint procedure was displayed in the entrance lobby. The home records complaints and compliments; there had been no complaints but many there were many compliments since the last inspection. Visitors said that the staff responded quickly to any concerns raised. Staff had been trained in responding to Adult Protection matters. Although the premises were being replaced the home remained well maintained and clean. A visitor and a resident commented that the domestic staff were very hard working and there was never any dirty or dust even with the building work going on around them. The home was staffed in accordance with recommended levels. Staffing levels were varied during the day to respond to changing demands. Agency staff were used to cover care hours. Agency staff on duty had been in the home before so they were aware of the routines; they had been trained in fire safety procedures before their first shifts. Staff said the training provided was of a good quality. Some had attended specialist dementia training and they were all encouraged to take NVQ level 2 in care. Fire safety precautions and training records were up to date. Staff were trained in safe moving and handling techniques. Guidance on specific cases was provided through an Occupational Therapist. What has improved since the last inspection? What they could do better:
The care plans were in place but one showed that specialist equipment was in use however, this was had not been the case following a review. The care plans should reflect current needs or there could be confusion for the care staff. The staff records showed thorough recruitment procedures were followed however one file did not have evidence of Criminal Records Bureau clearance. Streets Meadow D55 S32210 Streets Meadow V229093 270605 Stage 4.doc Version 1.30 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Streets Meadow D55 S32210 Streets Meadow V229093 270605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Streets Meadow D55 S32210 Streets Meadow V229093 270605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 3. Standard 6 intermediate care was not offered at the home and was therefore not assessed. Information provided by the home allows the residents and or their representatives to make informed choice about the suitability of the home. New residents were only admitted following assessment to ensure that their needs can be met. EVIDENCE: The home provides an information pack for prospective residents and their representatives. The previous inspection report was posted on the notice board inside the entrance. Some visitors confirmed that they had been provided with suitable information about the services provided in the home. The records seen confirmed that pre-admission assessments were carried out to ensure the home was able to meet the identified needs. There was also a copy of confirmation that the home would be able to meet the identified needs and information on fee structures. Streets Meadow D55 S32210 Streets Meadow V229093 270605 Stage 4.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Care plans were in place to give staff clear information about how the needs were to be met. The home worked with community health services to monitor and maintain residents’ health. Medication systems in the home protect the residents from administration errors. Residents were treated with dignity and respect to protect their basic rights. EVIDENCE: The files seen contained care plans and risk assessments. The care plans had been developed from the pre-admission assessment and any changed care needs identified at care reviews. They showed that residents and or their representatives were involved in the care planning process. One file identified an item of equipment to be used, however the item was only used for a short time and by the time of the visit was no longer required but the care plan had not been updated. Care plans should be updated as changes occur. Streets Meadow D55 S32210 Streets Meadow V229093 270605 Stage 4.doc Version 1.30 Page 11 Staff said that they were advised of basic care needs of new residents and that the care plans were accessible to them. Any changes in care needs were discussed at handover and recorded. The home has good relations with community health services. Residents and visitors said that the community nurses attended to any clinical care. A brief check of the medication systems showed that the items were correctly stored, this included temperature sensitive medication with records showing maximum and minimum temperatures. Photographs of the residents were on file to assist in identification along with information on allergies was also held. All medication coming into the home was checked and there was a clear audit trail. Staff confirmed that they were only involved in the administration following training and an assessment. Residents seen were very complimentary about the care provided by the staff. One resident described them as kind and helpful and added that they were well treated and there was always good humour. During the visit a good rapport was observed between residents and staff. Streets Meadow D55 S32210 Streets Meadow V229093 270605 Stage 4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15. The home’s activity programme allows residents to follow their preferred pastimes. The home encouraged contact with the community, family and friends to help the individuals not to feel isolated. Meals were provided in suitable surroundings, the menu offered good levels of choice and the food was appetising to encourage a healthy nutritional intake. EVIDENCE: The home organises a variety of activities and there had been two trips recently to the New Forest and others were being planned. One the day of the visit a local vicar had been in the home offering communion. Monthly residents’ meetings were held to get their views and the topics included ideas for excursions. Excursions were funded through a non-contributory amenity fund. Most people said they were very satisfied with the activities offered but one person commented that the bus used for outings only catered for 2 wheelchair users and so her opportunities were limited, although she had trips out with her family. Residents were encouraged to maintain links with their families and friends. During the visit there were several visitors in the home and they said that they were always made welcome and were always offered refreshments.
Streets Meadow D55 S32210 Streets Meadow V229093 270605 Stage 4.doc Version 1.30 Page 13 Residents said that the food was very good there was always a choice. One person said that the portions were varied to the individuals’ preferences and that suited him as he found that too much food on his plate curbed his appetite. Chef attends the monthly residents’ meeting and food is always a topic. Where concerns were identified then nutritional intakes were monitored. Streets Meadow D55 S32210 Streets Meadow V229093 270605 Stage 4.doc Version 1.30 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The home had an accessible complaints procedure allowing people to raise concerns. Adult protection procedures help to keep residents safe will in the home. EVIDENCE: The home had an accessible complaints procedure. No complaints had been recorded since the last inspection. The records also showed many compliments received from residents and families. Residents seen said they were confident that they could raise concerns with the staff and management. None spoken to had made any formal complaints. One person said that the issues in the home were minor and gave an example of laundry items going missing which were normally promptly returned. The home had an adult protection procedure. One new member of staff confirmed that adult abuse was one of the topics covered in the induction training programme and she was aware of her responsibilities. Streets Meadow D55 S32210 Streets Meadow V229093 270605 Stage 4.doc Version 1.30 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not fully assessed during this visit. EVIDENCE: The home was midway through a rebuilding project. The work was going on at the site. Residents and staff said following the loss of the communal areas and the initial work there was little inconvenience caused by the work. Most people said they enjoyed watching the building taking shape. Staff and management were working hard to minimise any disruption. The home remained well maintained and clean. A visitor and a resident independently commented that the domestic staff were very hard working and that there was never any dust or dirt. Streets Meadow D55 S32210 Streets Meadow V229093 270605 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30. The home was appropriately staffed and the training programme ensured the safety of the residents. The home’s recruitment procedure was thorough although there was one issue found. EVIDENCE: During the evening the home was staffed by a deputy manager and six carers including two agency staff. The agency staff had worked regularly at the home and knew the routines and needs of the residents. The manager said that the home’s reliance on agency staff to cover shifts had greatly reduced. The night shift consisted of a shift leader and two carers. Staff records showed that the home’s recruitment practice was generally thorough, although one recent recruit’s Criminal Records Bureau check was not on the file. All other related documentation was in place. During the visit staff said that the home provided good training. Initial training included adult protection, manual handling and fire safety. Any specialist training needs were considered during staff supervision meetings. Staff were encouraged to complete NVQ level 2 care qualification. Streets Meadow D55 S32210 Streets Meadow V229093 270605 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The home’s safety systems promote the safety of residents and staff. EVIDENCE: The home’s fire safety system testing was up to date. Defects on the system were recorded and rectified. There was a fire safety risk assessment. The electrical and gas installations were inspected and serviced by approved contractors. Staff were trained in safe moving and handling and an Occupational Therapist provided guidance and advice on specific cases. Streets Meadow D55 S32210 Streets Meadow V229093 270605 Stage 4.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x 3 Streets Meadow D55 S32210 Streets Meadow V229093 270605 Stage 4.doc Version 1.30 Page 19 Are there any outstanding requirements from the last inspection? 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 OP29 Regulation 17(2) Requirement The registered person must ensure that all staff have the appropriate clearances. Timescale for action 31/8/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations The care plans should be revised as care needs change to ensure that the information available to staff is current. Streets Meadow D55 S32210 Streets Meadow V229093 270605 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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