Inspection on 11/06/07 for Tendring Meadows Care Home

This inspection was carried out on 11th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Tendring Meadows Care Home 17/09/08

Tendring Meadows Care Home 29/04/08

Tendring Meadows Care Home 12/05/06

Tendring Meadows Care Home 01/02/05

Tendring Meadows Care Home 09/09/04

Tendring Meadows Care Home 13/04/04

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Tendring Meadows Care Home The Heath Tendring Clacton on Sea Essex CO16 0BZ Lead Inspector Francesca Halliday Key Unannounced Inspection 09:30 11th – 21st June 2007 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 Tendring Meadows Care Home DS0000015329.V340605.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. Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tendring Meadows Care Home Address The Heath Tendring Clacton on Sea Essex CO16 0BZ 01255 870900 01255 870973 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) G A Projects Limited Post vacant Care Home 53 Category(ies) of Learning disability over 65 years of age (1), Old registration, with number age, not falling within any other category (53) of places Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 53 persons) One person, over the age of 65 years, who requires care by reason of a learning disability whose name was made known to the Commission in September 2003 Five persons of either sex, aged between 60 and 65 years, who require care by reason of old age only The total number of service users accommodated in the home must not exceed 53 persons 2nd November 2006 3. 4. Date of last inspection Brief Description of the Service: Tendring Meadows Residential Home is in a very rural position to the north of Colchester. It is registered to provide personal care for 53 older people. The home is also registered to accept five residents between the ages of 60 and 65. The resident accommodation is on two floors, the first floor being accessible by both stairs and lift. The home has a mixture of single and double rooms available. The accommodation is divided into four distinct areas, Clover, Poppy, Primrose and Bluebell. There are communal rooms in each of the four areas. One of the lounges is predominantly used as an activities area. The fees at the time of inspection in June 2007 were £375 to £450. These fees did not cover private chiropody, hairdressing and toiletries. For more up to date information on fees please contact the home directly. Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection included inspection visits on 11th and 21st June 2007. Throughout the report the term resident is used to describe people living at Tendring Meadows. The inspection included discussions with 5 residents and 5 relatives. 8 completed surveys were received from relatives. 5 staff including the acting manager were spoken with during the inspection. 2 community nurses were spoken with during the inspection and a GP for the home was telephoned following the inspection. Parts of the premises were inspected and samples of records were seen. What the service does well: What has improved since the last inspection? What they could do better: Care documentation was not person centred and medicines management needed to be improved. The acting manager said that increased audits were being undertaken following the inspection. The home needed to ensure that communication with relatives and health professionals was given a higher priority. Links with the local community needed to be developed. The staff from Latvia were frequently working extremely long hours, which could potentially impact negatively on the standard of care they provided. The manager said that following the inspection their hours had been reduced and staff were no longer working a mix of day and night duty in the same week. Some residents said that they had “trouble understanding what the foreign Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 Page 6 staff (from Latvia) say”. The acting manager said that a number of the staff were attending English courses to improve their fluency. Care training, related to residents’ conditions and care needs, was not being given sufficient priority in the home. The heating towers remained a potential hazard for residents despite this having been a requirement in previous inspection reports. Infection control practices were poor but training was being arranged following the inspection. The cleanliness of parts of the home was poor and although the acting manager was aware of this no action had being taken. Some staff had extremely stained uniforms, which did not give a good impression of the home, but staff said that they had to buy their own and could not afford to replace them. Locks on residents’ doors were not suitable and all residents did not have a lockable drawer. Relatives raised concerns about the security of the home, as the front door was not locked during the day. The acting manager did not have an understanding of quality assurance. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3, 4 (standard 6 not applicable) Quality in this outcome area is adequate. Residents receive an adequate assessment of needs prior to admission but those with dementia do not receive care from appropriately trained staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager confirmed that prospective residents received a preadmission assessment, which she normally carried out. A sample of assessments were seen, they contained adequate detail but none had been signed. There was evidence that information gained from the home’s assessment was usually supplemented by a social services assessment. The acting manager said that the home did not have any residents with dementia in the home. However, the home’s GP said that a number of residents in Tendring Meadows had dementia and this was evident in Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 Page 9 conversations with some residents and discussions with staff and relatives. None of the staff had received any dementia care training. Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 Quality in this outcome area is adequate. Residents receive a satisfactory standard of care but improvement is limited by a lack of person centred documentation. Poor medicines management potentially puts residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents and the majority of relatives spoken with and surveyed said that they were happy with the standard of care in the home. They felt that residents’ healthcare needs were met and considered that staff protected residents’ privacy and dignity. The health professionals spoken with considered that health concerns were reported promptly. The care plans sampled were of a variable standard, a very few were personalised but the majority seen were in a standard format with very little to identify the specific needs, abilities, interests, choices and preferences of the individual resident. Care staff spoken with generally had a good understanding of residents’ needs but said that they were not allowed to put this personal detail in care plans or daily records. There were no care plans in relation to residents’ psychological Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 Page 11 or emotional needs even when this was identified as a need in conversations with residents and staff. According to the records it took many months before the weight loss of one resident was reported to the GP and supplements were obtained. Some residents did not have a care plan in relation to activities, social contact and stimulation. Care plans were regularly reviewed but there was no evaluation of care and care needs. A number of care plans seen did not reflect up to date information about residents’ condition and needs. Residents, or relatives where appropriate, had not been involved in drawing up care plans or formally evaluating care and care needs. Some risk assessments were seen but this was an area that needed to be developed. Staff confirmed that they had very good support from visiting GPs and said that they were always available for advice. Community nurses visited every day. There were systems in place for residents to have chiropody and dental and optical checkups. One relative, who returned a survey form, gave examples of a number of times that communication between them and staff in the home had broken down. They said “I would really appreciate much more in the way of communication with the staff”. Two of the health professionals spoken with also considered that communication within the home could at times be improved. A Controlled Drug (CD) being administered by the community nurses, and checked by staff in the home, was not being recorded in the CD register. Another CD was not being stored in the CD cupboard or recorded in the CD register. Some residents’ property was being stored in the CD cupboard. The acting manager was advised that it was safe practice to only store CDs in this cupboard. It was not possible to establish from the records available whether all the medicines had been given in accordance with the prescriptions, as the audit trails were not clear. The acting manager was advised to ensure that an accurate record of all receipts of medicines was made, and to circle the start of the new supply on the Medicine Administration Record (MAR) in a red pen if any medicines were brought forward from the previous month. On some other occasions it was not clear whether one or two tablets had been given when the resident had been prescribed a variable dose. The acting manager was reminded that verbal orders for a change to a prescribed medicine must be dated and signed and a fax confirming this change requested. Staff were not always recording the reason a medicine was omitted or giving an explanation of the code used. Prescription only medicines were not always kept locked up in residents’ rooms. Some residents did not have a lockable cupboard or drawer in their room. One resident said that they were not getting their legs creamed each day. There was no record of the application of topical creams. The acting manager confirmed that the GPs carried out periodic medication reviews. Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 Page 12 The temperature of the rooms where medicines were stored was being monitored and was seen to be within safe limits. The drugs fridge temperature was on occasions recorded as between 0c and 1c, which was below the safe range of 2-8c. The acting manager was advised to have the fridge checked. It was very positive that one resident had retained control of the administration of their insulin. However, staff were advised to carry out regular risk assessments of the resident’s continuing ability to self-medicate competently. Homely remedies were not always recorded on the residents’ MAR. Staff were reminded that all creams and liquid medicines with a limited life on opening should be dated on first use. One medicine trolley had a large amount of liquid medicine encrusted on one shelf. One of the rooms for storage of medicines did not have a sink for staff to wash their hands, to wash the medicine trolley and medicine pots or to wipe bottles. Some medicines were labelled on the container but others were only labelled on the outer carton. This could increase the risk of cross infection if two residents were on the same medicines and mean that the medicines could not be administered if the outer carton was lost. The acting manager was advised that this should be taken up with the dispensing pharmacist. Staff who administered medication had received training but some staff received their training two years previously and one member of staff had not received any medication training for four years. The acting manager said that she had been carrying out a weekly audit of medicines. The acting manager confirmed that following the inspection more detailed audits were being carried out and that a staff meeting had been held to discuss the issues raised at inspection and remind staff of their responsibilities in relation to medicines. Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 Page 13 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): Standards 12, 13, 14, 15 Quality in this outcome area is adequate. Residents do not have equal access to activities and social stimulation and are not encouraged to maximise their independence. Food is nutritious but residents’ choices are not always met. The condition of the crockery and cutlery detracts from residents’ experience at mealtimes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The activity co-ordinator worked 20 hours each week but her hours were not covered when she was absent or on leave. The acting manager said that care staff were not involved in any activities. Some residents said that they enjoyed the activities, which included bingo, cards, dominoes, quizzes, tuck shop, discussing the newspapers and gardening. One resident said that they had enjoyed the visit to the pantomime at Christmas. However, other residents did not consider that the activities co-ordinator had enough time to see them individually. One resident said “It’s sometimes a bit boring here”, another resident who preferred to remain in their room said that staff did not have time to chat to them there. A discussion was held about the need to Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 Page 14 ensure that all residents had equal access to chats, stimulation and activities wherever they wanted in the home. Staff said that they did not have parasols for any of the garden tables. The activity co-ordinator said that the home did have a gazebo, but it had not been set up despite the day being very sunny. The table (an old snooker table) in the activities room was not at an appropriate height for residents sitting down and had a sharp screw sticking out of one leg. The acting manager said that the table would be disposed of following the inspection. None of the staff had received training in activities for older people or in providing seated exercise. The activity hours will need to be reviewed as occupancy rates in the home increase. The home had entertainers visiting approximately four times a year. The activities co-ordinator said that the mobile library would not visit the home any longer but that she obtained books on behalf of residents. An aromatherapist visited the home every six weeks and the manager said that residents appreciated her visits. The home did not have any visits from clergy, or religious services in the home, or any links to local clubs or schools. Links with the community were particularly important due to the very rural location of the home. The activity co-ordinator said that the member of the clergy who used to visit had retired and they were trying to arrange for someone to replace them. Relatives said that they were made to feel welcome in the home. Residents confirmed that they did have some choices in the home but this was not evidenced in the care documentation. The majority of residents were happy with the standard of food in the home. The current menu was on display. One resident did not like sandwiches at the evening meal. Staff were therefore providing a cooked meal for them on three days but not on the other nights. A number of the pieces of crockery seen in use and in the kitchen were very chipped. Some of the cutlery and plastic mugs seen were very stained. The majority of the requirements and recommendations from the Environmental Health Officer’s inspection had been actioned. However, according to the kitchen staff spoken with there was no cleaning schedule and eggs were not being stored in the fridge as recommended. The kitchen was generally clean on the day of inspection but there was staining around tiling and sinks. A range of fresh fruit and vegetables were seen. A new fridge and freezer had been purchased and the flooring repaired since the last inspection. The acting manager said that kitchen staff did not get direct feedback from residents about the food. A discussion was held about the benefit of a member of the catering staff attending the monthly residents’ meetings. Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 Page 15 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): Standards 16, 18 Quality in this outcome area is adequate. Lack of records of concerns and complaints potentially limits staff knowledge of residents’ concerns. Staff training has improved their ability to recognise and prevent abuse This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a complaints procedure and there was documentation for complaints investigations carried out by the previous manager. Residents and relatives confirmed that the acting manager addressed any concerns promptly. However, there was no record of these verbal concerns/complaints and the action taken to address them. There had been no Protection of Vulnerable Adults (POVA) referrals since the last inspection. The acting manager confirmed that all staff had received POVA training. Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 Page 16 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): Standards 19, 24, 26 Quality in this outcome area is poor. The environment has potential hazards for residents and they have no access to a safe garden. Poor cleanliness and infection control practices puts residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager said that all the corridors and one of the lounges had been redecorated since the last inspection. There were a number of heating towers around the home, which had notices stating that they could get very hot to the touch. However, residents with dementia were unlikely to be able to read the notices and the towers presented a potential hazard. Two relatives said that the window blinds in the dining room on Poppy were not providing enough shade when the weather was hot. The garden at the back of the home was not used so that residents only had access to a small paved area in front of the home. The acting manager did not know the reason the garden was not used. Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 Page 17 A number of relatives raised concerns about the security of the home as the front door was not locked during the day and there was only a part-time administrator in the entrance hall. The sample of locks on residents’ doors that were tested were stiff and difficult to use and the design was not suitable for older people and people with dementia. Residents did not all have a lockable drawer for the safekeeping of valuables, money or prescription only medicines. Some of the bed linen seen was in a very poor condition. Many of the towels were frayed at the edges and many of the sheets were thin and grey. A number of pillows were very lumpy. The acting manager said that some new towels and sheets were being delivered. The standard of cleanliness in the home was variable but was particularly poor on the first floor. The acting manager said that she aware that standards needed to be improved. However, the Annual Quality Assurance Assessment (AQAA) sent to the Commission did not highlight that this was an area that the home could do better and there was no evidence that any action was being taken to address the poor standards. An outbreak of diarrhoea and vomiting affecting both residents and staff occurred in the home in March 2007. The Essex Health Protection Unit was not informed of the outbreak of infection. A number of areas where staff would be providing personal care for residents did not have supplies of gloves available. Staff said that they hand sluiced foul linen prior to it being washed. The acting manager was advised that the practice of hand sluicing was poor infection control practice, which put staff at risk of infection, and that the correct use of red bags should prevent the need for staff to handle foul linen. Only two of the staff had received infection control training. The acting manager said that training for other staff was arranged following the inspection. Some staff had very stained uniforms but said that they could not afford to replace them. Residents said that they were happy with the standard of the laundry service. Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 Page 18 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): Standards 27, 28, 29, 30 Quality in this outcome area is poor. The long hours worked by staff potentially impacts on their ability to provide sensitive person centred care. Staff do not have the training to enable them to give the most up to date and appropriate care to residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A number of the staff from Latvia were working extremely long hours. On occasions staff were working four 13.5 hour shifts as well as two shorter days in one week. Some staff were working a mix of day and night duty in one week with only 6.75 hours between the finish of night duties and the start of the late duties. The acting manager said in addition to these hours a number of the Latvian staff also attended college. The acting manager said that following the inspection staff hours were reduced and staff no longer worked both days and nights in one week. The home had two cleaners. One who covered 5 days a week and the other six days a week. There was no cleaner on a Saturday, however, the acting manager said that the vacuum cleaner was locked up on that day. The home had a member of staff in the laundry from Monday to Friday but not at weekends. Care staff carried out laundry and kitchen duties in addition to their care hours, which resulted in less time available for care, particularly at weekends. Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 Page 19 5 care staff had completed and 2 were undertaking National Vocational Qualification (NVQ) at level 2. 3 staff with level 2 were undertaking NVQ level 3. The home had an induction but it did not relate to the Skills for Care common induction standards. The staff records were not inspected at this visit as standard 29 had been met at the last inspection and no staff had been recruited since then. Although staff had received some training (see standards 18 and 38) they had received very little training in relation to the health and care needs of current residents. For example in dementia care, Parkinson’s disease, diabetes, the promotion of continence, palliative care, infection control and pressure sore prevention. The acting manager said that they had applied for training with the local PCT liaison nursing service but the places had already been taken. Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 Page 20 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): Standards 31, 33, 35, 38 Quality in this outcome area is adequate. The acting manager lacks an understanding of quality assurance to enable her to assess and improve services and care for residents. Lack of staff training in some safe working practices potentially puts residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager had been covering the manager’s post since January 2007. She had completed NVQ level 2 and had previously held the post of deputy manager in the home. Relatives said that they found the acting manager approachable. An application for the post of registered manager had not been received by CSCI. Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 Page 21 An Annual Quality Assurance Assessment (AQAA) was sent to the Commission in June 2007. The AQAA demonstrated that the acting manager did not have an understanding of quality assurance and would benefit from training in this area. The audits carried out had not identified areas of poor standards and there was no action plan or quality assurance plan for the coming year. The acting manager said that the proprietor usually visited the home on a weekly basis. However, regulation 26 reports had not been completed each month. The home holds small amounts of money on behalf of residents. The money was held securely with individual records and receipts. The balances checked were correct. The administrator confirmed that the monies were audited on a regular basis. The acting manager said that all care staff received supervision. The supervision described was an assessment of competence in aspects of care but the documentation did not cover identification of training, support needed by the member of staff or issues identified within the home that related to staff. None of the support staff in the home had received an annual appraisal. Staff had received training in fire safety, health and safety and food hygiene. Care staff had received moving and handling training but support staff had not received load management training. None of the staff had received first aid training. The acting manager said that training in infection control and first aid was booked following the inspection. The fire risk assessment seen had not been fully completed. Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 1 X X X X 2 X 1 STAFFING Standard No Score 27 1 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 2 X 2 Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 Page 23 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. The requirements were discussed with the acting manager at the time of inspection. No 1. Standard OP4 Regulation 18(1)(c) Requirement Staff must receive dementia care training to enable them to give the most appropriate care to residents who have developed dementia. Care documentation must be developed in consultation with residents, and relatives where appropriate. The care documentation must reflect residents’ individual needs, abilities, interests, choices and preferences and be kept up to date. This is a repeat requirement, timescales of 31/07/06 and 31/03/07 not met. Risk assessments must be developed in relation to the specific risks for an individual resident and include details of the actions or interventions being taken to reduce the risk to the resident. This also relates to risk assessments to assess resident’s continuing ability to self-medicate competently Timescale for action 01/10/07 2. OP7 OP14 15 01/08/07 3. OP8 OP9 14 01/08/07 Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 Page 24 4. OP9 13(2) Controlled drugs must be stored in the CD cupboard and recorded in the CD register. Staff must ensure that a clear audit trail is available for all medicines received, stored, administered and disposed of in the home in order that checks can be made on whether residents have received all their prescribed medicines. 21/06/07 5. OP12 16(2)(m) (n) Residents must have equal access to 01/08/07 a range of daily activities and 1:1 sessions. The activity co-ordinator’s hours must be covered when they are not available. The activities co-ordinator and care 01/11/07 staff must have training in the range of activities and stimulation appropriate for older people and people with dementia. Staff must document verbal complaints and action taken to address them in order to improve communication within the home and prevent recurrence of the same complaints. The standard of cleaning throughout the home must be regularly monitored and action taken to maintain a clean and hygienic environment for residents living in the home. The methods of heating in the home must not create a hazard for residents. Staff must monitor the temperature in the communal rooms in hot weather and take action to ensure that residents do not become overheated. 21/06/07 6. OP12 18(1)(c) 7. OP16 22 8. OP15 OP26 13(3) 23(2)(d) 21/06/07 9. OP19 13(4) 01/10/07 10. OP19 12((1)(a) 21/06/07 Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 Page 25 11. OP24 OP9 12(4)(a) 13(2) Residents’ rooms must have locks suitable to their capabilities and accessible to staff in emergencies. All residents must have a lockable drawer in their room for valuables, money and prescription only medicines. 01/10/07 12. OP26 13(3) Staff must follow good infection 21/06/07 control procedures. They must be supplied with disposable gloves in all areas of the home where they provide personal care and must not handle foul linen, in order to reduce the risk of cross infection to both staff and residents. Staff must not work extremely long 21/06/07 hours and a mixture of day and night duty as this could impact negatively on the standard of care they provide to residents. Care staff must not carry out kitchen and laundry duties to the detriment of the amount of time they are able to spend with residents. (This refers to ensuring that the home has sufficient domestic and kitchen staff) This is a repeat requirement, timescale of 31/03/07 not met. Staff must receive a range of training relating to the health conditions and care needs of residents in the home. This also relates to updates in medicines administration and record keeping. This is a repeat requirement, timescale of 31/03/07 not met. The acting manager must receive quality assurance training and guidance on carrying out audits in order to improve overall standards for residents in the home. 01/12/07 13. OP27 18(1)(a) 14. OP30 OP9 18(1)(c) 15. OP33 24 01/09/07 Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 Page 26 16. OP33 26 The registered person must complete regulation 26 reports each month in order to demonstrate that ongoing monitoring of standards is carried out and that residents and relatives have been personally consulted about standards in the home. All staff must be appropriately supervised to ensure that standards are maintained in the home. The fire risk assessment for the home must be completed so that potential fire risks within the home can be identified and action taken to minimise them. 21/06/07 17. OP36 18(2) 01/09/07 18. OP38 23((2)(4) 01/09/07 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. Refer to Standard OP3 OP9 OP26 Good Practice Recommendations All pre-admission assessments should be signed. The medicines should be stored in a room with a hand basin in order that staff can wash their hands, wash the medicine trolley and the medicine pots and wipe bottles. Links with the community should be developed so that residents do not become isolated in such a rural location. Residents should be offered crockery and cutlery that is not chipped and stained. Residents should have access to a safe and secure garden. The security of the home should be reviewed to ensure residents feel safe. 3. 4. 5. 6. OP13 OP15 OP19 OP19 Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 Page 27 7. OP24 The quality of linen, towels and pillows should be reviewed and replacements ordered when necessary to ensure that residents are not supplied with very poor quality and worn items. At least 50 of care staff should complete National Vocational Qualification level 2 in order to ensure that staff are appropriately trained to provide care to residents. The induction should follow the Skills for Care common induction standards in order that a consistent standard of resident care can be provided. The care staff supervision should be expanded to include support, training needs and aspects of care practice. 8. OP28 9. OP30 10. OP36 Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Tendring Meadows Care Home DS0000015329.V340605.R01.S.doc Version 5.2 Page 29 - 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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