Inspection on 12/05/06 for Tendring Meadows Care Home

This inspection was carried out on 12th May 2006.

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 11/06/07

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 Lysette Butler Key Unannounced Inspection 09:30 12th May 2006 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.V295037.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.V295037.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 Mrs Eileen Freestone 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.V295037.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 March 2006 3. 4. Date of last inspection Brief Description of the Service: Tendring Meadows Residential Home is in a rural position situated north of Colchester. It is currently registered for 53 older people who need personal care only. Nursing care and dementia care is not offered at this home. The home accepts residents over the age of 65 years of both genders who require care by reason of old age; it is also registered to accept five residents between 60 and 65 years of both genders. The resident accommodation is on two floors and there has been a good attempt made to make it domestic in its decorative style. There is a mixture of single and double room accommodation. The accommodation is divided into four distinct areas, Clover, Poppy, Primrose and Bluebell. There are a number of communal areas throughout the home, which include a dining room in each of the four areas. One of the lounges was predominantly used as the activities area. Tendring Meadows Care Home DS0000015329.V295037.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection Started on 1st April 2006. The inspection process included: a site visit on 12th May 2006, which lasted 7 hours; discussions with the registered manager, senior carers, care staff, residents and relatives; review of resident & visitor surveys; discussion with visiting medical personnel; and a review of information supplied to the local office of the Commission for Social Care Inspection. The lead inspector was accompanied on the site visit by a second inspector Kathryn Moss. During the site visit the premises were inspected, including the grounds. Samples of records and residents care plans were also inspected. This home is still in need of redecoration throughout. This inspection covered all twenty-three key standards and three of the remaining standards. The manager and her staff approached the inspection in a positive and cooperative manner. What the service does well: What has improved since the last inspection? The assessment process had improved and the manager has a much clearer view of the information she needs to receive to assess the needs of prospective residents fully and appropriately. Care plans are improving and staff have a better understanding of the need to use them for all residents. The relationships with the local district nursing team have continued to improve, ensuring that the residents are offered the healthcare they need on a day-to-day business. The new GP for the home has scheduled a timetable of individual reviews of the residents’ medication and healthcare needs. The GP is also willing to come out to the home when asked by the staff, ensuring that the residents get prompt and correct medical care. Tendring Meadows Care Home DS0000015329.V295037.R01.S.doc Version 5.2 Page 6 Medication practices have improved significantly throughout the home and more staff are due to have further training, as they individually need. Staff are now allocated the equivalent of three days training hours, per year, to enable them to attend statutory and individual needs training. What they could do better: 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. Tendring Meadows Care Home DS0000015329.V295037.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.V295037.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 6 - Quality in this outcome area is adequate; this judgement has been made from evidence gathered both during and before the visit to this service. Pre-admission assessment procedures have been improved; ensuring appropriate residents are admitted to the home. Further improvement in the documentation within the home will help prospective residents to choose this home appropriately. EVIDENCE: The pre-assessment documentation has improved, but is still rather brief and now the manager does not go to assess prospective residents until she has received a completed social services assessment. However documentation is brief and does not ensure that the needs of all residents are met. There also needs to be continued reassessment of residents in the home to ensure that those needs continue to be met. During the site visit for this inspection the manager was asked to take an emergency admission, which she refused, as there had not been a social services assessment and there was no clear plan of care. She agreed to assess the person after the weekend if a COM 5 had been Tendring Meadows Care Home DS0000015329.V295037.R01.S.doc Version 5.2 Page 9 received and the person appeared to be suitable for Tendring Meadows. Intermediate care is not offered at this home. Tendring Meadows Care Home DS0000015329.V295037.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 - Quality in this outcome area is adequate; this judgement has been made from evidence gathered both during and before the visit to this service. There has been a general improvement in the health and personal care of residents throughout the home and it is continuing to evolve. EVIDENCE: Four care plans were reviewed during this site visit. The general content of the documents had improved, although they were still basic and brief. However the manager had written the majority. Evaluations were up-to-date and more descriptive. Care staff reported that they referred to the plans more often. However many of the sheets in the care plans had not been signed or dated and this needs to be improved. There were no concerns over the healthcare needs of the residents at this visit. The links with the district nurses had continued to strengthen and relationships were good. District nurse visits were documented appropriately in resident files. The day before the site visit a resident had been readmitted from hospital Tendring Meadows Care Home DS0000015329.V295037.R01.S.doc Version 5.2 Page 11 with a large number of bruises and two pressure sores, that had not been present when she went into hospital. The district nurse and home staff were following this up especially as there had been no instructions as to how to care for the resident’s hip following her surgery. The new GP attended the home regularly and had set up on-going regular reviews of medication for all residents. He also came out to see residents more regularly. The district nurse attended the home during this visit and was happy to speak to the inspectors. The district nurse felt the home liaises and communicates well with the district service. The manager was observed to engage with the nurse during her visit, to update her on one resident and to ask her to check on another. The manager showed appropriate understanding of the health issues affecting these residents, and was promptly reporting current concerns. The new GP for this service comes to the home on a regular basis and when called. He sees all the residents in rotation to review their healthcare needs and medications. During the site visit for this inspection the medications on all four units were inspected. All medication administration records were checked and no omissions were present. Medication procedures had been improved. Only staff that had been on medication re-training courses were administering resident medications. During the retraining sessions staff were informed about various aids, (eg: dividers,) that could be used to improve the procedures in the home, however when the manager tried to obtain the aids she had not been able to source them. The issues this has raised will be followed up at the next training session the staff are to attend. The remaining care staff were booked to attend medication training over the following two months. The medications trolley was being taken into all rooms and staff reported that they were not leaving it under any circumstances. Stock levels were generally good and there was no evidence of inappropriate use of medications in the home. The medication fridge was in need of defrosting and may have been the reason the temperature being shown was only just within limits. However the weeklyrecorded fridge temperatures showed that it was now working properly and the measurements were within limits. The medication room temperature was taken and recorded daily. A new controlled drugs book had been acquired and had been used correctly. All medications for residents who had died had been returned within seven days and there return had been documented appropriately. Medication changes and completion of medication courses (such as antibiotics) were still not being signed on the MAR sheets. Tendring Meadows Care Home DS0000015329.V295037.R01.S.doc Version 5.2 Page 12 As part of this inspection particular consideration was given to the standard of care of residents who have a history of falls or have been assessed to be at a high risk of falling. One resident told the inspectors that their friend at the home had recently died and they were missing the resident as staff had used to let them take their meals together in one of their rooms. The resident said that the staff were being supportive, whilst respecting the fact that they did not want to talk about it. Tendring Meadows Care Home DS0000015329.V295037.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 - Quality in this outcome area is good, this judgement has been made from evidence gathered both during and before the visit to this service. Evidence demonstrated that residents were given choice in their daily life and social activities that met their expectations. A healthy and varied diet was generally served throughout the home. EVIDENCE: The home has an activities co-ordinator who works from 9.15 to 2.15, five days a week, and has been working at the home for three months. During this time she has already attended POVA and fire safety training (and has done first aid and food hygiene with sea cadets in the past). Although the home has an activities room on the ground floor, the activities co-ordinator was finding some residents reluctant to travel the distance to this room, and was organising more activities on each unit (e.g. Bingo was seen being played by a group of residents in Poppy lounge on the morning of the inspection). Examples of activities provided included bingo, quizzes, dominoes, ball games and skittles, art and crafts, etc., although the co-ordinator stated that currently most residents just wanted to play bingo! The activities co-ordinator stated that she tries to organise one or two activities each morning, but may just sit and chat or read the newspaper to residents, if they do not want activities. She said that after lunch she tries to spend time with people who Tendring Meadows Care Home DS0000015329.V295037.R01.S.doc Version 5.2 Page 14 don’t like to join in with activities. She gave good examples of meeting the individual interests of particular residents. The activities co-ordinator was maintaining individual monthly activities records for each resident, using a code to indicate which activities they had participated in each day, and writing a brief overview at the end of each month. She described how these showed her progress in engaging residents. She thought that there was individual social profiles (past history, likes and dislikes, etc.) on residents’ files, but had not actually seen these. She did however show good knowledge of the individual residents discussed. The activities co-ordinator felt that they had a good range of resource to use for activities. She confirmed that there is a monthly church service in the home, and that the minister will visit individual residents. She was aware that there had been trips out in the past and hoped they could arrange some outings this summer, as one of the night carers is willing to drive the minibus. She had not received any training in activities for older people, seated exercises, etc. The cook on duty advised that menus were developed by the main cook, and was not aware if residents were consulted as part of this process. A sample of daily menus viewed showed a good range of main meals, including a choice of two main courses at lunchtime, with potatoes and two vegetables. Records showed that residents were offered a choice of lunchtime meal, and the cook confirmed that they would cook an alternative if requested. The menus showed that teatime meals were predominantly sandwiches and cake. Suppertime snacks were not discussed on this occasion. The current daily menu was seen displayed in dining rooms, although it was noted in one dining room that prior to the day of the inspection the menu had not been changed for several days. Residents spoken to were generally satisfied with the food, and one confirmed that they could ask for an alternative if they did not like the main choices; one person felt that the home used too much frozen vegetables, and said they would like to have more fresh vegetables. The cook stated that they generally served one fresh and one frozen vegetable each meal. Food stocks viewed appeared appropriate to the needs and numbers of residents, and included main brand products. The cook felt that the quality of products supplied to the home was generally good. The cook confirmed that she attended food hygiene training last year, and had also attended POVA training. She had not received any training on the nutritional needs of older people, or on the needs of residents who had diabetes. It was noted that the pudding on the day of the inspection was not suitable for diabetics, and the cook stated that people with diabetes would have ice cream instead. It was noted that diabetic products were not obtained by the home (e.g. jam, marmalade, sugar-free squash, sweetener, etc). Visitors to the home felt welcomed and respected when visiting the home. They can come and go as they wish to, but are expected to sign in and after 5pm at night the front doors are locked so visitors have to ring to gain entrance. Tendring Meadows Care Home DS0000015329.V295037.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 - Quality in this outcome area is adequate, this judgement has been made from evidence gathered both during and before the visit to this service. There had been no complaints or Protection of Vulnerable Adults issues at this home since the last inspection, so there is no evidence on which to base a change in judgement from the last inspection undertaken on 2/3/06. EVIDENCE: The commission had not received any complaints since the last inspection. There had been two previous PoVA investigations and all the issues raised were reviewed during this site visit. Both had been raised by social services in response to client complaints. Since the last inspection all staff who needed to had undertaken PoVA training. This included the kitchen staff and the new activities coordinator. Staff were booked to attend yearly updates as necessary. Tendring Meadows Care Home DS0000015329.V295037.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 - Quality in this outcome area is adequate, this judgement has been made from evidence gathered both during and before the visit to this service. Further attempts to increase the safety of the home throughout have been made, but overall decoration is still poor. EVIDENCE: Both inspectors undertook a tour of the premises at the beginning of the site visit. Two of the heating towers in one the lounges had been replaced and the manager understood that a further four replacement heaters were on order. This does not replace all of them and the action plan received after the last visit did not give a detailed timetable of replacement. Those that were turned on were noted to be very hot to touch. At the time of this visit the outside wood cladding was being repaired and painted, although the work that had started at the last visit, on the internal fire escapes had been halted and was not yet finished. There were no unpleasant odours throughout the home at this visit. In general the home is still in need of redecoration and repair internally, Tendring Meadows Care Home DS0000015329.V295037.R01.S.doc Version 5.2 Page 17 throughout. For instance the carpet in the lounge on first floor by the manager’s office, was badly marked and some furniture looked worn (e.g side table); and there was also a distinct smell of cigarette smoke in the corridor. In one room there were marked walls and furniture; a metal hospital style bed; ‘latch and padlock’ style lock fitted to bedside cabinet to provide lockable storage – this is inappropriate both in terms of its appearance (not homely) and use (difficult for residents to manipulate). During this visit a fire exit was opened and although an alarm was heard staff did not attend the door. The alarm is now on for twenty-four hours a day but it only sounds at the administrators’ desk at the front entrance of the home. The administrator only works part-time and the inspectors were worried that the alarm would not be heard at all times. At the time of this visit the windows in the downstairs lounges were open wide and the restrictors had been detached. The manager was informed and this was rectified before we left the home. During the tour one of the sluices was unlocked and there were CoSHH substances just inside the door. There was a key at the top of the door but it did not work in the lock. The maintenance man sorted out the right key and the room was locked before the inspectors left the home. The manager stated that the CoSHH substances would be kept elsewhere in future so that the door of the sluice could be kept open for staff convenience. The residents spoken to felt that the home was generally clean and “rarely smelt horrible, these days”. Cleanliness and odour control were generally good throughout the home on this occasion. Guidance on infection control in residential care homes was seen at one of the care staff workstations. The cleaners’ room had been left unlocked and CoSHH products were being stored inside. The laundry was viewed, and contained washing and drying machines, and a large metal sink. Two washing machines had wash cycles suitable for infection control purposes (a sluice wash function, and 65/71°C wash cycles). The manager confirmed that any soiled linen is rinsed in the sluice rooms and then brought to the laundry in red bags that are placed straight into the machines. There were paper towels available by the sink, but the soap dispenser was empty. Tendring Meadows Care Home DS0000015329.V295037.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 - Quality in this outcome area is adequate, this judgement has been made from evidence gathered both during and before the visit to this service. Communication throughout the home continues to improve, but care training is still poor. Statutory training has been planned and undertaken by the majority of staff. EVIDENCE: The manager has now been enabled to recruit locally, however she has found that most decline a job at Tendring Meadows when they discover the wages offered and the position of the home that is not near to a transport route. The staff team is made up mainly of carers who are not English; the Latvian staff have continued to take English lessons and their communication has improved. Some of the foreign care staff are now staying longer than their original contacts, which offers better continuity and it means that more of the staff can be put forward to undertake NVQ training. At the time of this site visit three staff had applied to start the level 2 courses, one was undertaking the level 3 course and the deputy manager was waiting for funding to undertake the level 4 course. Only two staff currently have NVQ qualifications. Tendring Meadows Care Home DS0000015329.V295037.R01.S.doc Version 5.2 Page 19 Four personnel files were reviewed during the site visit, all were complete. Staff do not start work until a PoVA first check is back and then only under supervision until the completed CRB is returned. One file contained a poor reference that had not been followed up by the manager and she was advised to do so in future. Overseas staff have separate contracts and handbooks, which are supplied with their contracts. Staff are now given a training hours allowance equivalent to three days study, which they can use against their statutory training requirements. All staff were now attending appropriate training. (See outcome group 16-18, above.) The deputy Manager told the inspectors that all staff do fire, moving and handling, health and safety, food hygiene and POVA training each year. The deputy had also attended seminars on the Single Assessment Process and wound care, as part of the training programme offered by the local PCT liaison nursing service. Tendring Meadows Care Home DS0000015329.V295037.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 - Quality in this outcome area is adequate, this judgement has been made from evidence gathered both during and before the visit to this service. Management lines of accountability are clearer, but quality assurance procedures do not currently demonstrate a commitment to continuing change and improvement. EVIDENCE: The registered manager stated that she is now regularly meeting with managers from other homes in the group. She has not yet visited other homes, but she was planning to do so. There was no current QA system, because the director at head office who arranged the programme had been on maternity leave. The inspectors Tendring Meadows Care Home DS0000015329.V295037.R01.S.doc Version 5.2 Page 21 explained that this should be organised and carried out within the home. There was no improvement plan for the home. The last resident survey had been carried out in December 2005 and had been reviewed during the last inspection. An individual home budget was not available for inspection and regulation 26 visits were not documented or supplied to the commission. The home is willing to hold small amounts of cash for safekeeping on behalf of residents: this was stored securely and individually, with clear individual records maintained, and receipts kept for purchases. If a resident’s money builds up, excess cash is passed to relatives to take away. Two residents’ monies were inspected, in both cases the cash and records balanced. On one record sheet it was noted that the resident had signed the sheet when their money was withdrawn; the administrator explained that this person was able to come and request money themselves. She stated that they encourage residents involvement in this where able, to enable them to maintain control over their finances. The home’s administrator is responsible for the management of residents’ monies, with records checked by the manager at least monthly, who signed the balance sheets when checked. Appraisals are being carried out on all staff. The process included a selfassessment form, which formed the basis of the appraisal. Supervision documentation was not kept in the staff members’ personnel files. Records reviewed during the site visit indicated that equipment and utilities were up-to-date with servicing. Evidence of fire drills was not inspected on this occasion. Records also showed the regular internal checking of relevant areas, including fire alarms and fire doors, and hot tap water temperatures. It was noted that the hot water supply to a bath in a double room was consistently several degrees higher than the recommended safe temperature: the maintenance person told the inspectors that the provider was aware of this, but confirmed that this bath was not currently used by residents. The home has five boilers providing hot water to the home: it was noted that these were all set to 50°C, which would not meet the recommended temperature to prevent risk of Legionella (i.e. that hot water should be stored at a minimum of 60°C, and distributed at a minimum of 50°C). An immediate requirement notice was left with regard to this. Risk assessments were discussed with the manager, who was not aware of there being any written risk assessments on safe working practices within the home. In particular, there was no evidence of any risk assessment for the home covering Legionella risks, there was no Tendring Meadows Care Home DS0000015329.V295037.R01.S.doc Version 5.2 Page 22 risk assessment on the use and storage of chemicals (although the home did have a file of hazard information sheets on chemicals used within the home), and there was no fire risk assessment on the premises. An immediate requirement notice was left regarding this. The home had a health and safety policy statement, but it was noted that this was out-of-date and needed reviewing. Only four incident forms were filed since January 2006 and they were kept in the residents’ files. The immediate requirement presented at the end of the site visit was with regard to H&S risk assessments to be carried out and the temperature of stored water. A reply to the immediate requirement was received by the local office of the Commission for Social Care Inspection on 19/5/06 - Risk assessments were being carried out and would be completed by 30th June; Water is now stored at 60oC, produced at 50oC and delivered at 43oC. Tendring Meadows Care Home DS0000015329.V295037.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X 2 X 2 STAFFING Standard No Score 27 3 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 2 3 2 X 1 Tendring Meadows Care Home DS0000015329.V295037.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14, 3(1a) Requirement The registered manager or her representative must make a detailed assessment before a prospective resident is admitted to the home. (Timescale of 30/4/06 not met.) The service user care plans must contain more detailed information to ensure their health and welfare needs are consistently met. The outcomes of service user risk assessments must be reflected in the care plan. The resident care plans must continue to improve by being specific and providing the basis of care delivered. The Registered Persons must ensure that records of medication reviews and GP contacts are accurate, up to date, and record the outcome of such visits. The Registered Persons must ensure that detailed written policies and procedures are in place for the safe use and management of medicines. DS0000015329.V295037.R01.S.doc Timescale for action 31/07/06 2. OP7 15(1) 31/07/06 3. 4. OP7 OP7 13(4b-c) 15 31/07/06 31/07/06 5. OP9 13(2), 17(1-3) 31/07/06 6. OP9 13(2) 31/07/06 Tendring Meadows Care Home Version 5.2 Page 25 6. OP18 13(6), 21(2), 37 7. OP19 23(2d) 8. OP24 16(1&2) 9. 10. OP28 OP30 18(1a-c) 2(4) 12(1a-b), 18(1a) 11. OP33 24(1-3) 12. OP34 25 13. OP34 26 14. OP36 18(2) The manager must ensure that all suspected issues of abuse or neglect of residents are investigated and reported promptly to the Commission for Social Care Inspection. (Timescale of 30/4/06 not met.) The registered persons must supply the Commission for Social Care Inspection with a plan of redecoration and repair for the home. The registered persons must replace poor quality carpets. (Timescale of 30/06/06 not met.) The registered manager must ensure all care staff are appropriately trained. The registered manager must ensure that all staff receive appropriate training for their grade. (This is specific to the catering staff requiring appropriate nutrition training, for the needs of the residents.) The registered manager must ensure that there is a current system for reviewing care for the home and that all audits are carried out in line with the programme. The registered individual must ensure accounts are available to the Commission for Social Care Inspection. The registered individual must undertake visits to the home in line with the requirements of regulation 26 and a report of these visits must be supplied to the local office of the Commission for Social Care Inspection. The registered manager must ensure that all staff received regular supervision. DS0000015329.V295037.R01.S.doc 31/07/06 31/07/06 30/09/06 31/12/06 30/09/06 30/09/06 30/07/06 31/07/06 31/07/06 Tendring Meadows Care Home Version 5.2 Page 26 15. OP38 12(1a), 13(4a-c) 16. OP38 13(3) The registered manager must ensure that risk assessments on safe working practices are carried out and alterations to practises made as required. (An immediate requirement notice was left at the time of the site visit regarding this issue.) The registered manager must ensure that there are systems for monitoring that the central hot water temperatures for the home remain above 60oC. (An immediate requirement notice was left at the time of the site visit regarding this issue.) 31/07/06 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. Refer to Standard OP3 OP3 OP9 OP9 OP12 OP15 OP18 OP26 Good Practice Recommendations Social service assessments should be received by the home before admission of a new resident is agreed. The registered manager should develop detailed preadmission paperwork, to cover all aspects of care offered at the home. Handwritten changes or additions to instructions for prescribed medicines should be signed and dated by the person making the entry. Records of medicines awaiting disposal should be maintained contemporaneously. The registered manager should arrange for the activities coordinator to attend an activities training course. Sugar free food alternatives, (e.g. jam, marmalade, sugarfree squash, sweetener, etc) should be supplied by the home for those residents who have diabetes. The registered manager should ensure that all staff in the home attends regular Protection of Vulnerable Adults training. The registered manager must ensure that staff are enabled to comply with all infection control procedures. DS0000015329.V295037.R01.S.doc Version 5.2 Page 27 Tendring Meadows Care Home 9. 10. OP29 OP33 (Specifically that all soap dispensers and hand washing facilities are kept ‘toped up’.) The manager should follow up references that highlight problems. Service user surveys should be anonymous. (This is a repeat recommendation.) Tendring Meadows Care Home DS0000015329.V295037.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: 0845 015 0120 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. 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