Inspection on 17/09/08 for Tendring Meadows Care Home

This inspection was carried out on 17th September 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 29/04/08

Tendring Meadows Care Home 11/06/07

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 19/12/2008.

CARE HOMES FOR OLDER PEOPLE Tendring Meadows Care Home The Heath Tendring Clacton on Sea Essex CO16 0BZ Lead Inspector Francesca Halliday Unannounced Inspection 17th September 2008 09:00 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.V372192.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.V372192.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 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.V372192.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 29th April 2008 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 up to 53 older people. The home is also registered to accept five people between the ages of 60 and 65. The accommodation for residents 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 weekly fees at the time of inspection in September 2008 were £383 to £500. The fee for respite care was £65 a night. There were additional fees for private chiropody, hairdressing and toiletries. For more up to date information on fees please contact the home directly. Tendring Meadows Care Home DS0000015329.V372192.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means that people who use this service experience adequate quality outcomes. This key inspection was carried out on 17th September 2008. The term resident is used throughout the report to refer to people who live in the home and the term “we” refers to the Commission for Social Care Inspection. All the key national minimum standards (NMS) for older people were assessed during the inspection. The report has been written using evidence accumulated since the last key inspection as well as that gathered during the site visit. The report includes views and comments from one relative spoken with during the inspection and from three surveys completed by residents, three completed by relatives and four completed by staff and returned to the commission. We also asked the GP and one of the district nurses who visited Tendring Meadows for their opinion on the care provided. We carried out a tour of parts of the premises and sampled the records held in the home. Time was spent talking to the manager and five of the staff. We also had chats of various lengths with four residents during the inspection. What the service does well: What has improved since the last inspection? The overall management and standards in the home had improved considerably since the last inspection. A member of staff told us “It’s a much more enjoyable place to work now, it’s a happier place. Residents are more involved in their care and in activities”. A number of audits had been put in place, which enabled the manager to monitor and improve standards in the Tendring Meadows Care Home DS0000015329.V372192.R01.S.doc Version 5.2 Page 6 home. The manager was putting an emphasis on team building and was involving staff in decision-making. The cleanliness of the home was much improved and safety of residents was being given a high priority. Seven rooms had been redecorated and their carpets replaced and communal bathrooms and toilets had been painted. The social services embargo on admissions had been removed and the social services monitoring team told us that the home had complied with all requirements. A relative told us “Standards have definitely improved, there’s not one member of staff I wouldn’t trust with my Mum”. 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. The summary of this inspection report can be made available in other formats on request. Tendring Meadows Care Home DS0000015329.V372192.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.V372192.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 1, 3, 5 (standard 6 not applicable) Quality in this outcome area is adequate. Prospective residents can be confident that they will have their needs assessed before making a decision about admission but cannot be assured that the information provided accurately reflect services in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a statement of purpose and service user guide for prospective residents, their representatives and their families, which gave information about services provided. However, a considerable amount of the information in the documents was incorrect and appeared to refer to another home owned by the company. This might result in prospective residents having false expectations about the facilities and services on offer in the home. Prospective residents were encouraged to visit and spend time in the home before making a decision about admission. A trial period of up to six weeks was offered Tendring Meadows Care Home DS0000015329.V372192.R01.S.doc Version 5.2 Page 9 before a decision was made on taking up a permanent placement in the home. The home also offered respite care for older people. The home’s GP told us that admissions to the home were now much more appropriate and the home was no longer admitting residents that they did not have the skills to care for. The manager said that she involved the district nursing team in the assessment process if there were any concerns that the potential resident might need more support than the district nursing team could provide. The manager or one of her two deputies carried out the preadmission assessments. The assessments we sampled were of a good standard and included some of the potential residents’ preferences. Risk assessments were also carried out in the preadmission assessment. A social services assessment provided additional information for those being funded by social services. Tendring Meadows Care Home DS0000015329.V372192.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 consider that they receive good care but some improvements in communication are needed to ensure their healthcare needs are met. Improvements in medicines management are needed to ensure residents’ safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents and relatives were generally very happy with the standard of care and the support from the care staff. A relative told us that staff gave “good care particularly when Mum was ill recently” and said that they were pleased that staff encouraged her to walk even though she was frail rather than putting her in a wheelchair. Residents we spoke with and who responded to our surveys told us that staff listened and acted on what they said. One resident told us “I’m quite satisfied, quite content. Staff are excellent”. Although one resident who responded to our survey told us that they did not always get the care and support they needed because some of the staff did not understand Tendring Meadows Care Home DS0000015329.V372192.R01.S.doc Version 5.2 Page 11 English well enough. A relative we spoke with told us that staff were very respectful to her mother and a relative who responded to our survey said “All the staff are friendly, gentle and always respectful to Mum”. Residents we spoke with confirmed that staff respected their privacy and treated them respectfully. Staff we observed had a friendly and caring manner and were respectful and supportive with residents. The home’s GP told us that staff now called the surgery about healthcare concerns promptly and more appropriately than in the past. The district nurse we spoke with considered that the care in the home was good. However, they said that communication about healthcare issues was on occasions poor due to some foreign staff not understanding their instructions and not passing important information on to other staff. The examples of information that had not been passed on appropriately concerned pain relief, the suitability and safety of the chair in a resident’s room and supplements not being given. The manager said that some problems with communication may have occurred because two district nursing teams had been giving staff different instructions about changes in care. She said that she had had a meeting with one of the district nurses’ managers to try and sort these problems out. The manager also told us that the staff from Latvia and Poland were all attending literacy and numeracy classes and English courses where needed. The care plans were of an excellent standard. They were detailed and focused on the specific needs of each individual resident. For example the care plans for one resident demonstrated how their medical condition affected aspects of their life at different times. Even though this resident’s condition and abilities varied from day to day there was evidence that staff were responding flexibly, encouraging their independence and only offering help when it was needed. The care plans were regularly reviewed and there was also evidence that they were updated when a resident’s condition changed. The manager said that she regularly checked the care plans to see whether changes in residents’ condition were being documented and any healthcare concerns were being identified. She also questioned staff about the content of the care plans to check on their understanding and on whether the care was being provided in line with the care plans and in a consistent manner. This is to be commended. The majority of residents’ care folders were now being held in their rooms. This enabled staff to update the records immediately after they had provided care and enabled residents to share their care plans with their relatives if they wished. Some residents did not wish to have their folders in their rooms and this was respected. The home had a range of risk assessments. Residents’ weight was monitored monthly unless there were concerns about their condition or they had lost weight, in which case they were weighed more frequently. The manager said that staff were aware of the links between dehydration and the increased risk of falls and confusion and said that staff encouraged residents to have regular Tendring Meadows Care Home DS0000015329.V372192.R01.S.doc Version 5.2 Page 12 drinks. The amount of fluids residents were drinking was monitored if there was any concern about their condition. Staff were keeping good records when residents had any marks on their skin or injuries. Accident records we sampled were well completed. Relatives who responded to our surveys told us that staff “always” kept them informed about any accidents or health concerns and the relative we spoke with confirmed this. The monitoring of residents’ healthcare needs had improved considerably and there was evidence that residents were referred promptly and appropriately if they had nursing or medical needs. Residents who responded to our surveys told us that they “always” received the medical support they needed and residents we spoke with during the inspection agreed. One resident told us “I’m getting the (medical) attention I need”. Staff told us that the GP and district nurses provided excellent support to the home. The manager said that the home’s GP was informed as soon as a new resident was admitted so that a health assessment could be carried out. The GP held a surgery once a week at the home and also visited on request when needed. Staff kept good records of the GP and district nurses’ visits, and recorded details of any changes to their treatment or care. Residents told us that they had visits from the chiropodist and had optical and dental checks. Medicines were stored securely in a room on each floor. The temperatures of the storage areas were monitored regularly to ensure medicines were kept at the appropriate temperature to maintain their quality. There was a need to ensure that the date of opening was clearly recorded on medicines with a limited shelf life. This will prevent medicines being used for the treatment of residents beyond their usable life. There were a number of examples where the printed instruction on the medicine administration charts (MAR) was for the medicines to be given regularly but they were only being given on an “as required” basis and a resident who was prescribed a medicine three times a day was only receiving it once. Some medicines had clear instructions on the MAR on how to give “as required” medication, however, others had no instructions for staff on how to administer the medicines. There was a need to discuss all these issues with the GP and with the supplying pharmacist to ensure the records were accurate and the residents were receiving the dose intended by the GP. One medicine had been incorrectly transcribed onto the MAR giving an incorrect dose and some topical creams had had been handwritten on the MAR with no date, no signature and no description of where and how frequently the medicines were to be administered. Where handwritten changes or additions are made to the medication records it is good practice for these to be signed and dated by the person making the change and for these to be checked for accuracy by a second person. Tendring Meadows Care Home DS0000015329.V372192.R01.S.doc Version 5.2 Page 13 Some eye drops that should be stored at between 2-8c were not being stored in the drugs fridge but this was rectified during the inspection. It was not possible to audit medicines that were not in the monitored dosage systems, as the amounts left over from the previous month were not recorded as brought forward. These medicines were frequently prescribed with a variable dose but it was sometimes very difficult to establish from the records what dose the residents had actually been given. The manager was asked to check the prescription and the dose being given for one resident as it was not clear from the records if they were getting the correct dose of an important medication. The home held some stocks of homely remedies for residents; however, staff had been taking some of the homely remedies themselves rather than bringing in their own medicines when on duty. One resident had been given eight doses of one homely remedy during the previous two weeks but only three of the doses had been recorded on the MAR. This could result in the GP and other staff being unaware that the resident had received the medication. Staff had combined the tablets of two different forms of a homely remedy (one dispersible and one not) in one of the cartons. This meant that staff did not have the instructions or the expiry date for one of the medicines. The balance of the two drugs had also been recorded together but this was sorted out at the time of inspection. We checked the controlled drugs (CDs) and found the balances to be correct. The home had one cupboard provided for the storage of CDs but the cupboard did not comply with the Misuse of Drugs (Safe Custody) Regulations since it was not fixed to the outside wall with rag or rawl bolts. The manager confirmed that all senior staff had completed a foundation course in medication and said that staff were supervised and assessed before they administered medicines on their own. The manager also told us that following the inspection steps were taken to change the supplying pharmacist. She said that the new pharmacist was going to provide additional staff training and would assist staff to carry out regular medication audits. Tendring Meadows Care Home DS0000015329.V372192.R01.S.doc Version 5.2 Page 14 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 good. Residents benefit from a range of activities and from the developing links with the community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had two activity coordinators, although one was on long term sick at the time of inspection. The home had a range of activities both in groups and in one to one sessions and there was evidence of an increase in social events for residents. A resident told us that they had enjoyed the recent fete and were looking forward to bonfire night in November, when they were having fireworks and a barbecue. The manager told us that she had consulted with the residents about how to spend the money made at the fete and that it was being spent on a DVD player for one of the lounges and for entertainments for residents once a month. One resident who responded to our surveys told us that there were “always” activities that they could take part in and two residents told us that there were “usually” activities that they could take part in. Residents we spoke with said Tendring Meadows Care Home DS0000015329.V372192.R01.S.doc Version 5.2 Page 15 that there were activities they could join in with if they wished, although they said that there were no activities when the activity coordinator was away. The manager was putting considerable stress on the importance of improving choices for residents and moving away from all types of institutional practices. She said that she was trying to ensure that residents had a genuine choice about the time that they got up in the morning. One of the deputies was coming in at six o’clock and monitoring night staff to ensure that they were genuinely getting residents up at a time of their choice. The manager was also ensuring that she spoke to night staff on a regular basis once or twice a week. Residents we spoke with told us that they got up and went to bed at a time that suited them and spent the day where they wished. There was evidence from discussions with residents and relatives and from the documentation we looked at that staff were encouraging residents’ independence and promoting choices. The manager had made commendable efforts to develop links with the local community as there had been no links previously. The manager was going to speak to the children at a local primary school and was also developing links with the local secondary school. She said that local school children were coming to the bonfire night barbecue in costumes. The home had unrestricted visiting and relatives told us that they were made to feel very welcome. One complimentary letter we saw said “thanks for making the family welcome”. The food we saw at lunchtime looked nutritious and appetising. The menu offered a choice and different diets were catered for. Two residents who responded to our survey told us that they “always” liked the food in the home and one resident told us that they “sometimes” liked the food. A resident we spoke with said that they were “quite satisfied” with the food, two residents told us the food was “good” and another described the food as “ tasty”. A relative told us that staff gave their mother time to eat some of the food herself to enable her to maintain some independence and then assisted her to finish to ensure that she received sufficient nutrition. Tendring Meadows Care Home DS0000015329.V372192.R01.S.doc Version 5.2 Page 16 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 good. Residents can be confident that their concerns will be addressed and they will be protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents and relatives who responded to our surveys all told us that they knew how to make a complaint and said that staff always responded appropriately if they raised any concerns. One relative said “I’ve not had to raise any concerns”. A resident told us that they had “no complaints, staff sort things out for me every time”. One relative who had made a complaint was very happy that the issues had been resolved and said “an apology was given”. We saw a good response to a complaint that demonstrated that the standard of investigation and response had improved since the last inspection. The manager said that verbal concerns and complaints were now being documented and we saw evidence of this. The manager considered that she was now dealing with small problems and concerns and stopping them developing into more major complaints. The complaints procedure needed to be updated to reflect the name of the current manager and the role of the Commission and Social Services in reviewing and investigating complaints. The home had a safeguarding policy. Staff we spoke with told us that they felt confident in reporting any poor care practices or suspected abuse and there was evidence that staff had reported a potential safeguarding issue very Tendring Meadows Care Home DS0000015329.V372192.R01.S.doc Version 5.2 Page 17 promptly to the manager so that it was resolved. The majority of staff had received training in the safeguarding of vulnerable adults. The manager had also obtained a safeguarding DVD training pack with questions for staff, which she was hoping to start using as an additional training tool. The minutes of staff meetings also provided evidence that safeguarding and good practice issues were regularly reinforced at team meetings. Tendring Meadows Care Home DS0000015329.V372192.R01.S.doc Version 5.2 Page 18 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, 26 Quality in this outcome area is good. Residents benefit from a clean and fresh environment and steps are being taken to assure their safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The standard of cleaning had improved considerably. The number of domestic hours had been increased and was now eight hours on each floor on seven days a week. The home was very much cleaner than at the last inspection in April 2008. There were no unpleasant odours and all areas of the home we inspected had been cleaned to a good standard. One resident described the cleaning of the home as “excellent”. Seven residents’ rooms had been redecorated and had new carpets laid and communal toilets and bathrooms had been repainted since the last inspection. Tendring Meadows Care Home DS0000015329.V372192.R01.S.doc Version 5.2 Page 19 The safety of the environment had been improved. All the open heaters in communal rooms had guards put in place since the last inspection. A fence had been erected in the back garden to screen off a ditch along the length of the garden. Work was also underway to provide a level paved area in the back garden for residents to use safely. Hazardous chemicals had been stored safely and appropriately. The home currently had an assisted bath for each unit, which staff considered sufficient for current occupancy and needs. The home did not have any communal showers. All double bedrooms had an en-suite shower or bath and some of these had hoists. The single rooms had an en-suite toilet and basin. A number of baths without a hoist were not being used, as they were not suitable for the current residents in the home. The number of assisted bathing facilities may need to be reviewed when occupancy increases. One communal toilet did not have any grab rails. The manager said that she would check all the toilets and assess whether any more grab rails needed to be fitted. The home had communal rooms on each of the four units. The manager said that staff monitored the temperatures in the lounges when the weather was hot and assisted residents to move to another lounge when necessary. The laundry looked well organised. A resident told us that the standard of laundry was “excellent” and told us that the laundry was “sent out in the morning and came back at night”. Another resident said that the standard of the laundry was “good”. They told us that they had lost two items of clothing but that one had since been found. The laundry assistant worked from Monday to Friday and the domestic staff carried out some laundry at weekends. The laundry had washing machines with a sluice cycle and had dissolvable bags for handling soiled linen. Staff confirmed that they had sufficient personal protective equipment for use when carrying out personal care. The laundry assistant told us that the laundry was locked when not in use and that they had information on the chemicals used in case of any accidental contamination. Tendring Meadows Care Home DS0000015329.V372192.R01.S.doc Version 5.2 Page 20 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, 28, 29 Quality in this outcome area is good. Residents receive support from an adequate number of well-trained and recruited staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had six care staff in the morning, five in the afternoon and four at night for twenty-five residents. Residents we spoke with told us that there were generally sufficient staff to meet their needs and from observation during the inspection this appeared to be the case. The home’s layout was very spread out in four separate units but staffing levels were adequate for the number and dependency of residents at the time of inspection. The manager confirmed that care staff were no longer working a mix of day and night duty in the same week. However, some staff were still working very long hours, sometimes in excess of sixty seven hours in a week. These hours put staff at risk of becoming overtired and not able to sustain their best working practice for such long periods, putting residents in the home at risk or at a disadvantage. The manager said some staff wished to work longer hours but that she was in the process of recruiting more staff and was reducing their hours. She also said that she monitored staff performance and that she cut their hours if she considered that they were becoming too tired. Tendring Meadows Care Home DS0000015329.V372192.R01.S.doc Version 5.2 Page 21 The manager told us that an audit of staff files had recently been carried out to ensure that all the required information was on file. We looked at the records for three staff who had been recently recruited. The recruitment procedures were sound. Checks with the criminal records bureau (CRB) and protection of vulnerable adults (POVA) list had been carried out, identification had been obtained and two references were on file. The process of recruitment had been improved. The manager was now using set questions with a scoring system at interviews for new staff and was keeping a record of the interviews. The manager was making considerable efforts to ensure that staff had the training to enable them to meet the specific needs of residents in the home. For example training in the care of older people with Parkinson’s disease and tracheostomy care had been given. She had arranged for training to be given to staff on care of a PEG feed before a resident was readmitted to the home from hospital following the insertion of a PEG. Training for staff to enable them to monitor the blood glucose level of residents with diabetes was also being given to a specific number of staff. Training in the prevention and management of pressure sores had been given as one resident had been admitted to the home with pressure sores. A high percentage of care staff had completed National Vocational Qualifications (NVQ). Thirteen staff had completed NVQ level 2 and two staff were starting the course and three staff had completed NVQ level 3 and 3 staff were starting the course. The manager and one of the senior carers were attending a foundation in counselling skills. Further training in first aid, moving and handling, fire safety, risk assessments and health and safety was booked. The manager had received training on the Mental Capacity Act and the training was also booked for senior carers. A number of staff had attended training on dementia care. The manager said that she was hoping to book training in communication, equality and diversity, MRSA and infection control, counselling and end of life care in the near future. She had also been downloading information for staff from the Internet on specific diseases or conditions that were relevant to residents in the home. Tendring Meadows Care Home DS0000015329.V372192.R01.S.doc Version 5.2 Page 22 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, 36, 38 Quality in this outcome area is good. The home is well managed and is run in the best interests of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager was appointed to the post in October 2007 and she told us that her application to be registered with the commission was being processed. She was undertaking the registered managers’ award. One relative who responded to our survey told us “The manager does a great job, she’s very approachable and caring”. A resident whom we spoke with said “The manager is very good, I think she’s doing pretty well”. One member of staff who responded to our surveys told us that the manager was “very supportive”, Tendring Meadows Care Home DS0000015329.V372192.R01.S.doc Version 5.2 Page 23 another said “The manager is very caring and puts residents first”. The manager had one full time and one part time deputy. The manager was running the home in the interests of residents and had made considerable improvements to the standards of care and services in the home. The systems for quality assurance were being developed and a number of audits had been put in place to monitor standards in the home. For example audits of accidents, cleaning and care documentation. Systems had been put in place to ensure that wheelchairs and hoists were fit and safe for residents to use. The temperature of water outlets used by residents was also checked every week. The manager had an open door policy and spoke regularly to all residents and relatives. The home had also conducted surveys with residents, relatives and staff. The manager had also put a comments/concerns box in the entrance hall for anyone who wanted to raise issues about the home. Staff meetings were being held about once a month. A member of staff we spoke with told us “communication between staff is much better now”. The minutes we saw gave clear guidance to staff on the standards expected of them, for example in the care documentation. The staff surveys carried out by the home demonstrated that staff felt supported by the management team in the home. This was also confirmed in the staff surveys returned to us. We saw a number of very complimentary letters from residents and relatives of residents who had spent time in the home. The administrator told us that they managed the monies on behalf of residents and the manager audited the records every three to four weeks. We inspected a sample of residents’ personal monies. The balances were correct and there were receipts available. The administrator confirmed that residents signed when they received any money and also that relatives signed to confirm the amount of money they were handing over for the residents’ use. There were systems in place for maintenance and servicing to ensure that equipment was safe for use in the home. Portable electrical appliance tests had been carried out. The home had a fire risk assessment. There was evidence that fire drills had taken place but fire alarm tests had only been carried out eleven times in eight and a half month and not weekly. The manager said that they would be carried out weekly following the inspection. Tendring Meadows Care Home DS0000015329.V372192.R01.S.doc Version 5.2 Page 24 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 1 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 3 X X 3 Tendring Meadows Care Home DS0000015329.V372192.R01.S.doc Version 5.2 Page 25 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 OP1 Regulation 4, 5 Requirement The provider must ensure that the statement of purpose and service user guide are an accurate reflection of services in the home so that prospective residents and their representatives are not give a false impression about services on offer. In order to protect and safeguard residents when administering medicines the following must be done: Keep accurate records of all medicines administered. Date medicines with a limited shelf life on first use. Retain medicines in their original cartons. Controlled drugs must be stored in accordance with the Misuse of Drugs Act and associated Regulations. The grounds at both the front and rear of the home must be made safe for residents’ use. DS0000015329.V372192.R01.S.doc Timescale for action 01/11/08 2. OP9 13(2) 17/09/08 3. OP9 13(2) 01/12/08 4. OP19 13(4) 01/01/09 Tendring Meadows Care Home Version 5.2 Page 26 The work in the grounds was underway but had not been completed within the timescale of 01/05/08 which was made in the last inspection report. 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 OP8 Good Practice Recommendations The manager should review the systems for communication with healthcare professionals to ensure that important information is passed on and is acted upon. Hand-written changes or additions to medication records should be signed and dated by the person making the change and checked for accuracy by a second person. The manager should consider allocating another member of staff to provide activities when the activities coordinator was not available. 2. OP9 3. OP12 Tendring Meadows Care Home DS0000015329.V372192.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tendring Meadows Care Home DS0000015329.V372192.R01.S.doc Version 5.2 Page 28 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!