Inspection on 20/06/07 for The Mead

This inspection was carried out on 20th June 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Mead 07/04/06

The Mead 10/02/06

The Mead 27/07/05

The Mead 03/02/05

The Mead 24/06/04

The Mead 26/09/02

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Mead Castleford Close Borehamwood Hertfordshire WD6 4AL Lead Inspector Alison Jessop Key Unannounced Inspection 20th June 2007 10:00 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 The Mead DS0000019580.V343747.R02.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. The Mead DS0000019580.V343747.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Mead Address Castleford Close Borehamwood Hertfordshire WD6 4AL 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) 0208 953 8573 0207 313 3961 www.quantumcare.co.uk Quantum Care Limited Ms Jeanette Crockett Care Home 60 Category(ies) of Dementia - over 65 years of age (60), Old age, registration, with number not falling within any other category (60), of places Physical disability over 65 years of age (60) The Mead DS0000019580.V343747.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th August 2006 Brief Description of the Service: The Mead is a two storey, purpose built residential care home for older people. It is situated in a quiet residential area of Borehamwood. Access to local shops, public transport and other local amenities are a short walk away. The home is built in a horseshoe shape around a courtyard garden, there is ample off road parking. Four separate suites each offer accommodation to fifteen residents. Bedrooms are designed for single occupation and each has an en-suite toilet and wash hand basin. There is one communal lounge and a dining area in each suite. Communal bathrooms are spacious and accommodate assisted baths and showers. There is a hairdressing salon and a guest room. The home also has a day centre however the Commission does not inspect this for Social Care Inspection. The charges for the home range from £470-£555 per week. Hairdressing and Chiropody is not included and separate charges are made for these services. The Mead DS0000019580.V343747.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Regulatory Inspector carried out this unannounced inspection over one day. Pre-inspection information was gathered and all core standards were inspected. The manager of the home was unavailable, however the deputy manager and two Quantum Care Operational Managers were available throughout the inspection. Time was spent talking to service users, staff and other visitors to the home. The outcome of the inspection was extremely positive. What the service does well: What has improved since the last inspection? New soft furnishings have been added around the home, providing a clean, homely atmosphere. There are also a considerable number of personal items around the home such as family photos in the communal lounges. A lot of therapeutic items such as bubble tubes, soft animals, fish tanks and large pictorial notices have been added to improve the environment for people who have dementia. The Mead DS0000019580.V343747.R02.S.doc Version 5.2 Page 6 New garden furniture with large parasols, which provide shading, has been added to the garden. 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. The Mead DS0000019580.V343747.R02.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 The Mead DS0000019580.V343747.R02.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): 3. Standard 6 does not apply. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Significant time and effort is spent making admissions to the home personal and well managed. The service considers carefully the needs assessment for each prospective resident before agreeing admission to the home. Prospective residents and their family, always have the opportunity to visit and spend time in the home prior to agreeing admission. EVIDENCE: The deputy manager was very clear about the importance of a comprehensive needs assessment for new referrals. Two operational managers were visiting the home that day as they were carrying out an assessment for someone who has complex needs. The manager had requested assistance in making a decision about suitability. Other service users living in the home are considered during this process and decisions appeared to be taken in a non-discriminatory manner. The Mead DS0000019580.V343747.R02.S.doc Version 5.2 Page 9 The manager stated that she plans to introduce a welcome pack with cards and flowers in the future to make admissions more comfortable and pleasant. The home does not currently provide Intermediate Care. The Mead DS0000019580.V343747.R02.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): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have a plan that has been agreed with them. This is written in plain language, is easy to understand and considers all areas of the individual’s life including health, personal and social care needs. The plan also includes a risk assessment. The home works to an efficient medication policy supported by procedures and practice guidance. Staff are aware of and understand the guidance, and quality assurance systems confirm that practice reflects policy. EVIDENCE: Care plans contain comprehensive and clear information about individual needs and preferences. People who are not familiar with its content could use the care plans in an emergency. All care plans observed had been reviewed regularly and had been signed by the resident or their representative. Very specific instructions are listed for individual needs and on how to minimise risks. The Mead DS0000019580.V343747.R02.S.doc Version 5.2 Page 11 Resident’s health and well being is closely monitored and families are informed of any changes where appropriate. One relative stated ‘the staff always talk to me if they have any concerns, it gives me peace of mind.’ One resident was asleep in the chair when drinks were served. The carer gently tried to wake him up but he remained asleep. She left him for a short time but then persisted until she was happy that the man had taken some fluids. No one living in the home has developed pressure sores in the last twelve months. Procedures relating to medication are satisfactorily maintained. The system is very organised and regular audits are carried out to ensure that procedures are being followed. There have been significant improvements in this area since the last key inspection and staff must be commended for their efforts. Staff interaction was kind and caring. There was a jolly atmosphere and staff were observed laughing and offering appropriate compliments to residents. Reassurance was being offered to one lady who has dementia and who at times became unsettled. Although most of the resident’s appearance was clean and tidy, several of the men looked unshaven and their hair had not been brushed. The Mead DS0000019580.V343747.R02.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. 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 using available evidence including a visit to this service. Although the activity programme has increased, more occupational-style stimulation would be beneficial for residents who are unable to or do not wish to participate in organised activities. This would enhance their sense of purpose and well being. EVIDENCE: It was identified during the quality assurance processes that there is a lack of activities in the home and during the inspection, many of residents said that they don’t have a lot to do during the day. Several relatives also commented on the annual quality assurance survey. A new activity co-ordinator has been employed who has implemented a wide range of activities both within and outside the home. Photographs of activities that have taken place are displayed in each unit. A gardening club has also been set up where plants that are grown will be sold in order to raise more money for the gardening fund. On the day of the inspection the activity co-ordinator took a resident out shopping to the supermarket. Another resident was seen leaving the home to The Mead DS0000019580.V343747.R02.S.doc Version 5.2 Page 13 go for his daily pint and trip to the shop. He was able to access the outside freely as staff had provided him with the code to the front door. Another resident said ‘I go to church on a Sunday, I have one of the staff to take me as its not safe for me to go alone, I don’t mind the company anyway.’ One of the residents stated that he had been out to a Quantum Care seminar at head office, he said that he enjoyed talking to staff there and was given a nice lunch. It was observed by the inspector that those residents who sit in the lounge and who cannot walk around, sat in the chair for long periods of time with no interaction from staff. Some of the residents were sleeping in the chair at 10.30am with the television on in the background. Although there were soft animals and other comforting objects around, these were not given to residents who would have taken comfort from them. Feedback about the food was very good. One resident said ‘they give us really nice meals, and we get snacks too.’ The residents had a choice of roast chicken with all the trimmings or jacket potato and salad. Snacks and drinks were also available in between meals with baskets of finger foods being left in the units. Staff were observed assisting residents to eat in a dignified manner. The Mead DS0000019580.V343747.R02.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and others associated with the home demonstrate a good understanding of how to make a complaint and they are very clear of what can be expected to happen if a complaint is made. Unless there are exceptional circumstances the service always responds within the agreed timescale. The outcomes from safeguarding referrals are managed well and issues are resolved to the satisfaction of all involved. EVIDENCE: One formal complaint was made to the service in the last twelve months. This was made by a relative who complained that incontinence pads had not been readily available to her mother. The deputy manager explained that it had been a communication error on that particular day and a key to the storeroom had not been handed to staff on duty. The complaint was responded to within the timescale and the complaint has been fully resolved. There has been three referrals in relation to safeguarding adults. One resident stated that a member of staff had humiliated her in front of other residents and staff. This is currently being investigated however the service, have correctly followed the procedures in order to protect residents living in the home. Two other incidents were reported to staff, both of which were dealt with in accordance with the Safeguarding Adults Procedure. The company’ disciplinary The Mead DS0000019580.V343747.R02.S.doc Version 5.2 Page 15 procedures were also implemented. The inspector spoke to one of the residents involved, who gave excellent feedback about the home and the staff team. Staff have received training updates on Safeguarding Adults and those spoken to were fully aware of the whistle blowing procedure. The staff have also promoted procedures on the awareness of elder abuse. The Mead DS0000019580.V343747.R02.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): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment offers homely, comfortable environment to the people who live there. Most areas of the home looked clean and tidy however malodours were detected in some bedrooms making this an unpleasant environment for the occupants. One example of poor infection control was observed causing a risk of the spread of infection. EVIDENCE: The communal areas and bedrooms are decorated and furnished tastefully and bedrooms viewed provide evidence of the occupant’s belongings and other personal effects. All units have new lounge furniture and new carpets have been fitted in many areas of the home. The Mead DS0000019580.V343747.R02.S.doc Version 5.2 Page 17 The home has been awarded £16,500 Capital Grant, which will be used to upgrade and refurbish the three existing shower units. Also more shaded areas will be added in the garden. Malodours were detected in some of the bedrooms in the home and a wet pad, underwear and wet duvet were observed left on a table in the relaxation room. This increases the risk of the spread of infection. The Mead DS0000019580.V343747.R02.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): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service ensures that all staff within its organisation receives relevant training that is targeted and focussed on improving outcomes for residents. The service has a good recruitment procedure that clearly defines the process to be followed. EVIDENCE: Staffing numbers appeared to be appropriate to meet the assessed needs of the service users. Training profiles for individual staff members are maintained and training received, recorded. Mandatory training and a variety of other courses have been attended, including Basic and Intermediate Dementia. Three new staff files were inspected and all three had completed the Skills for Care Induction Standards. Robust recruitment practices are observed to offer protection to service users and staff, in line with legislation. The Mead DS0000019580.V343747.R02.S.doc Version 5.2 Page 19 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): 31, 33, 35 & 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The manager has the required qualifications and experience, is highly competent to run the home and meet its stated aims and objectives. There is strong evidence that the ethos of the home is open and transparent with the views of both staff and residents listened to and valued. EVIDENCE: The management team have worked hard to raise standards within the home and were spoken of very highly by the residents. One resident stated ‘I can always talk to the manager if I am concerned about anything, she is on holiday this week but I would talk to one of the others.’ The manager has completed NVQ 4 and Registered Managers Award. The Mead DS0000019580.V343747.R02.S.doc Version 5.2 Page 20 There are effective quality monitoring systems where residents, families and other representatives views are sought. An action plan is drawn up and suggestions on how the service could improve are so far as possible agreed. One relative stated ‘mum has settled in very well and seems to be thriving having put on weight.’ The home has a new administrator who deals with resident’s finances. She was very clear about policies and procedures to be followed and where it is safe residents manage their own finances. The home has good procedures to ensure the health and safety and welfare of service users and staff. The Mead DS0000019580.V343747.R02.S.doc Version 5.2 Page 21 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 4 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 2 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 4 X 3 X 3 X X 3 The Mead DS0000019580.V343747.R02.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO 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 OP10 Regulation 12(4)(a) Requirement Arrangements for personal care must ensure that service users dignity is respected at all times, for example shaving and tidy hair. Universal infection control procedures must be followed in order to prevent the spread of infection. Timescale for action 20/07/07 2 OP26 13(3) 20/07/07 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 Refer to Standard OP12 Good Practice Recommendations It is recommended that residents are offered more occupational stimulation throughout the day in order to promote their sense of identity and well being. 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