Inspection on 07/04/06 for The Mead

This inspection was carried out on 7th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 20/06/07

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 Unannounced Inspection 7th April 2006 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.V288911.R01.S.doc Version 5.1 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.V288911.R01.S.doc Version 5.1 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 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.V288911.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th February 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 this is not inspected by the Commission 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.V288911.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced inspection of the inspection year and was carried out by two Regulatory Inspectors 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. Meetings were also held with Quantum Care’s Pharmacy Consultant and the company’s Financial Auditor. Comment cards were sent to Gp’s who visit the home, however feedback has not currently been received. Overall this was a very positive inspection, many areas of improvement were observed however some standards were not met and Requirements made in order for the home to achieve further improvement. What the service does well: What has improved since the last inspection? New Procedures relating to the administration, storage and recording of medication have been reviewed. A lot of training has been carried out with staff, who appear to be more confident in this area. The appearance of service users had improved since the previous inspection. Service users were appropriately dressed, wore suitable footwear and oral hygiene had been attended to. The Mead DS0000019580.V288911.R01.S.doc Version 5.1 Page 6 A dedicated room has been introduced for the storage of equipment such as hoists, slings, weighing scales etc. This creates safer, more spacious areas around the home where these items were previously stored. 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 Mead DS0000019580.V288911.R01.S.doc Version 5.1 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.V288911.R01.S.doc Version 5.1 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 good. This judgement has been made using available evidence including a visit to this service. Due to previous inappropriate admissions, the home has a more robust admissions procedure. Management undertake comprehensive assessments and inappropriate referrals are not accepted, as the home may not be able to meet their needs. This reduces possible future issues within the home and prevents service users from having to move onto a more suitable accommodation. EVIDENCE: The operational manager was very clear about the importance of a comprehensive needs assessment for new referrals. Other service users living in the home are considered during this process and decisions appeared to be taken in a non-discriminatory manner. The home does not currently provide Intermediate Care. The Mead DS0000019580.V288911.R01.S.doc Version 5.1 Page 9 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 poor. This judgement has been made using available evidence including a visit to this service. Although generally service users care needs appear to be met, It was recognised that specialist dementia care awareness amongst the staff team needs to be developed. This would enhance the lives of service users who have dementia. The dignity of service users must also be respected. EVIDENCE: Service users looked well cared for, and were treated sensitively. One service user said ‘the girls are wonderful, it’s like walking with angels.’ Some good care practice was observed throughout the day. Information contained in care plans was comprehensive and regularly reviewed. Individual risk assessments could be more descriptive, as some generic risk assessments did not offer sufficient information about individual behaviours. Although life stories were available to staff, these did not appear to be used to enhance the care provided to service users who have dementia. Staff appeared The Mead DS0000019580.V288911.R01.S.doc Version 5.1 Page 10 to spend a lot of time carrying out practical tasks to make the environment look clean and tidy, whilst service users sat in chairs with very little social interaction or stimulation. During lunch one service user who has dementia was observed sitting alone at the table with her meal placed in front of her. The inspector sat with the lady and quite soon became aware that the lady required some prompting to put food into her mouth. After a long period of time the lady had not eaten any food at all and the inspector then asked staff if the lady required some assistance. The response given was that the lady takes along time to eat her food. Later the food was cut up and prompting and assistance was given by the carer which encouraged the service user to eat independently. On the day of the inspection the inspector was notified that an error of administration of medication had occurred the previous evening. The home had dealt with this in accordance with the homes procedures and had reported the incident to Adult Care Services in accordance with the Protection of Vulnerable Adults Procedure. The manager and Adult Care Services will make an investigation and the service user was being closely monitored by staff with no adverse affects at that time. A meeting was held with Quantum Care pharmacist Consultant who said ‘in my opinion the medicines here are being looked after properly.’ A new medication system has been introduced recently and all staff have received comprehensive training and capability assessments. The medication room was very tidy and orderly and all medication in stock accounted for. A lot of notices were observed around the home, in people’s bedrooms and in kitchenettes. These do not offer privacy and dignity to service users and it was suggested a more discreet method is adopted. One staff member was inappropriately dressed for work and the inspector overheard a carer state ‘I can’t wait to get out of here today’. This was not discreet and may have been overheard by service users. The Mead DS0000019580.V288911.R01.S.doc Version 5.1 Page 11 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 poor. This judgement has been made using available evidence including a visit to this service. There was a distinct lack of social activities in the home and service users were observed sitting in chairs for long periods of time or walking around the home with their coats on asking how to get out. The home are not meeting service users social needs which appears to be having an impact on general well being. EVIDENCE: Throughout the inspection no social activities were observed taking place and service users were observed sitting in chairs for long periods of time without any social interaction or stimulation. One visitor said ‘there is never any activities, and I feel that this is having an impact on residents health. I have been promised that an activity co-ordinator will be appointed however this has still not happened.’ Service users on the dementia unit, although appear not to be agitated, several were observed walking around the home with their coats on asking how they can get out of the home. Others who are unable to walk were observed sitting in chairs for long periods of time without any meaningful stimulation. The radio and television were left on and staff appeared not to The Mead DS0000019580.V288911.R01.S.doc Version 5.1 Page 12 spend much time talking to service users. Individual care plans stated that activities had not been attended since September 2005. Staff spoken to said ‘we try to do activities like play games or paint nails but we don’t get much time and people tend not to participate’. No activity plan or advertisements for activities were available. The Mead DS0000019580.V288911.R01.S.doc Version 5.1 Page 13 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 good. This judgement has been made using available evidence including a visit to this service. Complaints received by the home appear to have been acted upon within appropriate timescales and outcomes had been relayed back to complainant thus resolving the complaint. EVIDENCE: One complaint had been received by the home, this had been fully recorded and responded to within reasonable timescales. Staff spoken to had an awareness of the Hertfordshire Protection of Vulnerable Adults Procedure and Whistle blowing procedure. The Mead DS0000019580.V288911.R01.S.doc Version 5.1 Page 14 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 using available evidence including a visit to this service. The complete refurbishment of the home has immensely improved the environment for service users living in the home and staff appear to respect their surroundings much more than previously. The décor offers a relaxing and pleasant environment to service users. EVIDENCE: The home has been completely refurbished and soft furnishings offer a more homely feel. The home is clean and tidy and no malodours were detected. Various personal toiletries including a razor, bubble bath and hairbrush were being stored centrally in bathroom cupboards. These must be stored in individual service users bedrooms/bathrooms. One domestic was observed carrying a soiled incontinence pad from a service users bedroom to the clinical waste bin in the bathroom, which increases the The Mead DS0000019580.V288911.R01.S.doc Version 5.1 Page 15 spread of infection. Staff generally throughout the inspection were observed following universal infection control procedures. The Mead DS0000019580.V288911.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 good. This judgement has been made using available evidence including a visit to this service. Records pertaining to recruitment appeared to be satisfactory, thus protecting service users from abuse. EVIDENCE: The home has been in the process of recruiting an activity co-ordinator for a long time, however this has not been successful. It was suggested that other ways of covering this position are sought as the lack of activities in the home raises concerns. A comprehensive training plan is in place and evidence of mandatory training was observed. A lot of training had been given to staff on medication procedures and staff had been re-trained and capabilities assessed on a regular basis. The home currently has 41 of staff who have or are working towards NVQ 2 or above. The manager has completed her RMA and NVQ 4. The Mead DS0000019580.V288911.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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 using available evidence including a visit to this service. The manager of the home has now registered with the Commission for Social Care Inspection, and although she has been on leave, her return should offer some stability to the management of the home. EVIDENCE: A meeting was held with Quantum Care Financial Auditor who is currently visiting the home on a regular basis, as the home does not currently have an administrator. All records relating to service users finances were satisfactory, however a more detailed procedure must available for staff outlining procedures for recording transactions. Evidence was observed that day staff receive regular supervision, however records for supervision of night workers were not. The Mead DS0000019580.V288911.R01.S.doc Version 5.1 Page 18 Although notices were observed in kitchenettes for Fridge/freezer temperatures to be monitored and recorded this had not been done since January 2006. The Mead DS0000019580.V288911.R01.S.doc Version 5.1 Page 19 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 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 3 X X X 2 2 X 2 The Mead DS0000019580.V288911.R01.S.doc Version 5.1 Page 20 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 OP8 Regulation 12(1)(a)& (b) 13(2) Requirement Service users must be monitored and assisted during meals in order to ensure that they receive sufficient food intake. A report must be submitted to CSCI in relation to the investigation being carried out by the home about medication not supplied by the pharmacy. Instructions in relation to service users care must be placed discretely. The registered person must ensure that the care home is conducted in a manner that respects the dignity of service users. All staff must adopt appropriate use of dress and communication. A meaningful programme of activities must be provided to service users on a regular basis. A monthly activity plan must be submitted to CSCI. All staff must adopt universal infection control procedures and toiletries must be stored in service users personal bathrooms. DS0000019580.V288911.R01.S.doc Timescale for action 14/04/06 2 OP9 14/04/06 3 4 OP10 OP10 12(4)(a) 12(4) (a) 14/04/06 14/04/06 5 OP12 16(2)(m) &(n) 30/04/06 6 OP26 13(3) 14/04/06 The Mead Version 5.1 Page 21 7 OP35 17(2) schedule 4 8 9 OP36 OP38 18(2) 13(4)(c) The registered person must ensure that a clear procedure is available pertaining to the recording of storage of service users money. A copy must be provided to CSCI. Night care workers must receive regular supervision. Fridge/freezer temperatures must be monitored and recorded on a daily basis. 30/06/06 30/06/06 14/04/06 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 Refer to Standard OP7 Good Practice Recommendations Care Plans should be further enhanced for service users who have dementia and information gained about a service users history should be used to ensure that meaningful and appropriate care is offered. Information contained in risk assessments should be enhanced and should contain more descript information in relation to individual identified risks. It is suggested that other methods of providing dedicated staffing to the organisation of activities is adopted until the position is permanently filled. 2 3 OP7 OP27 The Mead DS0000019580.V288911.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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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