Inspection on 11/01/07 for The Meadows

This inspection was carried out on 11th January 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

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

CARE HOME ADULTS 18-65 The Meadows The Meadows Meadow Lane, Anstey Way Instow Bideford Devon EX39 4JE Lead Inspector Jo Walsh Key Unannounced Inspection 11th January 2007 09:30 The Meadows DS0000067890.V321155.R01.S.doc Version 5.2 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 Meadows DS0000067890.V321155.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 Adults 18-65. 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 Meadows DS0000067890.V321155.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Meadows Address 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) The Meadows Meadow Lane, Anstey Way Instow Bideford Devon EX39 4JE 01271 861124 01271 861124 Blue Opal Limited Susan Patricia Porteous Care Home 12 Category(ies) of Learning disability (12) registration, with number of places The Meadows DS0000067890.V321155.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One person with acquired head injury is accommodated in the home Date of last inspection Brief Description of the Service: The Meadows is a detached purpose built property situated in the coastal village of Instow. The home is registered to accommodate 12 people with learning disabilities. The home accommodates people who have disabilities, which are challenging. All service users are accommodated in large single occupancy rooms all of which have ensuite facilities. There is a large communal lounge and separate dinning room. The home has a high level of staffing to ensure that the needs of service users can be met. The range of fee are £1,545 to £2,608 per week. A copy of the CSCI Inspection report is made available to resdietns and staff and a copy is kept in the office. The Meadows DS0000067890.V321155.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out on a weekday in January and took 7 hours. The main focus of the inspection was to seek the views of the residents and 8 were spoken to through out the day. 8 staff was also spoken to including both deputy managers and the registered manager. The inspector would like to thank the residents and staff for their helpfulness during the inspection. Prior to this inspection the home were asked to complete a pre inspection questionnaire, which provides information about how the home manages health and safety issues, training and general maintenance of the premises. Residents and some staff were also asked to complete a survey and this information has helped to inform the inspection process. 12 surveys were sent to residents and all were returned and 15 were sent to staff and 7 were returned. During the inspection two individual residents were case tracked, meaning they were spoken to about their experiences of living at the home and records relating to them such as care plans and medication records were also looked at. Staff were asked what they knew about the needs and preferences of these individuals. This information helps us to understand how well the home meets individual needs and whether records kept are useful, accurate and updated. This home has recently been taken over by a new registered provider, Blue Opal, a limited company, whose director also has care homes in the Midlands. What the service does well: There are systems in place to ensure that detailed assessments are completed prior to any new residents being admitted to the home. This also involves introductory visits, staff getting to know an individual in their current environment and making sure information is obtained from funding authorities. This detailed process ensures the home can meet assessed needs and that the level of staffing will be appropriate for individuals. Detailed plans of care are in place for all individuals to ensure that all staff provide care and support in a consistent manner. Individuals’ personal, health care and social needs are well met by a high staffing ratio of staff that are well trained and supported to do their job effectively. The home offers a good range and choice of meals that gives residents a balanced diet. Residents said ‘the food is brilliant, meals are all very nice, I love the food, the food is second to none’ The Meadows DS0000067890.V321155.R01.S.doc Version 5.2 Page 6 High staffing ratios enables the home to offer an individualised programme of outings and activities that include educational, as well as leisure and social based activities. One resident said ‘I get to choose where I go out, I like going to the pub, discos and sometimes the Gateway club.’ The premises are furnished and maintained to a high standard, providing residents with a comfortable homely environment. Systems are in place to ensure that residents are listened to and any concerns are acted upon. Residents spoken to were all confident that they could talk to staff about any issues or concerns. They were all aware of who their key workers are, named members of staff that oversee an individuals needs, wishes and any significant events. The home has a good recruitment process and induction programme to ensure that new staff are fully checked and given the skills to do their job safely and competently. Most staff spoken to expressed a high level of job satisfaction. All said that there was good training and comments included ‘this home is well organised, we get to do all the necessary training.’ The registered manager is experienced and qualified and runs the home in the best interests of the residents. Staff and residents spoken to believe the management approach to be open and inclusive, many said they could go to the manager at any time with a concern, issue or suggestion. Comments included ‘this is the best job I have ever had, I love it here, the managers are really supportive and listen to you.’ What has improved since the last inspection? What they could do better: There was one minor recording error on the medication records. This was investigated and explained during the day of the inspection and assurances given that staff would be given updates on medication recording. The inspector does not therefore feel it is necessary to make a requirement or recommendation as the home’s management team have already instigated actions to ensure no further errors are made. The Meadows DS0000067890.V321155.R01.S.doc Version 5.2 Page 7 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 Meadows DS0000067890.V321155.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Meadows DS0000067890.V321155.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Potential new residents can be assured that their needs will be fully assessed prior to moving into the home. EVIDENCE: Assessment information was looked at for the two most recently admitted residents. The information included joint assessments from health and social care funding authorities as well as detailed assessments completed by the home. The registered manager said that they make sure they visit the individual in their current home and that they tailor the introductions to the Meadows to suit the individual. This may take several months if the person needs time to get to know staff, residents and the environment. One resident confirmed that they had been able to have several visits to the home prior to moving in and that staff had spent time talking about what sorts of things they needed help with and what activities they liked to do. The Meadows DS0000067890.V321155.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There are well documented plans of care for each individual that enables staff to understand their assessed and changing needs. Residents are supported to make decisions to help them to lead as safe and independent a life as possible. EVIDENCE: Two individuals were case tracked and part of this process included looking at their plans of care. The plans are well written and give staff clear information on how to support each individual to ensure their personal, health care and social needs are met. Plans are reviewed monthly and any changes to plans are clearly identified. Plans are shared with individuals where possible and each person has a plan that is person centred and includes the use of photos to help them understand what goals their plans include. The Meadows DS0000067890.V321155.R01.S.doc Version 5.2 Page 11 Risks are clearly identified with strategies identified to reduce or minimise risks. Any restrictions on choice or freedom of movement are clearly identified in plans and these are also reviewed monthly. This ensures that the home are not restricting individuals choice unnecessarily. Residents spoken to said that they were able to make choices about there every day life, although two said that they really wanted to move on to more independent living and to another area where they could be nearer their family. The registered manager said they were aware of individuals who wished to move on and had been in touch with funding authorities to make them aware of this. Staff spoken to on the day of the inspection had a good understanding of the two residents needs who had been case tracked. The Meadows DS0000067890.V321155.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Residents benefit from a good range of activities that includes access into the local community. Residents can be assured their rights will be respected Residents benefit from being offered a well balanced diet with choices. EVIDENCE: All residents spoken to said they were given a choice of activities to do, including local college courses, work placements and accessing local leisure facilities. One resident said they most enjoyed walking, swimming and going out for lunch. Two residents were going out to the cinema and for lunch that day and said that they get to choose a special activity/ outing at least once a week, The Meadows DS0000067890.V321155.R01.S.doc Version 5.2 Page 13 either one to one or in a small group. Some residents said they enjoyed going to the local Gateway club and going out to the pub in the evenings. All staff spoken to said that they believed residents had a really good choice of activities to suit their needs and preferences and this was due to high staffing ratios for each shift. Individuals’ plans of care detailed the weekly activities residents participate in and staff said they were always looking at what else might be on offer locally for residents. There appeared to be a good balance of social leisure and skills based learning activities that suited the needs and wishes of individuals. Residents spoken to said that they were supported to maintain family and friend contact, and any restrictions on relationships were clearly identified in their plans. Staff were observed to interact with residents throughout the day in a supportive and respectful manner. Residents spoken to said that staff treated them with respect, examples given were that they knocked on their bedroom door, sat and chatted with them at mealtimes, one resident said ‘staff will talk to you if you have a problem.’ All of the residents spoken to and all the surveys returned expressed a high level of satisfaction for the meals offered at the home. Comments included, ‘the food is brilliant, meals are all very nice, I love the food.’ The menu choices appeared varied and the registered manager said they had recently redone menu options with residents with a view to providing a healthy eating plan that included individuals’ likes and preferences. The Meadows DS0000067890.V321155.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ personal and health care needs are well met. Robust medication procedures are in place to protect residents. EVIDENCE: The routines of the home are flexible to suit individual needs and preferences. Most residents are able to attend to their own personal hygiene and where support of guidance is needed this is clearly identified in their care plan. Residents spoken to confirmed that they can choose what time they get up and go to bed and how they spend their days. Care plans clearly document what emotional and health care needs have been identified and what actions have happened to meet these needs. The home is able to use a private consultant Psychiatrist to provide monitoring and support for residents as well as being able to access the local community services. Residents are supported to attend health care appointments and staff keep detailed daily records on individuals emotional well being. The Meadows DS0000067890.V321155.R01.S.doc Version 5.2 Page 15 Medications are appropriately stored and administering procedures were seen to be robust. It was noted there was one error on the recording sheets of one individual’s medication from the previous day. This error was immediately looked into and explained to the inspector. The deputy manager said that the staff member concerned would be asked to refresh on the procedures and their competencies would be monitored to ensure that correct procedures were being followed. The Meadows DS0000067890.V321155.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ views are listened to and acted upon. Residents are fully protected from abuse through staff having an understanding of appropriate policies EVIDENCE: Resident surveys were generally positive about their views being listened to. Residents spoken to on the day said they could speak to their key worker or other staff about any concerns they have. The home has a written complaints procedure that residents are aware of and there are weekly residents’ meeting where issues can be raised. There have been no new complaints since the last inspection. The home has policies in place relating to the protection of vulnerable adults and their system for handling residents’ finances is well recorded, with a clear audit trail. The home is registered as a limited company so these records will be independently audited. This acts as an additional safeguard for ensuring residents monies are kept safe. The Meadows DS0000067890.V321155.R01.S.doc Version 5.2 Page 17 Staff spoken to on the day of the inspection were aware of what they should do should they suspect abuse, and knew where to look for information to help guide them. The Meadows DS0000067890.V321155.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides residents with a clean comfortable and safe environment EVIDENCE: The home is decorated, furnished and maintained to a high standard. During this inspection all of the communal areas and most of the residents bedrooms were looked at. The residents have large comfortable en suite bedrooms with locks on their doors to ensure privacy. Residents have been encouraged and supported to personalise their rooms and where there are issues relating to challenging behaviours, rooms have been furnished appropriately, for example using Perspex in display cabinets. Communal areas are well furnished, clean and homely. Smoking is permitted in an enclosed courtyard. The Meadows DS0000067890.V321155.R01.S.doc Version 5.2 Page 19 Residents have access to all communal areas, although some may have restrictions to accessing the kitchen. Where these restrictions are in place, this is clearly identified in their care plan. Residents spoken to said they liked their rooms and that the home was kept clean and tidy. One resident said they wanted a smaller place of their own and was waiting for some flats to be built on the site. The pre inspection questionnaire provides information to show that the home is well maintained and that procedures are in place to ensure the environment is kept safe. The Meadows DS0000067890.V321155.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a staff team that are trained, competent and well supported to do their job. EVIDENCE: The registered provider ensures staff has access to complete training in areas of health and safety as well as specialist training in working with people with learning disabilities and behaviour that challenges. Staff are encouraged to complete NVQ training and the home has over 85 with NVQ 2 or above. 11 care staff have first aid training, which ensures that a qualified first aider can be on shift at all times. Staff who completed surveys and those spoken to during the inspection all said that the home offers good training opportunities. Several staff said they felt they were well supported to do their job, that if there was an incident of challenging behaviour during a shift all staff were involved in a debriefing to look at what went well, and what they could have done better. Comments included this home is well organised, we get to do all the necessary training.’ Staff spoken to said they are given regular supervision and can talk to the managers at any time about any concerns or issues they have. Comments The Meadows DS0000067890.V321155.R01.S.doc Version 5.2 Page 21 included ‘this is the best job I have ever had, I love it here, the managers are really supportive and listen to you.’ The personnel files of the two newest staff members were looked at. These contained documentation to show that relevant checks and references were obtained. This ensures that a robust recruitment process is in place that protects residents. The staffing levels are high to reflect the needs of the current resident group. The staff team have a good mix of experience, skills and training to meet the needs of residents. Staff spoken to said that the staff team worked well together to ensure they provided a consistent approach to working with people with challenging behaviours. The Meadows DS0000067890.V321155.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well run home, where their views are taken into consideration and health and safety issues are taken seriously. EVIDENCE: The registered manager is qualified and experienced to run the home. She is committed to ongoing learning and has asked the new registered provider to consider further management training, which will enhance her skills to manage the home effectively. The providers have good systems in place to ensure that the views of residents are taken into consideration. They have weekly residents meetings, where individuals are encouraged to make suggestions or raise any concerns and they have a formalised quality assurance programme. This means that any surveys completed by residents or health care professions are collated and the The Meadows DS0000067890.V321155.R01.S.doc Version 5.2 Page 23 results are made available to the residents and copies sent to the Commission. The providers use this information to improve their service and include in their reports what steps have been taken to make any improvements. All residents and staff spoken to and those who completed surveys said that their views were listened to. The home have also recently achieved the Investors in People Award, which demonstrates that they ensure staff are well trained, included and supported to do their job effectively. The pre inspection information that the providers completed prior to the inspection provides details to show that the home ensures equipment and facilities are regularly checked and serviced, that key policies and procedures are in place in respect of all areas of health and safety and that staff have training in all core areas that relate to health and safety. During this inspection the fire logbook was seen to be well maintained and all checks completed. This shows that the providers take health and safety seriously. The Meadows DS0000067890.V321155.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 Adults 18-65 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 x 2 4 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 x 3 x LIFESTYLES Standard No Score 11 3 12 4 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 4 x 4 x x 3 x The Meadows DS0000067890.V321155.R01.S.doc Version 5.2 Page 25 N/A Are there any outstanding requirements from the last inspection? 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Meadows DS0000067890.V321155.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 The Meadows DS0000067890.V321155.R01.S.doc Version 5.2 Page 27 - 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!