CARE HOMES FOR OLDER PEOPLE
The Meadows 88 Louth Road Grimsby North East Lincolnshire DN33 2HY Lead Inspector
Theresa Bryson Unannounced 12 July 2005 9:30am
th 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 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 Meadows J54 2822 The Meadows v238122 12 July 2005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Meadows Address 88 Louth Road Grimsby North East Lincolnshire DN33 2HY 01472 823287 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Shire Care (Nursing & Residential Homes) Ltd Mrs Marilyn Robinson Care Home 30 Category(ies) of OP Old Age (30) registration, with number of places The Meadows J54 2822 The Meadows v238122 12 July 2005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None apply. Date of last inspection 20th January 2005 Brief Description of the Service: The Meadows is a 30 bedded care home providing care for people with general problems of old age. It is situated on one of the main roads into the fishing town of Grimsby, in a residential area, with access to local ameneties. The accomodation is on ground floor level and many rooms have en-suite facilities. There are adequate numbers of bathroom and toilet faciliites. The home has a large communal dining room and several other sitting areas. There are gardens around the home and adequate car parking facilities. Staff working in the home have their own rest area and the manager her own office. There is also a kitchen with storerooms and a purpose built laundry area. The home has the advantage of belonging to a small local group of homes, with the support of other managers, who are also professionally trained nurses, as The Meadows manager and a Director of Operations who is also a nurse. The Meadows J54 2822 The Meadows v238122 12 July 2005 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over a day and half on July 12th and July 20th 2005. To find out how the home was run and if people who lived in the home were pleased with the care they got, the inspector spoke to the manager, 6 service users, 3 relatives and 10 staff members. Paperwork kept in the home was also seen to make sure that the checks to make sure staff are safe to work in the home had been done. And that they had been trained to do their job safely. Paperwork was also looked at to make sure the home and the things in it were safe and checked often. The manager was not available for part of the first day and a senior care assistant looked after the inspector, but Mrs.Robinson, the manager, came later on and was present on the second half-day visit. What the service does well:
The staff looking after the people who live in the home were very friendly and knew a lot about each person. They showed dignity and respect to each person when they approached and assisted them through out the day, in a variety of tasks. The home was clean and tidy and had lots of space where people sit and relax or eat. The paperwork kept on each person was neatly written and showed how each person is cared for each day, problems solved, people such as doctors and relatives who visit and how they feel each day and night. People who live in the home and relatives spoken to spoke highly of the activities organiser and the paperwork showed a variety of events taking place and individual likes and dislikes being provided for each month. There were also a lot of outings and visits into the home from such as the Brownies, various church groups and entertainers. The Meadows J54 2822 The Meadows v238122 12 July 2005 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better:
More attention to detail was needed in the cleanliness in the kitchen to minimise the risk of infection. The home must ensure that a varied menu is provided and a system put in place to check the intake of each person in the home. This will make sure that each person has a sufficient diet over a period of time, to help his or her general health and well being. The water temperatures were checked and recorded on a regular basis by the handyman, but the manager must oversee these as some had been recorded with a high rating for some time. This could lead to people living in the home, staff and visitors being at risk from hot water scalds. People living in the home, relatives and staff all stated to the inspector that they felt the home was understaffed at times and not all needs could be addressed or quality time given to each person. The manager was asked to look at the numbers of staff on duty and ensure there were enough to meet the needs of the people living there. The training records of staff showed that some training had taken place since the last inspection, but this was spasmodically recorded and there was no
The Meadows J54 2822 The Meadows v238122 12 July 2005 Stage 4.doc Version 1.40 Page 7 training plan. The home needs to ensure that all staff are adequately trained to do their job and that all mandatory courses such as health and safety and manual handling occur each year and that other courses for example on dementia or diabetes are put on the programme to assist staff to understand the needs of the people they are looking after. The company still has not put together a quality assurance programme to audit the running of the home. This has been outstanding for some time and needs to be prioritised by the Directors of the company. This will enable them to ensure the home is safe and all needs are being addressed. 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 Meadows J54 2822 The Meadows v238122 12 July 2005 Stage 4.doc Version 1.40 Page 8 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 Standards Statutory Requirements Identified During the Inspection The Meadows J54 2822 The Meadows v238122 12 July 2005 Stage 4.doc Version 1.40 Page 9 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 standard(s) 3 and 6. Service users are provided with comprehensive documentation before entering the home, to enable them to make informed choice. Staff are given preadmission paperwork to enable them to adequately prepare for a person’s admission. EVIDENCE: The pre-assessment documentation was seen on each service users files tracked as part of the inspection. This remains unchanged since the last inspection. The tool was comprehensive and assessed the service user in a holistic manner. The manager completes all pre-admission documentation and instructions are left for her senior staff to complete as much as possible in her absence. This gives a good basis to prepare staff for any admission and plan a future care plan. The home does not provide intermediate care and therefore Standard 6 is not
The Meadows J54 2822 The Meadows v238122 12 July 2005 Stage 4.doc Version 1.40 Page 10 applicable to this home. The Meadows J54 2822 The Meadows v238122 12 July 2005 Stage 4.doc Version 1.40 Page 11 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 standard(s) 7,8 and 9. The home provides comprehensive care documentation to enable all service users needs to be monitored and assist the staff to deliver the appropriate care to each person and administer all medication correctly. This documentation had been correctly completed. EVIDENCE: 4 care plans were tracked in detail as part of the inspection process. The manager spot checks a number of care plans each month and places an audit sheet for work to be completed by the key workers at the front of each care plan. There was also a checklist for each key worker in each plan folder to monitor such items as tidiness of the room, tidying wardrobes and checking mobility aids. This enables the company to ensure staff are checking every aspect of care of a regular basis. The documentation seen was well written and legible. Individual needs had been addressed, as well as holistic care plan assessments such as mobility, sleeping, continence assessments and personal hygiene records. The daily report sheets showed how care was delivered and the responses of each service user were easily tracked. This gave the inspector a good picture of the
The Meadows J54 2822 The Meadows v238122 12 July 2005 Stage 4.doc Version 1.40 Page 12 type of care given and assurances that each aspect of care was evaluated on at least a monthly basis. Service users and relatives spoken to during the visit gave mixed responses as to their knowledge of whether they had seen the individual care plans and what actual input they had been able give to staff. This was fed back to the manager, who assured the inspector this would be a topic at the next staff meeting. A senior care assistant escorted the inspector when she was inspecting the administration of drug records. The home uses Boots Ltd as its supplier, who complete audits through out the year. All senior staff administer medication and certificates were seen to show they had attended a safe administration of medication course. All administration records were seen and there were a couple of minor areas, which did not pose any risk to service users. Adequate explanation was given. Each record had a photograph of each person, which was a good aid to the staff. The drugs trolley and storage areas were clean and tidy and there was no evidence of over stocking. A staff member was able to give a good account of the ordering system, which appeared to be very ordered and précis, neat records were seen to be kept. The homely remedies policy had recently been revised, but the main drug administration policy remained unchanged from the last inspection. The system in place and knowledge base of staff showed a good understanding of the importance of good drug administration and posed no risk to service users. The Meadows J54 2822 The Meadows v238122 12 July 2005 Stage 4.doc Version 1.40 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 and 15. The home provides a varied programme of activities for service user, which occupies their day and maintains their individual interests. The did not provide a varied menu to meet service users needs and parts of the kitchen and storage areas needed an effectual cleaning programme in place. EVIDENCE: The home employs an activities organiser who works between two of the company’s homes. Service users expressed to the inspector how they enjoyed the varied programme on offer and felt their individual needs were being addressed. Relatives spoken to stated how well liked the activities organiser was in the home. Staff also stated they found her input a great asset to and complement to their general caring tasks. In the care plans tracked were the social needs assessments of each service user and this was in addition to the clear records kept by the activities organiser. Each service user had aims and goals identified and the action plan was evaluated on a regular basis. This showed forethought on behalf of the
The Meadows J54 2822 The Meadows v238122 12 July 2005 Stage 4.doc Version 1.40 Page 14 staff in addressing changes in needs of service users. Sessions written on the sheets included;- poetry reading, crafts, games, gardening. Also outings and visits into the home of the Mother’s Union, various church groups, Brownies and entertainers. A variety of outings had taken place to suit individual needs. A senior cook showed the inspector around the kitchen area. The rota was seen and showed a cook plus a kitchen assistant on duty each day. Menus had been sent to the inspector prior to the visit as they had just been changed. The menus were not very varied and there were several negative comments made to the inspector concerning the choice and variety on offer, which did not appear on the menu, but which the cook admitted did occur. For example it was stated by some service users and relatives that belly pork is often used and they had not been offered a chef’s choice at teatime. It was admitted that belly pork was in use, but this does not appear on the menus and the chef’s choice is the hot choice and not a separate item as stated on the menu list. This has caused confusion to service users and shown that inaccurate records are kept. Poor choice could lead to an inadequate nutritional diet being available to service users and not aid their general well being. A cleaning rota was seen to be in place, but several areas of the kitchen were dirty. This included dust on the cooker hoods, where food was heating directly below the hoods; the storeroom shelves needed cleaning. On the first day of the visit there was a broken fly screen on the door, but a week later this had been replaced, after the inspector pointed out the hazards of flies on a hot day in the kitchen area. The boiler needed a decale, with the tap being particularly corroded. The standard of cleanliness was poor in some areas, which could result in the kitchen being unsafe to work and prepare food. There was evidence of home baking and supplies of fresh fruit and vegetables in the home. The cook stated she had just changed butcher’s to give better quality to the home. Some auditing of the processes need to be made by the manager to ensure kitchen staff are on top of all aspects of running the kitchen and also for her to survey the service users and relatives as to the meals provided. The dining area was light and airy and staff were seen to assist service users in a dignified and unhurried manner. The Meadows J54 2822 The Meadows v238122 12 July 2005 Stage 4.doc Version 1.40 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. A comprehensive complaints policy was in place for service users and other parties entering the home to see. Service users and their relatives were aware of how to make a complaint, were confident to do so and believed their concerns would be listened to and acted upon. There was a robust policy in place to ensure the service users were protected from abuse. EVIDENCE: The complaints policy remained unchanged from the last inspection and was on display in several areas of the home. The detail was up to date and relatives spoken to generally were confident the management team would address their concerns effectively. One relative did not feel this way and her concerns were fed back to the manager. The policy for the protection of vulnerable adults remained unchanged and the manager and 8 staff members had attended an up date study day with the local authority. Staff could state processes of referring abuse situations, when questioned by the inspector. They felt confident that any matters would be dealt with fairly by the company. The Meadows J54 2822 The Meadows v238122 12 July 2005 Stage 4.doc Version 1.40 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,24,25 and 26. The home was clean and tidy and the environment safe for this category of service user, except areas of the kitchen and kitchen store rooms. Planning of redecoration and refurbishment of the home was evident. EVIDENCE: The home was clean and tidy and staff stated they had sufficient hours to complete the main cleaning tasks, but were some times rushed to complete spring-cleaning. These comments were fed back to the manager. Several areas of the home had been redecorated since the last visit and service users stated how they appreciated the work of all staff, including the domestic and laundry staff. Key workers also have a check list to complete monthly, which assures that small tasks such a tiding wardrobes is maintained as part of the caring process for each individual. Of the care plans tracked each had a completed assessment of all furniture and fittings in use for each individual. This was over and above any individual
The Meadows J54 2822 The Meadows v238122 12 July 2005 Stage 4.doc Version 1.40 Page 17 assessment for other needs such as wheelchairs. Personal furniture and permissions for locks on doors were also in place. Service users and relatives stated how pleased they had been to be able to bring in individual items of furniture for their loved ones on admission. There was adequate ventilation and lighting in all parts of the home. The laundry was clean and tidy and all equipment in working order, previous problems had been attended to be the company. All safety notices were in place and staff were able to explain the processes to prevent cross infection in the home. The water temperatures were recorded on a regular basis but variances not brought to the attention of the manager. Some were recorded and high above the recommended levels and could cause injury to service users and staff if left unchecked. The Meadows J54 2822 The Meadows v238122 12 July 2005 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 and 30. The home has a robust system for staff recruitment, which ensures the safety to service users. The staff rotas system needs reviewing alongside the dependency levels of service users to ensure adequate staff are on duty at all times to meet all needs and that the training of those staff is up to date and recorded. EVIDENCE: Comments received by the inspector from service users, relatives and staff all indicated that at certain times of the day and when the home has shortages of staff due to sickness and holidays, corners have to be cut in the delivery of care to service users. The manager was asked to review the rota system. Talk to staff about issues concerning them and service users and look at dependence levels and needs of individuals. This should include the domestic staff, but levels in the kitchen and laundry appeared to be adequate. The home has almost reached the target of having 50 of its staff trained to NVQ level 2 by the end of 2005. 7 had completed their course and 2 under 25year olds had commenced. 4 staff personal files were looked at in depth as part of the inspection. The evidence produced showed that robust checks are in place to protect service users.
The Meadows J54 2822 The Meadows v238122 12 July 2005 Stage 4.doc Version 1.40 Page 19 The manager admitted that she still has to complete a training and development plan and ensure all records are up to date fro staff members. Of the training folders seen it showed that mandatory training had taken place and some service specific training. This has enabled staff to keep up to date in all training to be able to give effective care to all service users. Certicates are on display around the home, which service users and relatives stated they like to see and reassures them of training having taken place. The Meadows J54 2822 The Meadows v238122 12 July 2005 Stage 4.doc Version 1.40 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,36 and 38. There was no robust system in place to ensure the home uses an effective quality assurance programme, but all certicates to ensure the safety of service users in the home were in place. This also included sufficient records to show staff are supervised on a regular basis. EVIDENCE: The manager has now completed her Registered manager’s award and was putting her certificate on display at the time of the visit. She is now completing a certificate in organisational management and commenced the Investors in People Award for the home. She displayed a good sound knowledge base for her staff and also has maintained her “live” registration on the Professional nurse register. Service users and relatives stated they found her approachable and a kind person.
The Meadows J54 2822 The Meadows v238122 12 July 2005 Stage 4.doc Version 1.40 Page 21 The company is aware that it still needs to produce an adequate annual development plan, which has used a quality assurance tool suitable to the needs of the home. It is having some assistance with this now with the Investors in People assessors. Evidence log were produced to show that staff have regular supervision sessions and staff themselves were able to state to the inspector how the system works. This has shown gaps in knowledge base and procedural difficulties with some staff, which have been addressed. This ensures staff are up to date and observed at all times by their seniors. The home was able to produce sufficient evidence to show that all health and safety aspects of the home are maintained at all times. This included fire safety checks, risk assessments being up dated and audits of accidents taking place. The home appeared safe and fee from hazards for service users, visitors and staff. The Meadows J54 2822 The Meadows v238122 12 July 2005 Stage 4.doc Version 1.40 Page 22 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 x 15 2
COMPLAINTS AND PROTECTION 3 x x x x 3 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 1 x x 3 x 3 The Meadows J54 2822 The Meadows v238122 12 July 2005 Stage 4.doc Version 1.40 Page 23 yes 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. 1. Standard 15 Regulation 16.2.i. Requirement The registered person must ensure that a varied menu is avaliable and all areas of the kitchen are clean. The registered person must ensure that water tempertatures are checked regularly and adjusted as the need arises. The registered person must ensure that staffing levles meet the dependency of service users at all times. (Previous time scale of 30/04/05 not met). The registered person must ensure that all training records accurately record training that has taken place and a trainnig plan is in place. (Previous time scale of 20/05/05 not met). The registered person must ensure that the home has a quality assurance programme and that a report is open for inspection. (Previous time scale of 30/5/05 not met). Timescale for action 30/12/05 2. 26 13.4.a. 30/12/05 3. 27 18.1.a. 30/12/05 4. 30 18.1.ci. 30/12/05 5. 33 24.1a and b. 30/12/05 The Meadows J54 2822 The Meadows v238122 12 July 2005 Stage 4.doc Version 1.40 Page 24 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 28 Good Practice Recommendations Continue to work towards a minimum ration of 50 trained members of care staff to NVQ level 2 by 2005. The Meadows J54 2822 The Meadows v238122 12 July 2005 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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