Inspection on 13/10/05 for The Meadows

This inspection was carried out on 13th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Meadows 26/06/07

The Meadows 04/04/06

The Meadows 28/04/05

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE The Meadows Britwell Road Didcot Oxfordshire OX11 7JN Lead Inspector Delia Styles with Nancy Gates and Chris Hastings Announced Inspection 13th October 2005 09:35 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 Meadows DS0000062306.V252764.R02.S.doc Version 5.0 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 Meadows DS0000062306.V252764.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Meadows Address Britwell Road Didcot Oxfordshire OX11 7JN 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) 01235 518440 01235 518469 The Orders Of St John Care Trust Care Home 68 Category(ies) of Dementia - over 65 years of age (7), Mental registration, with number disorder, excluding learning disability or of places dementia (8), Old age, not falling within any other category (68), Physical disability (45), Terminally ill (5) The Meadows DS0000062306.V252764.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Condition 1 The maximum number of service users accommodated at any one time must not exceed 68. Condition 2 The maximum number of places that can be used to accommodate service users with nursing needs must not exceed 38. Condition 3 That the categories DE, MD and LD shall apply only to those service users transferred from the existing registered care home Ladygrove at Blue Mountains. Where proposed new admissions to the home do not come within the categories of servcice provided, OSJCT must apply for Variation to Registration. 28th April 2005 Date of last inspection Brief Description of the Service: The Meadows is a purpose built care home that provides both nursing and residential care to older people in Didcot that was completed in October 2004. Didcot is an expanding town, approximately 12 miles south of Oxford, with a good mainline rail service and bus links to local towns such as Abingdon and Wallingford. The home is next to a school and the town Civic Centre. Local shops and a major new shopping precinct are nearby. The home has three floors. All floors are served by a lift and stairways. There are 68 single rooms for residents that all have an en suite shower, toilet and hand basin. Each floor has spacious sitting and dining rooms and adapted toilets, bath and shower rooms for disabled residents. The ground floor also has a separate day care facility with its own entrance. There is a hairdressing salon, therapy room and shop just off the main reception area known as the ‘Heart of the Home’. The landscaped gardens have a central water feature, flower and herb beds and planted arbours. The kitchen and laundry areas, staff rest rooms, reception and administration offices and the home manager’s office are on the ground floor. The Meadows DS0000062306.V252764.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The lead inspector, supported by two other inspectors, conducted this announced inspection. Three inspectors undertook this inspection, as there have been significant concerns about this home and a high level of complaints have been made to the Commission. Eight unannounced additional monitoring visits have also been made to the Home between May and October 2005. There have been a number of changes at senior staff levels within the home. The home has a new manager, who has applied to be registered with the Commission, and is recruiting a Head of Care. The inspection started at 9.35am and finished at 6.40pm. During the inspection the inspectors looked at records and documentation, toured the building and spoke with residents, some relatives (both in private and in communal lounges) who were in the home, and staff who assisted in the inspection process. On Sunday 2/10/05, prior to the inspection, one inspector visited the home unannounced to look at the number of staff on duty. In addition, comment cards were sent to some service users, relatives, care managers, general practitioners and health professionals in August and September to ask for their views on the home. Observations from the unannounced visits and the comments received are also included in this report. The inspectors would like to thank the residents and staff who were very welcoming during the inspection and recognise the prompt action taken by senior staff in relation to some of the findings during their visit. The inspectors gained the overall impression that this home has a lot of work to do to fully meet national minimum standards and found commitment to do this from staff. It therefore has the potential to be a good home. There were very good relationships between residents and staff and residents spoke highly of the care that they received from staff but felt that there needed to be more staff on duty to ensure that their needs and the needs of other residents were fully met. The inspectors concur with this view. The inspectors received many positive comments from residents such as, ‘it is very good here, I love it, staff are very nice’; ‘I am happy here and well looked after’; and ‘staff are lovely they help you with what you need’. The inspectors found a large number of areas where improvement is required and are making a number of statutory requirements and recommendations. When implemented, the home should be meeting the required standards and ensure that residents are not put at risk by the concerns found during this visit. A number of the requirements are similar to those made in April 2005 and unless the requirements in this report are fully implemented the Commission The Meadows DS0000062306.V252764.R02.S.doc Version 5.0 Page 6 will need to consider taking enforcement action against the home, which could, if not implemented, lead to the closure of this service. The last inspection of the home took place on 28/04/05 and some of the standards assessed during that inspection were not reassessed during this inspection. Therefore to gain a full report on the home this report should be read in conjunction with the inspection report dated 28 April 2005. What the service does well: What has improved since the last inspection? Care planning has improved but needs further development. The level and range of activities available for service users has increased. The recruitment procedures for staff have improved. Access to the home for visitors has improved. The Meadows DS0000062306.V252764.R02.S.doc Version 5.0 Page 7 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 Meadows DS0000062306.V252764.R02.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection The Meadows DS0000062306.V252764.R02.S.doc Version 5.0 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 the following standard(s): 1 and 3. Standard 3 was also assessed in April 2005. Residents are provided with good information about the home although development is needed to ensure that all of the information is clear. Assessments need to be developed to ensure that all care needs are identified so a full care plan can be developed. EVIDENCE: The home provided the inspectors with a copy of an updated Statement of Purpose. This document provides information on the home for prospective residents, relatives and professionals. These documents are a statement by the home on what it does and how it achieves what it says it does. It contains the required information, although it appears that some information is being prepared for inclusion, for example, in two areas it states to be or yet to be compiled and the details of the home’s new manager are currently not included. The information in relation to complaints does not make it clear that in addition to individuals being able to complain directly to the home they may also complain at any stage directly to the Commission. There is a typing error The Meadows DS0000062306.V252764.R02.S.doc Version 5.0 Page 10 on the contents page that means that the numbers on this page do not match the numbers within the document. The Service User’s Guide (Resident’s Handbook) also needs minor amendments. The findings of this inspection show that the home is not working in accordance with its Statement of Purpose and Service User’s Guide and there needs to be considerable progress and development in the practice of staff so the information given to residents reflects what actually happens. The home has a system for the assessment of residents prior to their admission to the home. This gathers information on the needs of the prospective residents and what care is required to meet the needs identified. A very important part of the process is the development of the care plan following the assessment and this area needs to be developed. During the inspection the inspectors were able to identify areas of need from assessments and other documentation that were not properly addressed within the care plans. This potentially puts residents at risk. The Meadows DS0000062306.V252764.R02.S.doc Version 5.0 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 the following standard(s): 7,8,9,10 and 11. Standards 8 and 9 were also assessed in April 2005. Service users are at risk as the meeting of health care needs to improve considerably. The management of medication needs to improve. Service users are treated with respect and have good relationships with staff although this is sometimes compromised by insufficient staff on duty. The home appropriately records individual’s wishes in relation to becoming seriously ill and final wishes concerning the death of a resident. EVIDENCE: The inspectors have grave concerns about how health care needs are met and how this puts residents at risk. During the inspection the inspectors identified, in a sample of care plans, areas of need that had not been appropriately addressed. Examples were found where staff were not aware of or had received appropriate training in working with an individual with a severe allergy, a lack of skills in meeting the needs of people with diabetes and a lack of skills in managing continence. The Meadows DS0000062306.V252764.R02.S.doc Version 5.0 Page 12 Feedback from doctors who visit their patients in the home raises similar issues and concerns about the skills of some nursing staff needing to be developed. A relative commented that staff ‘seem to be lacking in knowledge about Parkinson’s disease’. Communication is raised as not being good by next of kin and also raised by the doctors as sometimes being difficult. Doctors have given examples of when their instructions or prescriptions have not been followed. Evidence was seen during this inspection of care plans having been reviewed and updated. Care plans were signed by the resident concerned. Risk assessments in relation to pressure areas and moving and handling were seen in the nursing units. The inspectors were able to see improvements in care planning since the last inspection but further improvement is still required so that the care instructions are written in enough detail, and there is evidence that the care given meets the residents’ needs. The planned recruitment of a Head of Care in the home should assist in addressing the shortfalls identified, but the manager and senior staff need to take urgent action to appropriately address the issues identified and any other health care issues in the home. Medication was found to be appropriately stored in all units. However, the records were not always completed appropriately and in one case more medication had been removed from the blister pack than was signed for. In another case a record of the administration of a medication was found in other notes but not on the medication administration record (MAR). The doctors in their comments to the Commission also gave examples of medication not being given as prescribed and in one example describe a patient not being given his/her prescribed medication which resulted in the patient being in pain. This is extremely poor practice and an immediate requirement was issued to the home on the day of the inspection. During the inspection medication was observed by an inspector to be given to two residents, who then either did not take the medication or removed it from their mouths. The medication was taken, but only because a care assistant prompted the residents. The nurse had already recorded that the medication had been taken. There are no shared rooms and residents spoke of staff treating them with respect and that their privacy and dignity were upheld. During the inspection staff were observed to have good relationships with residents and treat them with respect. Residents have access to payphones that they can use in private. The Meadows DS0000062306.V252764.R02.S.doc Version 5.0 Page 13 Clothes being lost in the home is a problem raised in comment cards received by the Commission from both next of kin and residents. During the inspection the laundry was visited and items of clothing were seen in boxes that were labelled with residents’ names. Items on hangers were also labelled. The management need to take note of the comments made and take appropriate action to ensure that clothing is not lost. Discussing with residents and next of kin their wishes in the event of a very serious illness and death is a difficult issue and one that needs to be handled with sensitivity. In care plans sampled, these wishes were recorded. One next of kin has raised the lack of sensitivity in the way that this information was requested, as it happened on her relative’s arrival in the home. The home should consider how they gain the information on an individual’s final wishes in a manner that is sensitive. During the inspection cards were seen that had been sent to the home thanking them for the care they had given to a relative. The cards included the following comments: ‘your staff were always very supportive to him’; ‘thank you for your kind care and attention’; ‘we appreciate the kindness you showed her’; and ‘a big, big thank you for all the care and friendship’. The Meadows DS0000062306.V252764.R02.S.doc Version 5.0 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14 and 15. Standard 12 was assessed in April 2005. A good range of activities is available within the home. Residents have good contact with their relatives and friends if they wish to do so. Residents’ choices are respected and acted upon by staff. Residents spoke positively about the food in the home and have a good diet. EVIDENCE: The home has an activities co-ordinator who organises activities in the home. Residents and next of kin praised her role. Notices detailing activities were seen throughout the home. On the day previous to the inspection there had been a ‘Hollywood Show’ and on the day of the inspection an entertainer visited the home. Residents chose to join in these planned activities or not. There is training planned for all staff so that other staff appropriately incorporate activities into a holistic approach to care. A book trolley contains books that residents may borrow and in the Heart of the Home there is a small shop. Following a recent fund raising event, The Meadows DS0000062306.V252764.R02.S.doc Version 5.0 Page 15 residents were consulted and a large cinema-type television was purchased for the main lounge. The other lounge areas also have televisions. Computers are available in the main ground floor lounge for residents to use. The home has two cats, two budgerigars and some fish. One lady told the inspector how much she loved the cats. Hairdressing is available in the home. The home has tried to get ministers of religion to visit the home and conduct services but this has not occurred on a regular basis. One resident expressed a wish to attend Mass at a local Catholic Church and the manager has agreed to see if this is possible. In comment cards received by the Commission relatives spoke about their visits and there were also visitors in the home on the day of the inspection. A previous problem of delays in staff opening the main door out of office hours has been rectified with the installation of a CCTV camera and a video link to the ground floor Bluebell unit, which allows staff to check the identity of visitors and open the front door to them, without having to leave their unit. Visitors may visit at any reasonable time and resident’s choices not to see a visitor will be respected by staff. The home has a day centre that is attended by older people living in the community. A future music and movement activity group will be open to users of the day service and residents in the home. The inspectors observed residents’ choices being respected on the day of the inspection. The home has a smoking lounge for residents who wish to smoke. The home distributes ‘customer satisfaction’ questionnaires for residents to complete every six months and from the responses, identifies areas for development. There are also meetings that residents can attend to discuss issues. The quality of the food in the home was praised by residents with such comments as: ‘lovely food’; ‘always hot’; ‘plenty of vegetables which is lovely’; ‘can have other things if we want them’; and ‘food very good’. Dietary needs were acted upon with the availability of soft and diabetic diets. Residents appreciated the recent changes that had occurred. Doilies are now used and fresh fruit is now available in the lounges. Residents told the inspectors that the menu had only been written on the wipe boards for the inspection. A relative commented on the fact that care was taken to present pureed food in the separate components on the plate, so that it looked attractive and was identifiable. When these changes were raised with senior staff the inspectors were told that the home had a new senior member of staff The Meadows DS0000062306.V252764.R02.S.doc Version 5.0 Page 16 in the kitchen who was implementing the changes to improve the choices and quality of food for residents. Whilst the home has its own nutritional assessment tool, it does not currently use the nationally validated nutritional assessment tool recommended by community dieticians in Oxfordshire – the Malnutrition Universal Screening Tool (M.U.S.T.), as this has not yet been agreed by The Orders of St John for use in its homes. The inspectors consider that this is a useful tool that should be implemented as soon as possible so that all residents have their nutritional status checked on admission and, depending on their risk, appropriate action taken to improve their diet. The Meadows DS0000062306.V252764.R02.S.doc Version 5.0 Page 17 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 and 18 Relatives and service users are not confident that complaints will be resolved by the home. The home has systems to protect residents from abuse but need to be aware of local guidance and procedures. EVIDENCE: During the inspection the inspectors saw three different complaints procedure notices. Only one of the procedures correctly identified that a complaint can be made to the Commission at any time. The other procedures stated that if complaints are not resolved satisfactorily then they may be referred to the Commission. Other elements were different in content and the home needs to develop a procedure that is consistent and meets national minimum standards. The Commission has received a high level of complaints about the home and these complaints have generally been about similar issues. Issues of concern have related to: the levels of staffing and staff being under pressure, the standard of care in certain areas, poor communication - both between staff within the home and with health and social care colleagues and relatives; healthcare and the inadequate skills of some staff; poor nursing care; poor management of incontinence; and lost laundry. Since March 2005 the Commission has received 9 complaints. Two complaints in March involved a total of 9 separate concerns, of which 4 were substantiated and 5 not substantiated. In April a complaint was made by a person who The Meadows DS0000062306.V252764.R02.S.doc Version 5.0 Page 18 withheld their name. There were 22 separate concerns listed as part of this complaint. CSCI inspectors who visited the home to investigate these found 20 of the 22 issues substantiated: many of these were to do with poor management and record keeping, such as incomplete or inadequate induction training for staff; inadequate accident investigation and recording; inadequate staff recruitment procedures and record keeping; and complaints not being thoroughly or effectively investigated. Three complaints are still being investigated. Comment cards from residents, relatives, GPs and care managers have identified similar areas of concern. The inspectors have also identified some of the same issues during visits to the home. Some residents and relatives said that they are happy to raise issues with senior staff in the home. However, the high level of complaints that have come to the Commission indicates that there is a lack of confidence that complaints will be managed, resolved and that appropriate action will be taken to ensure there is no reoccurrence of the issues that led to the complaint being made. During the inspection the home’s complaints log was inspected and a number of complaints had been upheld. The log is divided into months and there is not a front sheet listing each complaint that could assist with the management of complaints by senior staff in the home. Four thank-you letters to the home praising the care given by staff were seen and have been commented upon earlier in this report. The home has procedures in place to protect vulnerable adults from abuse, and good systems for ensuring the safety of money belonging to residents. Staff in the home need to be aware of the local guidance issued by Oxfordshire’s Adult Protection Committee in relation to how any concerns or allegations are investigated in Oxfordshire. The Meadows DS0000062306.V252764.R02.S.doc Version 5.0 Page 19 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 and 26. Standard 25 and 26 were assessed at the inspection in April 05. The home provides a very good standard of accommodation and facilities and is clean and well maintained. EVIDENCE: The home was purpose built to meet the needs of older people and provides a very high standard of accommodation. The home is pleasantly decorated. There were some comments that some areas of the home got very hot. One comment made by a resident was ‘sometimes its just too hot, I find the back of my hair is soaking wet’. The gardens are maturing and are well maintained. A CCTV camera has been installed at the front door to assist with the opening of the door to visitors and does not impact upon the privacy of residents. The Meadows DS0000062306.V252764.R02.S.doc Version 5.0 Page 20 The home is clean and generally odour free although some areas were noticed to have an unpleasant odour. The housekeeping team are commended on the standard they maintain, especially as the staffing numbers for domestic staff are below those agreed in the home’s staffing agreement: there are no cleaning staff on duty after 4 pm; at weekends there are only two cleaners in the morning and one until early afternoon. One visitor seen during the inspection commented ‘This is one of the cleanest and nicest nursing homes I’ve been to’. The Meadows DS0000062306.V252764.R02.S.doc Version 5.0 Page 21 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, 29 and 30. Standards 27,28 and 29 were assessed in April 2005. The staffing levels and skills of staff must be increased to ensure that residents are not put at risk and their needs are met at all times. The standard of training is poor. The home’s recruitment systems have improved. EVIDENCE: The inspectors are very concerned about the levels of staffing in the home and the training and skills of staff must be improved. Some of the skills that are needed have been identified earlier in this report. When the home was first registered staffing levels were agreed between The Orders of St John and the Commission. The home has failed to maintain staffing at the agreed minimum levels and this has impacted upon the standard of care in the home. On the 2nd October when an inspector visited the home to check on staffing levels there was found to be one less care assistant than the required minimum number. On this day, the inspector was told by staff that a resident who has to be sitting up to enable them to eat or drink, missed breakfast because there were too few staff to get the person up and s/he was got up at 11 am. On this occasion the home had been unable to get agency staff at short notice to cover the shortfall. Relatives have complained that there is The Meadows DS0000062306.V252764.R02.S.doc Version 5.0 Page 22 consistently a shortage of staff at weekends. Many of the residents are very dependent and need two carers to help wash and dress them – on one unit staff said of the 21 residents, 11 need 2 carers for their personal care and with mobility. Comments about staffing levels made by residents, relatives, care managers and GPs included: ‘staff members are very caring and treat me with courtesy and kindness. However, recently they seem under much greater pressure and consequently have been less calm and cheerful’; ‘I feel there is a lack of staff particularly at weekends, not always a manager available’; ‘inconsistent care when agency staff are engaged’; ‘staff do not always attend to his bell’; and (Primrose unit) ‘there only usually two girls on but today we’ve got three, that’s unusual’. During the inspection the inspectors became aware that a few staff had been brought into the home from other homes, which are part of The Orders of St John, for the day of the inspection. While some homes do employ extra staff on the day of an announced inspection to allow staff to talk to an inspector(s) without distracting from the care provision to residents, the bringing in of extra staff at The Meadows meant that that staffing agreement was met. One of these staff did not know the individual care needs of residents and the inspectors are unsure if s/he had any induction into the home’s procedures, for example, what to do in the event of a fire. The inspectors were informed that the home will be recruiting a Head of Care and this will be a vital post in assisting the manager and staff in developing and improving the areas identified in this report. The home is also currently recruiting more staff but must ensure that the staff employed have the correct skills and abilities to meet the needs of the residents. A statutory requirement was issued to the home at the time of the inspection that they must immediately ensure that the home is staffed at the levels agreed at the time of registration. They must also inform the Commission if these levels are not met at any time. A requirement in relation to there being sufficient numbers of staff to meet service users’ needs was made at the inspection in April 2005. If the home and The Orders of St John fail to meet this requirement the Commission will consider taking enforcement action that may require the home to stop new admissions to the home, or as a last resort, could lead to the closure of the home. The home is trying to implement changes to some staffing work patterns and rotas in the home and this had led to some communication difficulties among the staff. The OSJCT has provided independent facilitators to talk to staff to listen to their grievances and to feed staff opinions’ back to the home’s managers in order to resolve the problems and improve the poor staff morale. The inspectors consider that the way in which staff work should be for the primary benefit of residents and that the communication issues among staff The Meadows DS0000062306.V252764.R02.S.doc Version 5.0 Page 23 need to be resolved to ensure it does not have a negative effect upon residents. The home has registered 15 candidates on the NVQ in care award and this should help the home to develop the skills among its care staff. Two NVQ assessors visit the home to assess candidates. The home needs to undertake an audit of staff skills to identify both care and nursing skills that staff have, and need, and then to provide appropriate training to address any shortfalls identified. A sample of staff recruitment records was inspected and there has been improvement in this area and the standard has now been met. The home has an induction training system for staff but the inspectors were unable to judge the quality of the induction. Staff raised concerns about the induction they had received. The inspectors are very concerned about the gaps that were found in basic areas of staff training that placed residents at serious risk. The home employs 58 staff and of these only 17 were recorded as having received training in the home’s fire procedures. Seven staff were booked to go on external fire training but all staff must be aware of the home’s procedures. The inspectors consider that this should be covered on the first day of a staff member’s employment at the home. The home was required at the time of the inspection to undertake immediate action to remedy this and to cover the home’s fire procedures in staff handovers. Staff confirmed that they had training in moving and handling. The Meadows DS0000062306.V252764.R02.S.doc Version 5.0 Page 24 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): 35 and 38. Standards 36 and 38 were assessed in April 2005. Service users’ financial interests are safeguarded. The management of health, safety and welfare of residents and staff is poor and puts both residents and staff at risk. EVIDENCE: As stated earlier in this report the arrangements for the safekeeping of residents’ monies are good. An issue identified at the start of the inspection was resolved by the end of the inspection. This was in relation to a paper error rather than any area of greater concern. The inspector was impressed with the way the administrator was able to call upon the assistance of a manager from the accounts department of The Orders of St John to identify and resolve the issue. The Meadows DS0000062306.V252764.R02.S.doc Version 5.0 Page 25 Appropriate records of monies are kept and signed. Residents have access to money held by the home during office hours from Monday to Friday and the inspectors consider that residents should have access to their money at all times. The home has a number of items that have been found and are presumably the property of present or past residents and need to consider how they will resolve this. The home has a safe but there was no list of contents held in the safe and the inspectors recommend that there should be a record of all the items kept. The inspectors looked at the fire log, the records in relation to the testing of water temperatures and risk assessments and were very concerned about what they found. It is an expectation that the fire system is tested on a weekly basis and that a different fire point is used each time. The fire log recorded that the system had only been tested 19 times in the last year instead of the expected 52 times. The record also only recorded the fire zone in the home and not the individual fire call point. One fire call point checked in the laundry was not labelled so it would not be easy to identify it. The system is serviced but these tests that should be undertaken by staff in the home must happen in accordance with expectations. There were records in relation to the regular flushing of water outlets to guard against any contamination of the water system. Water temperatures should be tested on a regular basis to ensure that the temperatures for both hot and cold water remains within an acceptable range. This is both to prevent infection and scalding. In particular, the hot water temperature at all taps accessible to residents should be checked and recorded regularly because the temperature limiting devices can be affected by the hard water allowing the water temperature to exceed the recommended safe maximum. The records seen indicated that external contractors were undertaking these tests, but only a percentage of outlets were being tested each month, and it was not possible to identify which outlets had been tested. Senior staff in the home were not aware of the expectations of the contract and attempted to clarify this during the inspection. The senior staff need to look into this further to be assured that the tests are being carried out. The inspector was also concerned to hear that the home was only asked to undertake action to resolve the unacceptable (low) temperatures found by the contractors on 19/09/05, on the day before the inspection, 12/10/05 – three weeks after the contractors’ visit. The Meadows DS0000062306.V252764.R02.S.doc Version 5.0 Page 26 Staff in the home use chemicals for cleaning and laundry work that need to be stored and used safely. Each chemical has a product data sheet that details the action that staff should take if the product is spilt, accidentally swallowed or gets on the skin. The home had copies of these sheets. Members of the kitchen staff when asked about the product information sheets were not readily aware that they contained safety and first aid information. Their training needs to be improved so that they are aware of this and copies of the product data sheets are readily available to them. All staff should be aware of the Care of Substances Hazardous to Health (COSHH) and the information about the specific products used in the home so that they can reduce the risk of accidents. The inspectors observed and were told of problems relating to the equipment in the home and the flooring. For example, some of the hoists were difficult to move on the carpets, as were the laundry trolleys and the heated trolleys that care staff are expected to collect from the kitchen to take to the dining rooms. The heated trolley was very heavy and needed two staff to manoeuvre safely. The inspectors question if this task should fall to care staff as it takes them away from the units when they are needed to provide care. However, whoever undertakes this task, the home should consider providing more appropriate equipment so that staff are not at risk of injury. The care service manager, who was in the home at the time of the inspection, said that she would look into this issue. Limited risk assessments were seen in relation to individual residents. There were no risk assessments, other than a fire risk assessment dated 30/09/05, for general issues in the home, for example the satellite kitchens in the lounges, the heated trolleys used by staff and other items. The inspectors were told that these are about to be issued by The Orders of St. John. These risk assessments should already be in place. Care staff in the home commented that they had only been given individual antiseptic hand gel dispensers on the day of the inspection and thought that it was only nurses who were going to get them. Staff said they had not received recent training on infection control or the use of the hand gel. From this inspection and the issues raised in this report the inspectors can only conclude that the management of this home by The Orders of St. John has been very poor and needs to improve considerably. The inspectors hope that this report will assist the new manager in identifying what needs to be done and that with the support of a Head of Care will be able to move the home forward so that it meets standards and fulfils its potential. The Meadows DS0000062306.V252764.R02.S.doc Version 5.0 Page 27 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 2 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 4 X X X X X X 3 STAFFING Standard No Score 27 1 28 X 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 1 The Meadows DS0000062306.V252764.R02.S.doc Version 5.0 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4 Requirement Timescale for action 01/02/06 2 OP3 14 3 OP7 15 4 OP4 18 c The registered provider must ensure that the Statement of Purpose is completed, that the home operates in accordance with the Statement of Purpose and contains the correct information in relation to making complaints to the Commission. The registered provider must 01/02/06 develop systems for the assessment of residents so that all care and health needs are accurately identified. The registered provider must 01/02/06 ensure that care plans reflect the health and care needs of residents in sufficient detail and staff must be aware of their contents. The registered provider must 01/02/06 ensure that staff have training appropriate to meet the needs of residents that is based upon current good practice and clinical guidance. This training must include the management of diabetes, continence and other issues identified by the manager through an audit of staff DS0000062306.V252764.R02.S.doc Version 5.0 The Meadows Page 29 5 OP9 13 (2) 6 OP9 13 (2) 7 OP16 22 8 OP18 13 (6) 9 OP27 18 10 OP27 18 11 OP30 18 training. The registered provider must ensure that medication is administered in accordance with the GPs’ instructions and that the required records are kept. The registered provider must ensure that the staff that are required to administer medication have been appropriately trained including the use of an ‘EpiPen’ and blood glucose monitoring equipment. The registered provider must amend the complaints procedure so there is one procedure for the home and that it includes that complaints can be made to the Commission at any time. The registered person must ensure that staff receive appropriate training in protecting vulnerable adults from abuse and that this includes training in the Oxfordshire Interagency Codes of Practice. The registered provider must ensure that there are sufficient staff numbers to meet the needs of residents, that the home works in accordance with the staffing statement agreed at the time of registration and notify the Commission without delay if this is not the case. (Outstanding Requirement from 31/05/05) The registered provider must undertake a training audit of all staff to identify the training needs of staff and then provide appropriate training for any needs identified to meet the needs of residents. The registered provider must ensure that all staff receive adequate induction and training and specifically in what to do in DS0000062306.V252764.R02.S.doc 13/10/05 01/11/05 01/02/06 01/02/06 13/10/05 01/02/06 13/10/05 The Meadows Version 5.0 Page 30 12 OP38 23 (4) 13 OP38 13 (4) c the event of a fire. (Outstanding requirement from 31/05/05) The registered provider must 13/10/05 ensure that the fire system in the home is tested in accordance with the expectations of the fire service. The registered provider must 01/02/06 ensure that a thorough system of risk assessments is developed to include the assessment of all areas of the home and specific tasks that need to be undertaken by staff. 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 2 3 4 5 6 7 Refer to Standard OP32 OP18 OP12 OP25 OP16 OP15 OP14 Good Practice Recommendations The registered provider should work at improving communication among staff and with relatives and other professionals. The registered person should take notice of the comments made to inspectors concerning lost clothing and ensure that appropriate action is taken. The registered provider should consider how it would assist residents in attending religious services in local places of worship, if they wish to do so. The registered provider should take note of the comments made about some areas of the home being too hot and take appropriate action. The registered provider should develop a front sheet for the complaints log so that complaints can be easily monitored. The inspectors recommend that the home uses the M.U.S.T tool to assist in the nutritional and dietary assessment of residents. The registered provider should consider how systems could be introduced so residents can have access to their monies at times when the home’s office is closed. DS0000062306.V252764.R02.S.doc Version 5.0 Page 31 The Meadows 8 9 10 11 12 13 OP18 OP18 OP38 OP38 OP38 OP27 The registered provider should consider how it manages any lost property that is found in the home. The registered provider should consider introducing a system for recording the contents of the safe. The registered provider should develop a record of all fire points in the home to ensure they can be easily identified and tested on a regular basis. The registered provider should develop a record of all water outlets in the home to ensure they can be easily identified and tested on a regular basis. The registered provider should consider replacing some of the equipment in the home, as it is difficult for staff to manoeuvre safely. The registered provider should consider how the collection and delivery of meals to areas of the home is managed and if it is appropriate that care staff undertake this task as it takes them away from residents. The Meadows DS0000062306.V252764.R02.S.doc Version 5.0 Page 32 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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. Extracts may not be used or reproduced without the express permission of CSCI The Meadows DS0000062306.V252764.R02.S.doc Version 5.0 Page 33 - 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. 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