Inspection on 17/03/09 for The Meadows

This inspection was carried out on 17th March 2009.

CSCI found this care home to be providing an Poor service.

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

Other inspections for this house

The Meadows 27/01/10

The Meadows 08/12/09

The Meadows 23/09/09

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOMES FOR OLDER PEOPLE The Meadows Haycocks Road Hatchett Village Haverhill Suffolk CB9 7YL Lead Inspector Julie Small Key Unannounced Inspection 17th March 2009 09:55 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 DS0000072735.V374632.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 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 DS0000072735.V374632.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Meadows Address Haycocks Road Hatchett Village Haverhill Suffolk CB9 7YL 01440 762401 01440 768795 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) Minster Haverhill Limited Jacqueline Wright Care Home 53 Category(ies) of Dementia (53), Old age, not falling within any registration, with number other category (53), Physical disability (53) of places The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Physical Disability - Code PD The maximum number of service users who can be accommodated is 53 Not applicable, this is a new service 2. Date of last inspection Brief Description of the Service: The Meadows was registered with the Commission for Social Care Inspection 1st October 2008. The home is owned and managed by Minster Haverhill Ltd, a subsidiary of Minster Care Management Group, a national company with a large number of homes. The Meadows is a new care home for frail older adult, older people with a dementia and/or a physical disability. The home is situated in a village which is near to Haverhill in Suffolk. The home is a newly built property and the accommodation for people to live in is on the ground and first floor. The second floor of the home is used for staff rooms. The manager of the home told us that the fees for living at the home ranged from £335 to £803.80p per week. The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The unannounced inspection took place Tuesday 17th March 2009 from 09:55 to 20:55. The inspection was a key inspection, which focused on the core standards relating to older people and was undertaken by regulatory inspector Julie Small. The report has been written using accumulated evidence gained prior to and during the inspection. The manager was present for part of the inspection. Mr Derek Watkins is an Expert by Experience. ‘Experts by Experience’ are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use social care services. The term ‘Experts by Experience’ is used to describe people whose knowledge about social care services comes directly from using them. The Expert by Experience joined the inspector on this site visit. They spoke with six people that lived at the home, two staff members and they made observations of the work practice in the home. The comments and observations made by the Expert by Experience are added to this report. During the inspection five staff recruitment records, staff training records, the care plans and needs assessments of three people that live at the home, the medication records of six people that lived at the home and accident records were viewed. Further records viewed are detailed in the main body of this report. Observation of work practice was undertaken and seven staff members, one visitor and two people who lived at the home were spoken with. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was sent to the home. Staff, health professional and service user surveys were sent to the home. Three staff, six service user and two health professional surveys were returned to us before the inspection and the AQAA were returned to us, within the required timescales after the inspection. What the service does well: The interaction between staff and people that lived at the home was observed to be respectful and professional. The home was clean and attractively furnished and decorated. People’s finances were safeguarded and people were safeguarded by the home’s recruitment procedures. The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 6 Comments made in the service user surveys included ‘we moved from (previous home) – the difference is amazing the Meadows get 10 out of 10’, ‘the home that I am in is new. It is lovely and many times the staff get it right, but obviously there are teething problems, things will get better’, ‘we were invited to visit. Had an informative tour and were very impressed’ and ‘they were very helpful in support at a difficult time’. Comments made in the health professional surveys included ‘I have very limited experience of The Meadows, but I have been impressed by the understanding of individual care needs shown by staff. Also by the support shown to relatives’. What has improved since the last inspection? What they could do better: Written complaints were responded to and investigated in a timely manner and records of the actions taken were maintained. There was no method of reporting verbal complaints and the actions that were taken to resolve issues. Staff were not provided with regular supervision to enable them to discuss how they were working. Whilst staff had said that they had been provided with an induction when they started working at the home, which was the provision of training courses. It was not clear if the induction met with the Skills for Care Common Induction Standards and the provision of a formal induction was not evident in the staff records that were viewed. Therefore we could not be assured that staff were provided with the information that they needed when they started working at the home to ensure that people’s needs were met. It was noted that people were not always provided with their prescribed medication, which placed the people that used the service at risk. The reasons for the non-administration of medication were not consistently and clearly used in the MAR (medication administration records) charts. An immediate requirement letter was sent to the home the day after the inspection. Three requirements were made for the home to ensure that people were protected by the home’s medication procedures and processes. People’s dignity was not always respected, such as at meal times. The lack of staff support was evident during meal times and during activities. It was not clear if this was due to there not being enough staff on duty or due to poor organisation. During the inspection a person who lived at the home was observed to swear at another person who lived at the home. There were no care staff present, however, two non-care staff were present and there was no reaction during or following the incident. Therefore we could not be assured that people were safeguarded from actions of their peers. The Meadows DS0000072735.V374632.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 DS0000072735.V374632.R01.S.doc Version 5.2 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 DS0000072735.V374632.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People that use the service can expect to be provided with the information that they need to enable them to make a choice about where to live and to have their needs assessed before they move into the home. The home does not provide an intermediate care service. EVIDENCE: People were provided the information that they needed which helped them to make decisions about if they wished to live at the home in the Statement of Purpose and the Service User’s Guide. Six service user surveys stated that they had been provided with enough information about the home before they moved in to help them to decide if it was the right place for them. Comments made in the surveys were ‘we were invited to visit. Had an informative tour and were very impressed’ and ‘everything was explained in great detail and we had a guided tour of the home’. One person that lived at the home was spoken The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 10 with and told us that they had been provided with information about the home before they moved in and that they and their relatives visited the home. The AQAA stated ‘the home has a very clearly written statement of purpose and service user guide. All the required information is contained within the documents which are updated regularly and audited monthly’. The registration report for the home stated ‘The Statement of Purpose contains all appropriate information to allow residents and purchasers of care to assess the appropriateness of The Meadows as a home for them’. The Statement of Purpose was provided to people who had expressed an interest in the home and it was displayed in the entrance hall to the home. We viewed the Statement of Purpose and it included information about the home such as the aims and objectives of the home, information about the management of the home, which needed updating to show the current management arrangements, the staffing arrangements and training, accommodation, care provision, admission criteria, what is included in fees and what is not included e.g. dry cleaning, meals out, hairdresser and funeral expenses, fire safety and a summary of the complaints procedure, which included CSCI (Commission for Social Care) contact details, should people wish to contact us. The Service User Guide was viewed and the document was provided to people who lived at the home and it was displayed in the entrance hall of the home. The Service User’s Guide was in an accessible format for people that lived at the home and was in picture and text format. The Service User’s Guide stated that it could also be provided in larger print or in audio format. The document included information such as the philosophy of care, how they consulted with people who use the service, life in the home, security, citizenship, insurance, fire safety and relevant address’ such as Minster Haverhill Ltd, Meadows Care Home and CSCI, services provided at the home, standards, advocacy and complaints. The AQAA stated ‘the home consistently ensures pre-placement assessments are carried out and new service users are only admitted following discussions and research into the care needs requirements of each prospective service user. During this assessment the service user is placed at the centre of the assessment and where appropriate relatives, friends and healthcare professionals are involved to get a clear picture of the care needs but also the individual’s preferences and choices about the care they wish to have provided to them. This forms part of the homes assessment into where the care needs can be appropriately met by the home and to ensure all modifications and adaptations where required are installed prior to the service users admission’. The records of three people who lived at the home were viewed and each held needs assessments which had been undertaken before they moved into the home and for local authority customers a needs assessment completed by the placing authority was also present. Care plans were in place which identified The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 11 how the people’s assessed needs were to be met. The AQAA stated ‘service users will all receive a 6 week review once moving into the home with their key worker and management staff from the home, social worker and allowing the service user to invite important people that they wish to attend’. The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use the service can expect that a care plan is in place to identify how their assessed needs and preferences are to be met. They cannot be assured that they are protected by the home’s medication procedures. EVIDENCE: The care plans of three people who lived in the home were viewed and each held a care plan which identified how their assessed needs were to be met. The manager was spoken with and they explained that they were in the process of updating and improving the format of the care plans for people that lived in the home. They said that they had planned to complete the work Thursday and Friday following the inspection. The AQAA stated ‘the home is developing a person centred approach with all care plan documentation and the delivery of the planned care. This has focused on looking at the individual The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 13 strengths of each service user and how the staff supporting them can best promote their independence. This then impacts on the emotional wellbeing and dignity of each service user’. One care plan, which was viewed, had been completed in the new format. Two of the care plans that were viewed were in the process of being updated and we viewed both the old and the new formats. The new format care plan included a life story. The manager explained that the life story work was being undertaken for all people to include the information about each person’s life, which had been obtained from the person and their family and friends. They said that this would assist the staff when working with the person. The care plans identified people’s preferences regarding the support that they were provided with and what areas that they could attend to independently, such as with their personal care. The care plans detailed the support that people required with their communication, mobility, fire evacuation, continence, falls, dietary needs and manual handling. Each held a manual handling risk assessment, which identified the support that they required with manual handling, the equipment that was used and the numbers of staff required to assist them. The manager showed us the templates for nutritional assessments and skin assessments, which they were in the process of completing for each person. The service user survey asked if they were provided with the care and support that they needed. Three answered always and three answered usually. One health professional survey commented ‘professional approach at all contact from care staff, admin. and manager. I feel the home are aware of my client’s needs and deliver care according to individual care plan’. The staff survey asked if they were given up to date information about the needs of the people that they supported. Two answered always and one answered usually. The health professional survey asked if the staff at the home sought advice and acted upon it to manage and improve people’s health care needs. One answered always and one answered usually and comments included ‘in my limited dealings with the Meadows this has been the case seeking advice from GP, diabetic nurse and CPN’. One health professional survey commented that a review of a person’s continence had not taken place. The manager was spoken with and suggested the person who this may have referred to and the person’s records were viewed and it was noted that the support that they required was documented. Two health professional surveys said that people’s health care needs were always met. The AQAA stated ‘the home has established good working relationships with the doctors from the G.P. surgeries the home works closely with to which service users are registered. This enables the home to quickly and effectively deal with all healthcare needs of the service users’ and ‘the home ensures service users have appropriate access to all necessary healthcare professionals including opticians, audiologists, chiropodists and dentists’. The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 14 The records of people that were viewed included daily records that identified their well being and the support that each person had been provided with on a daily basis, which included records of health care support that they had been provided with, such as doctor and chiropody appointments. The Expert by Experience had spoken with people that lived at the home and reported that they had spoken with one person ‘(the person) had a rash and had asked for a doctor but they said that they would “get a doctor to look at you; 2 to 3 weeks nothing done.. could have been treated”’ and ‘according to the (relative) (the person) started at the home on (date) and (the person) had a swollen foot which (relative) felt ought to have been seen to earlier, only today “going to get a doctor”’. The manager was spoken with regarding a complaint that had been made to the home about a nursing staff’s refusal to call out a doctor to a person who lived at the home. The manager said that staff were directed that the doctor was only called out to the home in an emergency and at the weekend. They said that they ensured that they maintained a positive relationship with the doctor’s surgery. We explained to the manager that we would expect that staff would use their professional judgement regarding when a doctor should be called out based on individual events, the manager agreed with this. The service user survey asked if they were provided with the medical support that they required. Three answered always, two answered usually and one did not answer. The manager reported that medical appointments were arranged when required and there was no evidence in people’s records that showed that health care appointments had not been made when required. We observed a staff member supporting a person to administer cream to their foot following a doctor’s appointment on the day of the inspection, they clearly explained why the cream had been prescribed and the care that they should take with their foot. The staff member showed us the MAR (medication administration records) charts where they had recorded the prescribed cream to ensure that staff were aware that it should be administered. Comments made in the service user surveys included ‘the staff are always too busy to fit me in because other residents have greater needs than me’ and ‘the staff are responsible for 2 very different patient groups who are currently residing on one level. This means that at times they are spread thin as some resident’s requirements are more demanding than others’. The Expert by Experience had spoken with a person who lived at the home and a relative of a person and they commented ‘I feel I’m going down … stressed up because of the shouting’ and ‘staff are very good … I dislike the noisy patients’. Four staff members that were spoken with stated that two people that lived at the home were upset by the shouting by other people that lived at the home. The Expert by Experience reported that ‘there was a lot of shouting during my visit’. The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 15 The Expert by Experience reported ‘a (person) in a room next to the dining room was at about 1.30 pm calling out loudly and regularly “I want to go to the toilet please help me”. As no one was responding I went into the dining room to mention to a member of staff…’ The AQAA stated ‘over the next few weeks the home will be establishing the second floor and some residents with dementia will be moving upstairs to create to different care environments. It is following consultation with residents that it has been noted to be an important move to ensure the needs of each resident can be effectively meet by the home within the two different floors. The lower floor will care for residents with predominant nursing needs and the upper floor support residents with dementia care needs’. The manager was spoken with and explained that they had planned for the people with nursing needs to live on the ground floor of the home and for the people with dementia to live on the first floor when the home was fully occupied. There were twenty four people living at the home at the time of the inspection and two people lived on the first floor and the other people that lived at the home with both dementia and nursing needs lived on the ground floor. We explained to the manager that they should ensure that people that lived at the home were not adversely affected by the behaviours of others and that they managed the moves of rooms to ensure that people’s distress was minimised. The manager explained that the rooms on the first floor were exactly the same as the rooms on the ground floor and that when people were moved onto the first floor their bedrooms would be the same. The health professional survey asked if people’s privacy and dignity was respected. One answered always and one answered usually. Two people that were spoken with reported that the staff treated them with respect and we observed that the interaction between staff and people that lived at the home was respectful and professional. We observed staff knock on bathroom and bedroom doors before entering them to ensure that people’s privacy was respected. The Expert by Experience reported ‘I observed residents being treated with respect’ and ‘the residents seemed to be appropriately dressed’. The Expert by Experience spoke with people and their comments included ‘yes, treat with dignity’ and ‘staff knock if the door is shut’. There were issues with how people’s dignity was respected in the home regarding meal times and activities, which is discussed in the daily life and social activities section of this report. The AQAA stated ‘service user’s privacy and dignity is respected by staff in all areas of the care delivered’. We could not be assured that people were protected by the home’s medication procedures and processes. The MAR (medication administration records) charts of six people that lived at the home were viewed which was the current MAR chart and the previous MAR chart. It was noted that three people’s MAR charts The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 16 were satisfactory and three showed that people were not provided with their prescribed medication and the reasons for the non-administration of medication were not used clearly and consistently by the staff that were responsible for the medication administration. The Expert by Experience spoke with one person that and reported ‘about a week ago (the person) went “3 or 4 days without tablets” and “I told them”. (The person) couldn’t remember what the tablets were but said the hospital told (the person) not to miss (the person’s) tablets’. We spoke with a staff member regarding the person’s medication and they confirmed that the medication had not been available and that the code ‘M’ (make available) was used in the MAR charts to show that the medication had needed to be ordered. They said that they had also recorded the need for the ordering of medication in the diary and that they had verbally informed the matron. We viewed the person’s MAR charts and it was noted that ‘M’ was recorded for one of their prescribed medication for seven days. The MAR charts also showed that the person had been prescribed another medication to be taken four times each day, both of ‘M’ and ‘F’ (unavailable) had been recorded over a period of four days. The staff diary was viewed and it was noted that messages had been left to show that the medication needed to be ordered. The manager was spoken with and said that there had been a problem with the pharmacy not sending out the medication, they said that the matron had faxed the pharmacy. Evidence of the fax was not seen during the inspection as the manager had reported that the matron kept this documentation. The MAR charts of another person were viewed and issues were for one of their medication both codes ‘M’ and ‘F’ were recorded for three days and another medication for six days. The manager reported that one medication had not been ordered because they were waiting for results from the doctor, however, the MAR charts did not show this information. During the inspection we observed the tea time medication round and a person told the staff member that the agency nurse had not given them their ‘anti depressant tablet, the large red one’ the previous evening. They said that they had told the nurse that they needed to have the tablet but the nurse had told them that they could not find it. The staff member found that the tablet was in the MDS (monitored dosage system) blister pack and the MAR charts were viewed, which showed that the medication had not been administered. The manager was spoken with regarding the issues with the medication and they assured us that they would start to audit the medication regularly to ensure that errors and issues were identified and rectified in a timely manner. The manager was unaware that the person had not been provided with their medication the evening before the inspection. It was noted that there was no The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 17 reference in the AQAA about how they monitored the medication and any shortfalls that they had identified. An immediate requirement letter was sent to the home the day after the inspection. A response was sent to us 23rd March 2009, which identified how they would address the issues, which included regular medication audits, refresher training for nursing staff, documented clinical supervisions to nursing staff and that all records would be monitored in the Regulation 26 visits. During the medication round the staff member was observed to interact with people in a professional and respectful manner. They referred to the MAR charts and MDS system, which was stored in a medication trolley, to check that they were administering the correct dosage of medication. The staff member was spoken with and explained the procedures for administering medication, they confirmed that they had been provided with medication training and only nursing staff administered medication. They said that there were issues with the ordering of medication and they said that they did not feel that people were protected by the home’s medication processes. The home’s medication procedures were viewed and clearly identified how the medication should be stored, administered and handled safely. The health professional survey asked if people were supported appropriately with their medication. One answered always and one answered usually. The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People that use the service can expect to be provided with the opportunity to participate in activities, to be supported to maintain their chosen contacts and to be provided with a balanced diet. However, they cannot be assured that meal times and activities are an enjoyable experience for all. EVIDENCE: The home employed an activities coordinator, who told us that they had been looking at CSCI website for ideas of activities that they could offer to people and they said that they were going to provide a ‘sing song’ activity for people with dementia on the morning of the inspection. We spoke with a person who lived at the home and they told us that there was plenty to keep them occupied and that they particularly enjoyed the book club. During the inspection we observed the activities coordinator in a lounge with six people that lived at the home and it was noted that there were no care staff present to assist people with the planned activity. It was noted that the The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 19 planned activity was not actually being provided, one person was continually grabbing at the activities coordinator’s private body parts and the activities coordinator was occupied with fending off their grabs. One person was shouting out that they wanted to go home and another person swore at them. One person was sitting at a table with a cooked breakfast on the table in front of them and it was noted that they were not eating the meal. As the time was 11:05 we asked if the person had chosen to have their breakfast at this time, they did not respond, the two non-care staff said that they did not know and there were no care staff in the room to ask. Later in the inspection the manager was asked about the time of breakfast, they said that previously there had been issues of disorganisation in the home and that people were getting breakfast late, so they had set a time for breakfast of between 8:00 to 9:30. If people wished to have breakfast in bed or have a later breakfast this could be organised. A staff member was also spoken with later in the day and they were asked about the person that was sitting with their breakfast. They said that they had got up early that morning but they had been ‘sleepy’ all day. It was unclear if the person had chosen to have their breakfast later. We spoke with the manager about the sexualised behaviour of the person that was observed in the lounge. They said that staff were instructed about how to protect themselves both verbally and in the person’s care plan. Discussions with three staff members and the care plan that was viewed confirmed this. However, from the observations of their actions in the lounge it was not clear if the activities coordinator had been provided with the guidance of minimising the person’s inappropriate behaviour. The Expert by Experience spoke with the activities coordinator and the Expert by Experience reported ‘starting from scratch and having to generate (activities coordinator) most of (activities coordinator) materials and resources I felt that encouraging progress had been made so far with plans afoot to develop the activities further. A life story form is used to assess individual needs often with a valuable input and support of relatives and visitors. (Activities coordinator) sees “main job to spend time on 1 to 1 and to assess individually … on Monday mornings sees everyone”. Daily activity boards are used and weekly activity sheets. For this week there was a good spread of activities on each day and most commendably at the weekend. (Activities coordinator) has introduced recently sedentary exercises, is starting a reading/book club, has ordered reminiscence cards and has plans to develop activities in the garden’. The Expert by Experience reported that people had told them about the activities in the home and comments included ‘(person) chose the small lounge “..because it is quiet, no television”’, ‘making cards … not a great deal’, ‘make Easter cards, starting a reading and book club, a church service once a month’. The service user survey asked if there were activities that were arranged which they could participate in. Two answered always, two answered usually, one The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 20 answered sometimes and one commented ‘I can sometimes watch activities but I am not well enough to take part’. The AQAA explained how they could do better ‘the home aims to develop the community contact and social events within the home. The home has an activities coordinator who will be working closely with each service user to develop activities and events which they wish to attend as well as involving the community in activities within the home’. The records of three people that were viewed clearly showed the arrangements for contacts that people chose to maintain with their family and friends and when contacts had been undertaken. During the inspection several people’s relatives were observed visiting the home. A person was spoken with and said that their relative visited often and that they were always made welcome. One service user survey, which had been completed by their relative on their behalf stated ‘it would be nice to have some facilities where we can make our own drinks instead of relying on staff members (who are very busy and overstretched) to assist us’. During a tour of the building it was noted that there was a ‘kitchenette’ facility which included a hot water urn and microwave on the first floor of the home. However, the urn had a notice on it, which stated that it was not to be turned on. The manager was spoken with and agreed that they would need to complete risk assessments on the use and location of the equipment before it was used and the manager said that they were in the process of considering the suitability of the location of the urn due to the safety of people that would be living on the first floor. The Expert by Experience spoken with visitors to the home and reported ‘other comments from the visitors were “staff not seem too bad, seem quite nice…made welcome as visitors…nice atmosphere, trying to get organised”’. The AQAA stated ‘visiting times are very open at the home. The home gives no restrictions of visiting times and welcomes visitors to stay for meals if they wish to’. The Expert by Experience stated ‘I observed lunchtime in the main dining room. 2 residents were sat at the table and 4 were eating in armchairs. I wondered why more residents were not sat at a table to make it a more social occasion. A member of staff said that more were capable of so doing. During the 15 minutes that I was in the room there was only one member of staff helping out and (staff member) was feeding a resident in a very caring and appropriate way. There was a need for more staff to help and oversee the eating; for example one (person) was spitting out onto (the person’s) dinner and a little later a resident tipped part of (the person’s) dinner into (the person’s) lap. I couldn’t see a menu on the tables or in the room. The choice of 3 juices arrived on the trolley well after the main meals had been served instead of at The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 21 the outset. The meals arrived already plated without an explanation. A resident put (the person’s) hand in (the person’s) gravy and (their relative) offered one of (relative’s) own serviettes; I didn’t notice any on the tables or nearby. In another room [Picasso] 4 residents had their dinners on side tables. One (person) was asleep with most of (the person’s) dinner uneaten; in the 5 minutes or so that I was in there I didn’t see any members of staff. In a room (a person) swallowing problems was being sensitively fed by a member of staff’. The Expert by Experience was told that a person had been provided with a soup which a staff member said that they did not like and that people made their choices of meals the day before. The Expert by Experience reported ‘resident views were “food varies, we have a choice … food practically cold because not put on hot plates”, “food is regular, dislike when not cooked enough, trouble with meat”, “food quite alright mostly hot … one day fish and chips dodgy” and (a relative) of a very recent resident said that the food seemed ok’. The service user survey asked if they liked the meals at the home. Two answered always, three answered usually, one answered sometimes and comments included ‘would like a more personalised menu, especially tea time not just sandwiches’ and ‘if there is something on the menu that is not suitable/liked the staff are very willing to do something different. On occasions the food has not been as hot as expected, however, staff have been very willing to rectify this’. There was a bowl of fresh fruit in the lounge that people could help themselves to. We observed a group of people in the quiet lounge during the evening meal, they were eating their choices of sandwiches, soup and fresh fruit salad and cream, which included a good range of fruits such as strawberries and star fruit. All five people were eating their meals in armchairs and one person was observed eating their fruit salad and cream with their fingers. They did not respond to us when we asked if they wanted a spoon and we were unable to ask them if using their fingers was their choice. There were no staff members present during this time and the staff member that was administering the medication told us that the staff that were on duty were assisting those who needed help eating their meals. Two people were spoken with and one said that their soup was not hot enough and one said that the food had improved but it was not always hot and that the food was not very good but they could not tell me how they could improve the menu. The manager was spoken with and they told us that there had been some previous disorganisation at meal times with staff not knowing what they should be doing, they said that they had improved by advising staff of their roles at meal times. The manager was told about the lack of staff that the Expert by Experience had identified at lunch time and we suggested that they could consider staggering meal times to ensure that those who did not need assistance with eating were also provided with support during meal times. A The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 22 staff member was spoken with and said that often meal times were chaotic and felt that it was because the lack of direction. The AQAA stated ‘care and dignity are offered at meal times ensuring all service users are supported to be as independent as possible during meal times. The menu’s are flexible and a wide range of choices are offered to ensure each individual has the opportunity to eat food that they are excited about and enjoy in addition to a well balanced meal’. The AQAA stated that they had improved by ‘meal times have over the last few weeks become more structured and organised following consultation with service users’. The menu was viewed, which was displayed in the entrance hall to the home and a copy was kept in the kitchen. There was a ten week menu and it was noted that a balanced diet was provided. There were three choices of each meal including a vegetarian option. The AQAA stated ‘the home offers a wide range of drinks and snacks both hot and cold throughout the day and over night at the convenience of the service users’. The chef was spoken with and told us that the evening meal was a choice of sandwiches, soup or beans on toast. They said that people’s specific dietary requirements were communicated by senior staff members but the chef took the responsibility of checking with staff on a daily basis if there were any changes in people’s requirements or choices. The chef had a good knowledge of the dietary requirements for people with diabetes. The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 23 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service cannot be assured that all their complaints will be acted upon and that they are protected from abuse. They can expect to have their written complaints listened to and acted upon. EVIDENCE: People were provided with information about how to make a complaint about the service that they were provided with in the Service User’s Guide and the Statement of Purpose. Three staff members were spoken with and three staff surveys said that they were aware of actions to take if a person wished to make a complaint about the service that they were provided with. The health professional survey asked if concerns that were raised were responded to appropriately. One answered always and one answered usually. Six service user surveys said that they always knew who to speak to if they were not happy, that they knew how to make a complaint and that the staff listened and acted on what they said. Comments included ‘vaguely’ and ‘we had an issue when first moving in. The complaints procedure was explained in full. It was dealt with very professionally and promptly and was rectified to our satisfaction’. The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 24 The Expert by Experience asked people if they knew how to make complaints and they commented ‘not sure take care of complaints’, ‘staff alright as a rule, tell them and they put it right’ and ‘tell manager or carers’. The complaints records were viewed and it was noted that written complaints that had been received were investigated and acted upon in a timely manner and the people who had made the complaint were advised of the outcomes. The manager was asked how they dealt with verbal complaints, they said that they responded to all concerns quickly and acted upon them. However, there was no system in place to show how verbal complaints had been acted upon, for example a person had told the Expert by Experience that they had informed staff that they had not been provided with their medication, we had been informed that two people that lived at the home were disturbed by the actions of others and that food was not hot enough. We were told that the issues had been reported to staff and the actions that were taken as a result of the issues were not recorded. The manager was asked if people that lived at the home were provided with the opportunity to participate in home meetings where they could discuss common issues. The manager said that they did not have home meetings and that if there were issues they were dealt with immediately on an individual basis and that this ensured people’s confidentiality. The AQAA stated ‘Over the last six months the home has responded to all complaints within a 28 day period. The home has a very open and positive approach to complaints. Complaints are seen as an opportunity to assess how effectively care is provided to individuals living at the home and to evaluate how the service could improve those outcomes for service users. Each individual complaint is taken seriously and proactive strategies are implemented following complaints to ensure that all necessary actions are taken to prevent it from occurring again’. The training certificates of five staff members were viewed and all had attended safeguarding training, however, one did not hold any certificates and the manager said that they had done the training in their full time job role in the local authority. The manager showed us a training plan and it was noted that updated safeguarding training was to be provided to all staff at the end of March 2009. Three staff members were spoken with and they confirmed that they had been provided with safeguarding training and had a knowledge of their roles and responsibilities. The AQAA stated that they had improved by ‘all staff have been receiving the Safeguarding Adults training again to refresh their learning and understanding’. The safeguarding procedures and the local authority safeguarding guidelines were available for staff reference to ensure that they were aware of actions to take if there were issues or concerns about people’s safety. The AQAA explained that they planned in the next twelve months to ‘the home aims to The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 25 ensure that all staff complete the Suffolk County Council work booklets to further their knowledge of safeguarding vulnerable adults’. During a tour of the building we observed a person shouting out that they wanted to go home and another person had swore at them. There were no care staff in the room and the two non-care staff did not respond to the incident. Therefore, we cannot be assured that people that lived at the home were safeguarded from actions by their peers. The AQAA stated ‘as legislation has been changed and implemented, the home has been supporting service users in line with the Mental Capacity Act 2005 to protect their individual rights and choices appropriately and effectively. Consultations have been sought with the relevant professionals where concerns have been raised regarding the suspected infringement of rights and issues relating to the safeguarding adults’. The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 26 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can expect to be provided with a clean, well maintained and comfortable environment to live in. EVIDENCE: A site visit of the home was undertaken 10th September 2009 as part of the CSCI registration process and it was noted that the home was fit for purpose. The registration report stated ‘it is finished to a very high standard throughout. There is high quality new furniture and matching soft furnishings throughout. The bedroom doors are one of six colours that alternate throughout for ease of identification by the residents. The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 27 All bedrooms are above 12m2 and contain all the furniture required by the National Minimum Standards. Each one has an en-suite containing shower, toilet, sink, lockable medicine cabinet and appropriate grab rails. All are carpeted. There are a mix of electric nursing beds and divans. The electric beds are high/low beds, with attached bedrails. Some of the beds go right to the floor if required’. The AQAA stated ‘all environmental standards are met through the careful design of the building. All necessary adaptations are made for each individual service user and all areas of the home are disabled access. The home is kept clean, well maintained, homely and free from odours’. A tour of the building was undertaken during the inspection and it was noted that the home was clean, warm, light and tidy. Six service user surveys said that the home was always fresh and clean. The bedrooms of people that were visited reflected their individuality and held items of personal memorabilia. A person that lived at the home was spoken with and said that they were allowed to bring their personal items of furniture that they wished to use in their bedroom. There was a lift which provided access between the ground and first floors for people to use. The lift did not provide access to the second floor, which was accessible through a key pad locked door. The second floor provided staff areas, such as a staff room and staff lockers. The communal areas included a large lounge and lounge/dining area and a quiet room on the ground and first floors. People that were spoken with said that the building was always clean, tidy, comfortable and that they could choose which communal areas they wished to relax in. There were four assisted bathrooms on both the ground and first floors, all of which provided automatic lights and fans which came on when the bathrooms were entered. The water temperatures were controlled by temperature valves and the records of regular water temperature checks were viewed, which ensured that people were safeguarded. Each communal bathroom provided hand wash liquid and disposable paper towels to ensure that the hand washing facilities minimised the risks of cross contamination. There was a meetings room, for staff and resident meetings and small group training, an administrator’s office and manager’s office off the reception. The reception area held a staff and visitor signing in book, a copy of the Statement of Purpose, Service User’s Guide, a record of activities and the menu. The home’s registration certificate and certificate of insurance were displayed on the wall. A security CCTV screen that displayed the external areas of the home was in the administrator’s office, there were no CCTV cameras inside the building. The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 28 The Expert by Experience stated ‘the building has been furnished to a good standard with plenty of pictures and attractive communal rooms of varying sizes with nice easy chairs arranged in small groups. The home was clean and tidy with an absence of odours. Although the bedroom doors had the resident’s name on them more could be done to make them more easily recognisable, especially for dementia residents. Outside there was a garden partly grassed and with 2 raised beds. There will be a need for outside furniture and plans to utilise the area both as a social area and for activities’. A staff member said that garden furniture would be provided when the weather improved. There was a large kitchen with a good provision of storage areas, the kitchen held hand washing facilities and it was noted that it was clean and tidy. The staff in the kitchen were observed to wear appropriate protective clothing to minimise the risk of cross contamination. The laundry was viewed and it was noted that it was clean and provided hand washing facilities and sufficient space for clean and dirty areas. The laundry held two washing machines and two drying machines. There was a sluice machine on both the ground and first floors, where commodes could be cleansed. Four staff members that were spoken with had a good knowledge of their roles and responsibilities regarding infection control. They said that disposable aprons and gloves were always available. During the inspection staff were observed to use good infection control practices, such as wearing protective clothing and washing their hands when working with food, medication and personal care. The AQAA stated that they could do better by ‘the home will be improving the infection control training and development of infection control practices ensuring staff have the knowledge of why they carry out the practices they do with infection control’. The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 29 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can expect to be protected by the home’s recruitment procedures. People cannot be assured to be supported by staff that are appropriately trained to meet their needs. EVIDENCE: The AQAA stated ‘the home has a good range of staff experience and varied skills among the team to support service users individually and with a person centred approach’. The manager was spoken with about the staffing arrangements at the home. They stated that they had increased the staff in the home as people had moved in and staffing would be increased again when the numbers of people living in the home further increased. The manager said that they had calculated the numbers of staff that were required to meet people’s needs with the support that each individual required. The AQAA stated ‘active recruitment has continued over the last year to build an established settled staff team with bank staff incorporated to minimise the need for agency usage. This has benefited the service users as they are supported by a familiar staff team who The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 30 are fully aware of their care needs’. The AQAA said that they planned to improve in the next twelve months ‘over the next few months the home aims to closely study the actions and activities of staff in relation to the direct and indirect care needs of service users and the service provided. This will be assessed using time in motion studies carried out by staff, close observations and using evidence collated from the revised care plan documents’. The staffing rota was viewed for the week of the inspection and it was noted that the manager was on duty 09:00 to 17:00 Monday to Friday, as was the matron. However, the manager had informed us that the matron was on leave and they immediately changed the rota when we pointed out the error. There was one nurse on each shift, including the night shift and the manager told us that there were plans to provide one nurse on each of the ground and first floors when the home was fully occupied, there were twenty four people in the home at the time of the inspection. They said that they had difficulties with employing nursing staff and that they had recruited the assistance from a staffing agency to assist with the staff recruitment. They said that there were four full time nurses that worked at the home, six bank nurses and that three nurses were in the process of being recruited. The Expert by Experience had been told that three nursing staff had recently handed in their notice. The manager was asked about this and said that one full time nurse and two bank nurses were leaving the home. The AQAA stated ‘the home has found the employment and retention of full time registered nursing staff a particular issue which has been a barrier to the growth and development of the home. The home has a small number of full times nursing staff but continues to have a very healthy supply of bank nurses’. There were six care staff on the morning shift, five care staff on the afternoon shift and three carers on the night shift. The manager said that there were no care staff vacancies. A staff member was spoken with and told us that there was only four care staff on the afternoon shift, when we advised the manager of this and that the rota actually showed that there were five care staff for that day, they said that they were unaware. There was a team of kitchen and domestic staff, a maintenance worker, an activities coordinator and an administrator who assisted in the upkeep of the home. Four staff members spoken with said that when there were six and five care staff working at the home, they managed well. They said that if there was staff sickness or leave then they struggled to meet people’s needs. Two staff said that they felt that the nursing staff should be increased and that the nurses were often working under pressure to meet with all their duties. A staff member told us that they often felt frustrated as there was no organisation at the home and that they would benefit from having more direction so that everyone knew what they were supposed to be doing. One staff member reported that there was sufficient staffing to allow staff to support people in The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 31 their physical needs, but there was little time to meet their emotional needs, such as time to talk to people. All staff that were spoken with reported that they liked working at the home. The manager said that there had been previous issues with the management and organisation of staff time, particularly at meal times and that this was in the process of being addressed. There had been some issues with staffing and organisation that were identified, such as during the provision of activities, medication and meal times at the inspection and this was discussed in the ‘daily life and social activities’ and the ‘health and personal care’ sections of this report. It was noted that call bells were answered promptly. The Expert by Experience reported ‘the impression I had was of a home with staff who were very busy but generally there was a need for much better organisation and utilisation of the staff. There is also the issue of whether there have been sufficient staff’. The Expert by Experience had spoken with staff and they had said ‘the care staff work as a team but most of them are relatively new to this work’, ‘nurses are pushed to the limit … one nurse per shift for 20 people …difficult, not give care [residents] like. No time for therapy or intervention. Psychiatric and general together does not work’, ‘5 carers with 14/15 [residents] need hoists’ and ‘care staff pushed to limits’. People who lived at the home had told the Expert by Experience ‘stick 2 new staff together’, ‘staff are very helpful but are under stress’ and ‘staff alright as a rule, tell them and they put it right’. The service user surveys asked if the staff were available when they needed them. Three answered always, two answered usually and one answered sometimes. Comments made in the surveys included ‘the staff always seem too busy to fit me in because other residents have greater needs than me’ and ‘the staff are responsible for two very different patient groups who are currently residing on one level. This means that at times they are spread very thin as some resident’s requirements are more demanding than others. The carers in particular are very good and remain professional, helpful, patient and courteous in spite of challenging circumstances of being over stretched’. The staff survey asked if there were enough staff to meet the individual needs of all the people who use the service. Two answered usually and one answered never. Two surveys had stated in the ‘what could the service do better’ section ‘have more staff to provide better service and help needed get to know their staff team more’ and ‘more team work in all areas and more staff’. One survey commented ‘we have a good bunch of enthusiastic and kind staff who are always willing and hard working’. The manager told us that two care staff had achieved an NVQ (National Vocational Qualification) level 3 and six staff had started working on the NVQ level 2. Eight care staff had not yet started working on their awards. The home The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 32 had not yet met the target of 50 care staff to have achieved a minimum NVQ level 2 as identified in the National Minimum Standards relating to older people. However, it was noted that the home was a new service and that they were actively working towards ensuring that care staff were appropriately qualified. The manager told us that a domestic staff member, the administrator and a kitchen assistant were all working on an NVQ that was relevant to their roles. Three staff that were spoken with confirmed this. The AQAA stated that in the next twelve months they planned to make improvements which were ‘the home aims to have all staff working towards an NVQ qualification or working towards a higher NVQ qualification by the start of November 2008’. Four staff members that were spoken with said that they had been provided with an induction training course before the home had opened, which was training on manual handling, safeguarding and dementia. Two had said that the induction provided them with the information that they needed to know when they started work and one staff member stated that they felt that the training was ‘rushed’ and that they felt that they needed to refresh the information that they had been provided with. The staff survey asked if their induction covered everything they needed to know to do the job when they started. One answered very well, one answered partly and one commented ‘no induction’. The AQAA explained how they planned to improve in the next twelve months ‘the staff are currently undertaking the skills for care induction, although the time it takes to support staff through this induction could be improved’. The training records of five staff members were viewed and none evidenced that they had been provided with an induction which was in line with the Skills for Care Common Induction Standards. There were training certificates, which showed that the above training had been provided to the staff team before the home was opened. The manager was spoken with and confirmed that they would ensure that induction training was documented and they showed us the templates for an induction work book which they would ensure that all staff completed. They also told us that they were in the process of ensuring that the staff training records were up to date and that each staff member would be provided with an individual training plan and record and they showed us the templates of how they would document the training. Staff training certificates that were viewed showed that they had been provided training on issues such as manual handling, health and safety, challenging behaviour, safeguarding, infection control, dementia and customer care. This was confirmed by four staff members that were spoken with, they also stated that they had various training booked for the next three months. The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 33 The maintenance worker was spoken with and showed us their fire safety records, which identified that staff had been provided with fire safety training. The staff survey asked if they were provided with training which was relevant to their role, helped them to understand and meet the individual needs of people who lived at the home and that kept them up to date with new ways of working. Two answered yes and one answered no. The survey asked if they felt that they had the right support, experience and knowledge to meet the different needs of people that lived at the home. Two answered usually and one answered never. The health professional survey asked if the care staff had the right skills and experience to support people’s social and health care needs. One answered always and one answered usually. The manager showed us the training plan, which identified the future planned training for March and April 2009. The training included manual handling for the day following the inspection, safeguarding, dementia, health and safety and COSHH (Control of Substances Hazardous to Health), infection control, communication, report writing, food hygiene and supervision. The manager said that the supervision training would be provided to the heads of each department and this would allow them to be responsible for the supervision of the staff in their team. The manager told us that there would also be clinical training arranged for the nursing staff which was being organised by the matron. The training records of one staff member showed that they had been provided by training by another organisation, the manager told us that they were a bank worker at the home and that they worked permanently elsewhere. However, they said that they would ensure that they were included in the home’s training to ensure that they were made aware of the requirements of the home. Five staff recruitment records were viewed and each held the required documentation which showed that people that lived at the home were safeguarded by the home’s recruitment procedures. Records included two written references, POVAfirst (protection of vulnerable adults) checks, CRB (Criminal Records Bureau) checks, identification and a record of their work history. The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 34 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service can expect to have their financial interests safeguarded. People could not be assured that the home was managed by a person who was fit to be in charge. People who use the service cannot be assured that the home is managed to ensure that their health, safety and welfare is fully protected. EVIDENCE: The registered manager had left the home before the inspection and a new certificate showing the registered manager post was vacant was distributed following the inspection. The home was managed by a person who had worked The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 35 at the home since January 2009 to provide operational support and they were in the process of making a registered manager application with CSCI. The manager was supported in their role by the matron (previous deputy manager), who took a clinical lead in the home and the administrator. The AQAA stated ‘the home manager has achieved the NVQ level 4 care and management alongside the Registered Managers Award and has 4 years experience of managing a care services. The deputy home manager who undertakes the role as the clinical lead for the home as Matron has 34 years nursing experience. The home manager and matron have a very positive approach to training and personal development within their individual roles which is disseminated to the staff team as a whole’. We had received comments in a health professional survey which stated that a member of staff had discussed with them a ‘difference’ in how the home was run. We discussed this with the manager and they said that there had been some areas of disorganisation and unrest in the home, such as at meal times and that staff were not aware of what their roles and responsibilities were. The manager said that there were improvements at the home and this was evident in the improvements of the care plans and the training that had been booked. However, we had noted some areas that was in need of management intervention, which were identified in the previous sections of this report, such as the poor medication processes, how people were upset by the actions of other people that lived at the home and staffing cover during activities and meal times. The records of five staff were viewed and showed that they had been provided with one supervision meeting since the home had opened where they could discuss their roles and responsibilities and raise concerns if they needed to. Three staff that were spoken with said that they did not have formal supervision meetings where they could discuss how they were progressing in their roles. They said that there was always someone on shift that they could approach if they had concerns and felt that they were confident that they would be listened to. A staff member said that they had attended one staff meeting since they had started working at the home, which was brief and the meeting was to let them know what was happening in the home. The manager said that they had planned supervision training for the head of each department for March 2009 and that they would be responsible for ensuring that staff were appropriately supervised on a monthly basis. The staff survey asked if the manager met with them to give support and to discuss how they were working. One answered regularly and two answered sometimes. The AQAA explained how they would improve in the next twelve months ‘the home will be developing the supervisions held within the home and training more staff to be able to supervise staff ensuring that all staff receive 6 supervisions annually’. The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 36 We had discussed with the manager methods of how the monitoring of the home was undertaken to ensure that issues were rectified and that it was run in the best interests of the people that lived in the home. The manager said that there were weekly visits that were undertaken by the home’s responsible individual and/or director. There were no Regulation 26 visit reports at the home, however, these had been e-mailed to the manager during the inspection and the manager had filed them. The manager said that they would ensure that copies of all the reports were maintained in the home. The reports for January and February 2009 were viewed and it was noted that they had discussed management issues with staff members and the management team in the home, that records were viewed and that people that lived at the home were spoken with. The home’s quality assurance procedure was viewed and it identified the various methods of monitoring the home that were in place, which included CSCI inspection reports, health and safety, Regulation 26 reports, audits, satisfaction questionnaires and complaints. There had been no satisfaction questionnaires undertaken at the home as yet and the manager told us that they would be undertaken on an annual basis. The issue of non-formal complaints and how people’s concerns were managed and recorded is discussed in the ‘complaints and protection’ section of this report. The AQAA stated that they could do better ‘surveying and evidencing how we are monitoring the approach taken by the home to ensuring we are consulting with service users and developing the quality of the service provided’ and that the plans for the next twelve months were ‘the development of the quality assurance monitoring will continue next year to more comprehensively document the assessed outcomes of the delivery of the service in relation to the people using the service. Once this is carried out then the information can be used to increase the satisfactory outcomes for service users’. The finance records and balance of monies were viewed for two people who lived at the home. It was noted that the records clearly recorded financial interactions and receipts were maintained for purchases. The balance of monies matched with the records that were viewed. The home’s procedure for people’s finances was viewed and they clearly showed the methods of ensuring that their finances were safeguarded. The AQAA stated ‘all financial transactions whether relating business or service user finances are comprehensively documented within the home’. The maintenance worker was spoken with and they had a good knowledge of their roles and responsibilities regarding the health and safety of the home. They told us that they were responsible for undertaking regular health and safety checks in the home, which included fire, nurse call bells, water temperatures, lighting and laundry equipment. They showed us the records that they maintained to show what checks had been made and any actions that they had taken to address identified issues. It was noted that their records The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 37 were well maintained and they had kept a daily log of what they had done each day. The fire safety records that were viewed showed that they had undertaken regular fire safety checks and that they had trained the staff in the fire system. They had not yet undertaken an evacuation of the building, but they had planned to do this in the near future. They told us that the housekeeper was also a fire marshal and that they could perform the fire safety duties in the maintenance worker’s absence. Health and safety certificates were viewed, which showed that people were safeguarded, which included electrical instalment, loop testing, gas testing, fire detection, lifting equipment, nurse call bell and assisted baths. The chef was spoken with and they had a clear understanding of their roles and responsibilities regarding health and safety. They showed us the records for the fridge and freezer temperature checks, cleaning and food temperature checks. They said that the food was sent out on a trolley and was the appropriate temperatures. We had previously identified in the ‘daily life and social activities’ section of this report that people had said that food was not always hot. Further investigation in the home may identify where the problem lies with the food temperatures. The accident records were viewed and it was noted that they were completed appropriately and that if further actions were needed they were clearly recorded. The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 38 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 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 3 X 3 3 3 3 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 2 X 2 X 3 X X 2 The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 39 Are there any outstanding requirements from the last inspection? N/A 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 OP9 Regulation 13 Requirement People must be provided with the medication that is prescribed to them to ensure that they are safeguarded by the home’s medication procedures and processes. The medication administration records must be consistently recorded by staff responsible for administering medication which identifies the reasons for the non-administration of medication to ensure that people are safeguarded by the home’s medication procedures and processes. Ordering of medication must be completed in a timely manner to ensure that people are provided with their prescribed medication. Timescale for action 17/03/09 2. OP9 13 17/03/09 3. OP9 13 17/03/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 40 No. 1. Refer to Standard OP24 Good Practice Recommendations It is recommended that the provision of signage to bedroom doors be provided to enable people with dementia to recognise their bedrooms. The Meadows DS0000072735.V374632.R01.S.doc Version 5.2 Page 41 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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