Inspection on 02/08/05 for The Meadows

This inspection was carried out on 2nd August 2005.

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

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

Other inspections for this house

The Meadows 28/06/06

The Meadows 20/02/06

The Meadows 07/03/05

The Meadows 11/08/04

The Meadows 26/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE The Meadows Wrenbury Crescent Berryhill Stoke on Trent Staffordshire ST2 9JZ Lead Inspector Berwyn Babb Announced 02 August 2005 10-30am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Meadows E51-E09 S32500 The Meadows V237940 020805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Meadows Address Wrenbury Crescent Berryhill Stoke on Trent Staffordshire ST2 9JZ 01782 234750 01782 234751 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Stoke on Trent City Council Mrs Diane Marie Ackley Care Home 54 Category(ies) of 10 DE registration, with number 5 MD(E) of places 54 OP 5 PD 54 PD(E) The Meadows E51-E09 S32500 The Meadows V237940 020805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 5 Physical Disability (PD) - Minimum age 55 years on admission Date of last inspection 07 March 2005 Brief Description of the Service: The Meadows is owned by Stoke on Trent City Council and managed by Stoke Social Services Department. The home was registered under the Care Standards Act to provide care for up to 54 elderly residents with a variety of needs, and 5 persons [min age 55] with physical disabilities [P. D.]. Accommodation is provided in single bedrooms on two floors serviced by a lift. There are five living/dining areas on the ground floor separated by partitions. Upstairs is a smoking area, two small lounges and kitchen/diner areas and a hairdressing salon.There are small “Breakaway” areas sitting two to four people found at intervals around the home, and these, and the quiet lounge, provide an ideal venue for meeting family and friends, or spending some “time out.”There are spacious grounds, mainly put to grass, and a car park to the rear of the property. The proprietors are undertaking an extensive renovation and modernisation program, to allow an intermediate care facility to be incorporated. Some issues will need to continue as requirements, for instance locks on bedroom doors, Fire Officer recommendations, and ensuring that pipes and radiators are not a potential hazard, but the commission have been kept informed of programs being undertaken to complete these standards, and of the risk assessments undertaken to ensure that the most urgent areas receive the highest priority. The Meadows E51-E09 S32500 The Meadows V237940 020805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During this 7.5 hour annual inspection, much of the focus was directed towards the steps that have already been taken to facilitate the opening of an Intermediate Care unit on the premises. All existing permanent residents were occupying rooms on the ground floor, releasing the first floor for construction work to form the separate I. C. unit. This has been planned to be in two stages, with two nominal sub-units reflecting the re-provision of two off site existing services, and work was well advanced on phase one. Existing residents who spoke to the inspector were not disadvantaged by these alterations, and some had exchanged bedrooms for ones that were larger than their original, and had benefited from refurbishment prior to their moving in. All staff had become involved in training for new roles, and their morale was at a very high point, with many excited about the prospect of a high percentage of people in their care destined to return to their own homes as a result of staying at The Meadows. Some long-standing issues were in the next Tranche of work to be done. For example, application of appropriate privacy locks on bedroom doors were stated to be programmed for inclusion on the replacement doors, required by the Fire Inspector before the unit could be approved. The guarding of radiators and hot water pipes, were also seen to be nearly completed, with a few communal areas still waiting to be done. The program of redecoration had resulted in visible improvement to the ambience, not only of bedrooms, but communal areas, particularly the main stairwell, which only required new stair carpet to complete the transformation. What the service does well: The Meadows has a good history of providing permanent care for elderly frail residents, employing staff from the local area who understand, and are able to relate to and help residents continue to enjoy, the culture and regional identity of Stoke-on-Trent. This can be particularly seen in a sensitive familiarity that encourages companionship without infringing upon the privacy and dignity of the individual resident. The Meadows E51-E09 S32500 The Meadows V237940 020805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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 E51-E09 S32500 The Meadows V237940 020805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Meadows E51-E09 S32500 The Meadows V237940 020805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4, and 6. The home demonstrated an engagement with the need to provide, accurate information, an appropriate contract, a meaningful assessment of needs and choices, the opportunity for pre-admission visits where appropriate, and both permanent and intermediate care to improve the life experiences of frail elderly people. EVIDENCE: In discussion with the Registered Care Manager, it was established that the Statement of Purpose was being amended to the aims, objectives, and philosophies of the planned new Intermediate Care unit. New procedures were being worked out in relation to contracts, which for the six weeks of the Intermediate Care stay will not be funded by the resident, and thinking about this has already appreciated that if the aim of the service is not met in individual cases, then the assessment procedure for transfer into permanent care will need to be urgently initiated. In some care plans examined, there was mention of visits being made to the home prior to admission, and one resident spoke about becoming familiar with it during earlier periods of respite, and then having made the conscious The Meadows E51-E09 S32500 The Meadows V237940 020805 Stage 4.doc Version 1.40 Page 9 decision to enter The Meadows when she needed permanent care. The Registered Care Manager was aware that once the Intermediate Care unit is in operation, it may not always be possible or appropriate for prospective residents to leave hospital in order to pre-view the home, but was determined that in such cases their nearest relative/supporter/closest friend should do so on their behalf, and that she or another senior member of staff would visit the individual to discuss their future care, requirements, choice, and anxieties. Plans for the opening of the Intermediate Care unit had progressed, with redecoration of existing first floor bedrooms, and some internal re-organisation and structural changes to establish lounge/diners appropriate to peoples needs. The inspector was concerned that in the area designated for wheel chair users to take their meals, the window was above the level at which someone could look out from a seated position (See, say, Regulation 23. [2] [a]), and useful discussion followed on possible solutions. Selection and training of staff was progressing, and those met by the inspector were all extremely positive about this new [to them] venture. The Meadows E51-E09 S32500 The Meadows V237940 020805 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, and 10. Discussion, observation, and documentation demonstrated that good records of health and social care needs supported care practices that respected peoples individuality and ensured they obtained what was necessary for their wellbeing. EVIDENCE: The inspector examined a sample of current resident’s care plans chosen as a result of discussion with them, and because of details observed in their care, or their accommodation. These demonstrated that there was a detailed plan of action to be followed by staff, based on individually identified needs or choices made by, and in relation to, each resident. They had been regularly reviewed, and showed evidence of endorsement by residents or relatives [where appropriate], or both. Details were recorded of hobbies and chosen activities, and there was a thumb nail sketch of the previous life of the individual covering lifestyle, work [and service] history, and holiday destinations. The Meadows E51-E09 S32500 The Meadows V237940 020805 Stage 4.doc Version 1.40 Page 11 Medical details included the meeting of previously established needs, together with regular input from G. P.’s and other preventative measures such as annual health checks, and regular monitoring of feet, eyes, dentistry, continence needs, and diabetic stability. There were details of advice being sought and given from relevant professionals with regard to specific concerns, such a Cancer care, Dementia care, Arthritis care, and special diets. Medication Administration sheets [M.A.R.] were scrutinised without uncovering any discrepancies or omissions, and the arrangements for the storage of current, and safe disposal of out of date or no longer required were found to be in accordance with established best practice. None of the residents currently at the home were managing their own medication, and appropriate arrangements were seen for training staff to undertake this role for them. All rooms had lockable facilities where any future resident could store medication, if they chose to do so, and had been assessed as capable. Details found in care plans, and the observation of the interaction between staff and residents during the day, confirmed what those residents interviewed had told the inspector about the sensitive, caring, and dignified way they were treated, and the manner in which their privacy was being upheld. The Meadows E51-E09 S32500 The Meadows V237940 020805 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, and 15 Discussion with residents and reference to their care plans, suggested that their lifestyle experiences in the home matched their expectations and preferences, and satisfied their social, cultural, religious and recreational interests and needs. EVIDENCE: When talking to the inspector, some residents stated that they were able to have a rest in the afternoon if they chose not to join in with the program of activities organised by the staff, and others said they could read a book or listen to the radio. Activities listed on the board in the hall included nail painting on Mondays, movement to music on Tuesdays, board games on Wednesdays, the hairdresser on Thursdays, Bingo on Fridays, a film on Saturdays, and watching Songs of Praise on the T. V. on Sundays. In the care plans examined there were references to hobbies, activities, likes and dislikes, [love of indoor plants, abhorrence of smoking], funeral arrangements, and the contact from members of the church. One lady confirmed that she had lots of visitors, and that they could come whenever they liked, and that they were always made welcome. The Meadows E51-E09 S32500 The Meadows V237940 020805 Stage 4.doc Version 1.40 Page 13 The same lady corroborated the testimony of several other residents concerning the excellence of the food at The Meadows. The inspector was told that cooked alternatives were always available for her, by a lady who acknowledged that her choice of foodstuffs was severely restrictive, and who had nothing but praise for the catering staff who were able to meet her needs. The inspector then examined the kitchen and its associated storage and preparation areas, and could not remember being so favourably impressed with what he saw. Not only was the kitchen and preparation area spotlessly clean, and the fridge and freezer temperatures recorded twice daily [and within the desirable ranges], but the quantity and quality of goods in store was only matched by the orderliness of their arrangement. Menu plans exhibited variety and imagination, with special dietary needs being included where possible in the main menu to avoid stigmatisation of the individual. Lastly he sampled the lunch, and thought this to be commendable. The Meadows E51-E09 S32500 The Meadows V237940 020805 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Residents appeared to be well protect ed by the complaints procedure in place, and talking to staff suggests that those people caring for them are well aware of the range of occurrences that would be an abuse, and what steps to take if they had any suspicions that they needed to take action to protect vulnerable adults. EVIDENCE: The inspector spoke to residents, perused, documents, and interviewed staff. No complaints had been received by either the home or the C. S. C. I. in the period since the last inspection, and he was able to locate a copy of the procedure in those care plans reviewed, and displayed near to the main entrance. The home had a copy of the arrangements for the protection of vulnerable adults agreed by all local relevant agencies, and the member of staff interviewed confirmed that not only had she read it, but had been required to confirm that she had so. He learned from her also of a wide range of happenings that would constitute abuse of a resident, and what steps would have to be taken following suspicion being aroused that someone was being abused. He was particularly satisfied to be given an account of various seemingly trivial omissions which she correctly identified as abusive care practice. Examples she gave him included raising ones voice to a resident, requiring them to do anything against their wishes, not responding promptly to requests for assistance, or withholding items that had been requested. She knew the importance of strictly following procedure, and reported that discussion of abuse was often an agenda item for team meetings, as well as the subject of regular induction and refresher training. The Meadows E51-E09 S32500 The Meadows V237940 020805 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 23, 24, and 25. Areas of the home were being improved to provide facilities more in line with current standards, and when this work has been completed by the registered proprietors, residents will benefit from an improved environment. EVIDENCE: During a tour of inspection, it was noted that in some toilets and other areas to which residents have access, such as corridors and bathrooms, there were radiators that had no guards, and were not of low temperature surface construction. Requirements have been made regarding this issue, and will be repeated in this report. One bedroom had been redecorated in a warmer colour, a shade of red, and this gave the impression of making the room seem very small. When this was checked against the terrier of room sizes held in the home, it was noted that many of the bedrooms would not now be registerable, and it will be recommended in this report, that further measures are taken to make resident’s personal space more acceptable to modern demands. The Meadows E51-E09 S32500 The Meadows V237940 020805 Stage 4.doc Version 1.40 Page 16 The lack of privacy locks has been brought to the attention of the registered proprietors before, and whilst the inspector was assured that these will be fitted to the upgraded doors required by the Fire Officer, until this happens Standard 24.5 can be said to be met, hence the requirement in this report. Whilst progress has been made in bringing the facility up to the standard required to meet current fire regulations, some firebreak doors have not yet been fitted in corridors, and the Registered Care Manager was unable to confirm that existing fire breaks had been extended into the roof void. In an area intended to be used for a wheelchair users diner/kitchenette, the inspector pointed out to the Registered Care Manager that the sill of the window was too high for a seated person to see anything but sky, and recommended that a more suitable location should be found, or the window lowered to make the room suitable to resident’s needs. In other current and intended shared facilities much improvement had taken place to make The Meadows a more pleasant place to live. Worthy of especial notice has been the expanding provision of smaller dining areas, often as a diner/lounge or diner/kitchenette combination, and these have to be a welcome step in de-institutionalising the style of care provided. Similarly, especially on the first floor, there were small “Breakaway” area, where two or three people could go for more privacy or some quiet time, without having to go to their bedroom. These areas would be especially useful for entertaining visitors. The Meadows E51-E09 S32500 The Meadows V237940 020805 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, and 30. The needs of resident’s were being met by sufficient staff who demonstrated knowledge of the conditions of old age, and the skills to meet these. EVIDENCE: The rota of staff on duty for the month during which the inspection took place showed there would always be sufficient staff to meet the assessed needs of residents, and observation during the inspection confirmed that those people on duty had the various skills and knowledge necessary to meet their duties in a friendly manner, that never compromised the privacy or dignity of the residents. Staff interviewed displayed sensitivity and a culture of positive regard for the residents of The Meadows, and an excitement about the new role the home is fulfil, together with appreciation of the training that they were receiving to enable them for this new role. The Registered Care Manager had made arrangements for the employment of agency staff to more easily facilitate the intensive education arranged for existing staff, to introduce them to the needs of resident’s admitted for Intermediate Care. One member of staff interviewed in greater depth, confirmed that the recruitment procedures operated by the home were robust and designed to protect residents from abuse. The Meadows E51-E09 S32500 The Meadows V237940 020805 Stage 4.doc Version 1.40 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 35, 36, and 38. The internal management of the home now conforms to the required standards. EVIDENCE: Since the previous inspection, Mrs. Ackley has completed the process of becoming a “Fit Person”, and has been registered with the C. S. C. I. as the manager of The Meadows. She demonstrated that she had vast experience in the care of the elderly, and the management of a residential establishment, and that was further demonstrated in her ability and co-operation during this inspection. Colleagues and residents spoke highly of her compassionate nature, and knack of getting things done. The Meadows E51-E09 S32500 The Meadows V237940 020805 Stage 4.doc Version 1.40 Page 19 Time was spent with the resource officer, and her records demonstrated that those small amounts of finance dealt with directly by the home were covered by proper accounting systems. A random check of personal allowances being retained revealed a perfect match between the actual cash held, and that recorded in the documentation. In his formal interview with a member of staff, the inspector was assured that the records held on the supervision of staff accurately reflected the openness of this two way process, and she gave voluntary testimony to the benefit gained from having such an approachable and experienced manager. Records showed that there were sufficient staff holding current First Aid certificates to ensure that there was one present in the home at all times. Records also showed that the necessary regular fire checks and training events were being carried out at or in excess of the recommended intervals. Short comings in the environmental aspects of the fire officer’s requirements have been dealt with elsewhere in this report, and will not be duplicated here. The Meadows E51-E09 S32500 The Meadows V237940 020805 Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 4 COMPLAINTS AND PROTECTION 2 3 x x 2 2 2 x STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 4 x x x 3 3 x 3 The Meadows E51-E09 S32500 The Meadows V237940 020805 Stage 4.doc Version 1.40 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 19 Regulation 23 [4] Requirement Outstanding recommendations made by the Fire officer must be implemented, especially in the matter of fire break doors, and the dividing of roof voids with fire breaks. Residents must have privacy locks of an approved type available on the door of their private rooms. Radiators and hot water pipes must either be of a low temperature surface constuction, or have guards over them to prevent the danger of accidental burning to residents. Timescale for action By 02/10/05 2. 24 12 [4] By 02/10/05 By 02/10/05 3. 25 13 [4] RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 23 Good Practice Recommendations Steps shall be taken to improve the space available in residents rooms to make them suitable to their needs The Meadows E51-E09 S32500 The Meadows V237940 020805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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