CARE HOMES FOR OLDER PEOPLE
The Meadows Britwell Road Didcot Oxfordshire OX11 7JN Lead Inspector
Marie Carvell Unannounced Inspection 26th June 2007 10:50 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Meadows DS0000062306.V338382.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 DS0000062306.V338382.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Meadows Address Britwell Road Didcot Oxfordshire OX11 7JN Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01235 518440 01235 518469 manager.themeadows@osjctoxon.co.uk www.osjct.co.uk The Orders Of St John Care Trust Mrs Heidi Simpson Care Home 68 Category(ies) of Dementia - over 65 years of age (7), Mental registration, with number disorder, excluding learning disability or of places dementia (8), Old age, not falling within any other category (68), Physical disability (45) The Meadows DS0000062306.V338382.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28th December 2006 Brief Description of the Service: The Meadows is a purpose built care home that was completed in October 2004. It provides both nursing and residential care to older people. Didcot is an expanding town, approximately 12 miles south of Oxford, with a good mainline rail service and bus links to local towns such as Abingdon and Wallingford. The home is next to a school and the town Civic Centre. Local shops and a major new shopping precinct are nearby. The home has three floors. All floors are served by a lift and stairways. There are 68 single rooms for residents that all have an en suite shower, toilet and hand basin. Each floor has spacious sitting and dining rooms and adapted toilets, bath and shower rooms for disabled residents. The ground floor also has a separate day care facility with its own entrance. There is a hairdressing salon, therapy room and shop just off the main reception area known as the ‘Heart of the Home’. The landscaped gardens have a central water feature, flower and herb beds and planted arbours. The kitchen and laundry areas, staff rest rooms, reception and administration offices and the home manager’s office are on the ground floor. The current scales of charges as at June 2007 are between £620.00 and £700.00 per week for residential care and between £805.00 and £885.00 per week for nursing care. There are additional charges for hairdressing, chiropody (none diabetic service users), newspapers, toiletries and taxi fares (tokens). The Meadows DS0000062306.V338382.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’ carried out over two days. The inspector arrived at the service at 10.50am and was in the service until 5.00pm on the first day and from 09.00am until 4.00pm on the second day. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s manager, and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the service and other people seen during the inspection or who responded to surveys that the Commission had sent out. Eleven service users, six relatives, five General Practitioners and two healthcare professionals responded to surveys sent out. In addition three relatives requested to speak to the inspector by telephone and time was spent with one relative visiting during the first day of the inspection. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standards of the service. The inspector toured the building, examined records and met with service users individually and in small groups in each of the units. The inspector also spent time talking to staff and observing how care was being delivered to the service users and joined service users for lunch in two of the units. At the (main) inspection carried out in April 2006, ten good practice recommendations were made, these related to choice of home, individual needs and choices, lifestyle, personal and healthcare support, environment, staffing and conduct and management of the home. These are referred to in the body of the report. An additional unannounced, focussed inspection was carried in December 2006 to check compliance with issues raised following a complaint notification to the Commission. At this inspection an addition four good practice recommendations were made, these related to individual needs and choices and lifestyle. The recommendations are referred to in the body of this report. Some feedback was given to the manager throughout the two days and feedback of findings at the end of the second day to the manager, head of care and the operations manager, who visited the home on both days. This was a positive inspection. The Meadows DS0000062306.V338382.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection?
The home has updated its admissions policy and evidence was seen of a detailed pre admission assessment having been undertaken. The manager or head of care now carries out all assessments. The use of clinical tools to assess the service users dietary, communication and mobility needs, risk of falls, continence and mental state are well developed. In discussion with the manager she is very clear that she will refuse admission to the home any prospective service user who has care needs that cannot be met by the staff team, despite increasing pressure from relatives or outside agencies. The Meadows DS0000062306.V338382.R01.S.doc Version 5.2 Page 7 In discussion with a recently admitted service user and his/her husband/ wife it was confirmed that senior staff from the home had visited the prospective service user in hospital and had been provided with sufficient information about the home to enable them to make an informed choice as to whether the home was able to meet the prospective service user’s care needs. The husband/wife of the prospective service users said that the assessment was very detailed. The prospective service user declined to visit the home, but his/her husband/ wife had been invited and encouraged to visit the home several times to meet the staff team, observe the routine, see the room offered and the facilities available. The relative said that he/she was very impressed about the process and at all times staff were available to answer any queries. The manager is currently reviewing care-planning documentation and the home has been using a new format for some months. It is expected that the new care planning documents will be in place for all OSJCT homes by the end of July 2007. A full time activity organiser is now in post and was observed to be involved with service users discussing individual and group activities to be arranged. In March 2007 the manager sent food surveys to all service users/advocates asking whether service users would prefer a later evening meal from the current 4.30pm time and asking for comments on the new menus to be implemented. Forty plus responses were received and all were positive about the new menus and the evening meal being served at 5.30pm. A new kitchen assistant has been recruited and once in post the new menus and 5.30pm evening meal will be put into place. Since the last inspection in December 2006, the home has successfully recruited two registered nurses, a full time head of care and a full time activity organiser. These individuals are now in post and the home is fully staffed with registered nurses. Staff recently appointed include a full time care leader, three full time care assistants, a part time care assistant, a part time kitchen assistant and a part time domestic assistant. All have been interviewed and offered a post and are waiting for police clearance before commencing their staff induction. Interviews were taking place during the inspection to fill the remaining four full time care assistant posts and one full time care leader post. The manager advised the inspector that the home is recruiting to its establishment hours plus an additional 10 to cover sickness, leave and training. In discussion with permanent members of staff it was clear that the recruitment of permanent staff is welcomed. Nursing staff said that the appointment of the head of care was seen as being very positive. Permanent staff said that OSJCT is a good employer and look after the welfare of its staff by providing accommodation. Staff said that they felt well supported and that their views were listened to. The Meadows DS0000062306.V338382.R01.S.doc Version 5.2 Page 8 The manager was registered with the Commission in January 2007, but had been in post since August 2006 as the head of care. She is a well qualified nurse and is currently working towards the Registered Managers Award. The newly appointed head of care, who is also a well qualified nurse, supports her. 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 summary of this inspection report can be made available in other formats on request. The Meadows DS0000062306.V338382.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Meadows DS0000062306.V338382.R01.S.doc Version 5.2 Page 10 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): Standards 3 and 5. Standard 3 was subject to a good practice recommendation at the inspection undertaken in April 2006. Standard 6 is not applicable, as the home does not provide intermediate care. Quality in this outcome area is good. Service users are fully assessed prior to admission to ensure that their needs can be effectively met by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has updated its admissions policy and evidence was seen of a detailed pre admission assessment having been undertaken. The manager or head of care now carries out all assessments. The use of clinical tools to assess the service users dietary, communication and mobility needs, risk of falls, continence and mental state are well developed. In discussion with the manager she is very clear that she will refuse admission to the home any
The Meadows DS0000062306.V338382.R01.S.doc Version 5.2 Page 11 prospective service user who has care needs that cannot be met by the staff team, despite increasing pressure from relatives or outside agencies. In discussion with a recently admitted service user and his/her husband/ wife it was confirmed that senior staff from the home had visited the prospective service user in hospital and had been provided with sufficient information about the home to enable them to make an informed choice as to whether the home was able to meet the prospective service user’s care needs. The husband/wife of the prospective service users said that the assessment was very detailed. The prospective service user declined to visit the home, but his/her husband/ wife had been invited and encouraged to visit the home several times to meet the staff team, observe the routine, see the room offered and the facilities available. The relative said that he/she was very impressed about the process and at all times staff were available to answer any queries. Information recorded on surveys completed by service users confirmed that only three service users felt that they had received enough information about the home before moving in. Comments received included ‘Can’t remember. Came originally to the old Ladygrove home.’,‘ I think so, but can’t remember that far’, ‘ I came to the care home because I kept falling over and was unable to get myself up. My daughter and X arranged for me to come into this care home’. From discussion with the manager, the inspector considers that the home is able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. The Meadows DS0000062306.V338382.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): Standards 7,8 9 and 10. Standards 7,8 9 were subject to good practice recommendations at the inspection undertaken in April 2006 and standards 7 and 8 at the inspection carried out in December 2006. Quality in this outcome area is good. Service users’ health, personal and social care needs are being met. Service users feel that they are treated with dignity and respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is currently reviewing care planning documentation and the home has been using a new format for some months. It is expected that the new care planning documents will be in place for all OSJCT homes by the end of July 2007. Service users and relatives, as appropriate, are involved in the care planning process and care plans are signed and dated by the service users. Care plans are reviewed each month by senior staff. The Meadows DS0000062306.V338382.R01.S.doc Version 5.2 Page 13 It was evident from information recorded in service user files that the home works closely other healthcare professionals, such as the tissue viability nurse, fall specialist service, community matron for palliative care, continence advisory service and speech and language therapists. Training has been provided to staff to identify service users at risk of falls. Entries made in daily contact sheet validated information recorded in care plans. All service users have a formal review of their care every six months, which include health and social care professionals as appropriate. All service users are weighed on admission and then at monthly intervals and an evidence based nutritional assessment is undertaken. Comments made on service user surveys were varied. To the question “ Do you receive the care and support you need”. Four surveys stated ‘always’, five surveys stated ‘ usually’, two surveys stated ‘Depends what staff are on duty’. Comments made on surveys completed by relatives to the question “ Does the home meet the needs of your relative” included three surveys stated ‘ usually’, ‘Sometimes. My father/mother recently had a stroke and is unable to function fully. I saw a nurse take him/her to the toilet and then straight to the table for his/her tea- no hand washing. This was an agency nurse, not the regular staff’, ‘X was not feeling well and I asked for him/her to see a doctor. It was two weeks before he/she did and he/she had an infection. I feel that he/she should not have to wait this long to see a doctor’, ‘ Usually/sometimes. Not in connection with staffing levels/amount of agency staff. No supervision in lounges. Residents able to ask for the toilet wait for up to 35 minutes (then it is too late). I often feel that drinking and feeding need more supervision. Food is often poor standard. For several months lack of activities has been appalling’. Comments made on surveys completed by healthcare professionals to the question “Are individual’s health care needs met by the care service?” included ‘Usually. Can only comment on what I see when I visit individual patients. Staff can be very busy, but do their best to provide care and assistance. Whenever I have been present privacy and dignity have been maintained’, ‘ Some staff seem very good, others not so. There has been some lack of care in the past perhaps due to staff shortages and lack of training or empathy to the needs of the residents. Generally most of the staff have appeared helpful and seem to try their best’. The community nursing team are responsible for meeting the nursing care needs of service users admitted to the home for social care only. The medical needs of the service users are provided by five GP practices. Regular meetings are held between the home and some of the practice GPs. Comments made on surveys completed by GPs, confirmed that four GPs were satisfied with the overall care provided to service users within the home and one GP stated ‘ No, but is improving’.
The Meadows DS0000062306.V338382.R01.S.doc Version 5.2 Page 14 Service users are able to take responsibility for their own medication following a medication assessment and risk assessment. There are detailed policies and procedures in place regarding medication administration, recording, storage and disposal. The manager is to implement recommendations made following a recent pharmacy inspection. Blood glucose monitoring equipment is now calibrated on a regular basis by nursing staff. Staff were observed to interact with service users in a respectful and appropriate manner. Privacy, dignity and respect is discussed at staff induction and explored at staff meetings Service users said that permanent staff were always very busy but most were kind and helpful. Comments made on surveys completed by relatives included ‘The regular staff are dedicated and kind, but because of over work have little or no time to do anything other than the basis care requirements’, ‘The staff seem to change quite often and they use agency nurses who seem to find the work tedious’, ‘Agency staff don’t know the needs of residents, one or two are very good, but some are not committed to the general well being of residents’. During the inspection it was noted that all service users were appropriately dressed and well groomed. Attention had been given to ensuring that service users had dentures, spectacles and hearing aids in place. The Meadows DS0000062306.V338382.R01.S.doc Version 5.2 Page 15 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): Standards 12,13,14 and 15. Standard 12 was subject to a good practice recommendation at the inspection carried out in April 2006 and standard 12 and 15 were subject to good practice recommendations at the inspection carried out in December 2006. Quality in this outcome area is adequate. Arrangements are being put into place to provide a range of activities to meet the needs of the service users and food choices and meal times are improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A full time activity organiser is now in post and was observed to be involved with service users discussing individual and group activities to be arranged. A hairdresser visits the home weekly; due to be increased to twice weekly, Holy Communion is brought to the home monthly. The manager has unsuccessfully attempted to find a volunteer to take a Roman Catholic service user to mass on a Sunday. The newly appointed activity organiser is to arrange visit by a PAT dog and increase the number of volunteers to man the home’s shop, currently open from 9am until 12midday on Mondays, Tuesdays and Fridays.
The Meadows DS0000062306.V338382.R01.S.doc Version 5.2 Page 16 Service users expressed their satisfaction of the well maintained gardens and many said that they made use of the garden in the good weather. Entertainment records for June and July showed that several sing-alongs, a church service, Holy Communion and music shows had been provided. Several service users said that they would like more activities such as bingo and games, other service users said that they did not wish to join in group activities and were happy to read their newspapers, books and watch television in their own bedroom. Resident’s and relatives meetings take place every three months, the minutes of the March meeting were seen and at this meeting the manager discussed the appointment of an activity organiser and concerns about food quality were acknowledged. Several service users commented on the lack of control over their daily lives and one of the examples given was the waiting time when asking to be taken to the toilet. This was also mentioned in discussion with relatives and recorded on relative surveys. One relative also felt that service users are put to bed very early (by 8pm) and when this was discussed with a member of staff was informed that staff like to have service users in bed before the night staff come on duty. The inspector observed that in one lounge, there was no staff present for some considerable time and the inspector needed to intervene when a service user almost fell out of a chair. This was discussed with the manager, who was asked to address the issues raised and agreed that this highlighted a concern about staff deployment rather than staffing numbers. Many of the service users have friends and family who are able to visit on a regular basis. Service users are encouraged to maintain contact, as far as possible, with the local community. The home is within walking distance of a newly built cinema, library and age appropriate organisations and clubs. The manager said that that more volunteers were needed in order to accompany service users on outings. In March 2007 the manager sent food surveys to all service users/advocates asking whether service users would prefer a later evening meal from the current 4.30pm time and asking for comments on the new menus to be implemented. Forty plus responses were received and all were positive about the new menus and the evening meal being served at 5.30pm. A new kitchen assistant has been recruited and once in post the new menus and 5.30pm evening meal will be put into place. The inspector joined service users for lunch on two units over two days. The first day the meal was adequate, but vegetables were over cooked. Some service users were not provided with aids such as plate guards to assist with eating in a dignified manner. It was clear that a choice of main meal was available and service users spoken to said that they had enjoyed their meal.
The Meadows DS0000062306.V338382.R01.S.doc Version 5.2 Page 17 The inspector observed that staff were very busy and not able to assist all service users with eating their meal. On the second day, the meat was nicely cooked, but the vegetable were again overcooked and placed on the tables to go cold before the meat was served. Some service users left their meals untouched or very little eaten and several service users complained about the cold vegetables and lack of condiments. One service user said that he/she was a diabetic and was expected to purchase his/her own desserts. However, the manager denied that this ever happens. It was unclear how the food intake of service users is monitored as no records are maintained. Following the inspection the manager advised the Commission of the new procedure for recording actual food intake at all meals. The manager was asked to consider introducing “ protected mealtimes” in the home, which means that all nursing staff are available in the dining rooms observing meals being served and ensuring that all service users are assisted as necessary, rather than carrying out other tasks such as medication rounds. The manager has agreed to discuss this with the home’s GPs. Comments made on surveys completed by service users included four that ‘always’ liked the meals served, four ‘usually’ and three ‘sometimes’, ‘ I always enjoy my dinner, but not so much the teas. There is a lot of spaghetti and pasta that I don’t like’, ‘ Staff need to help me by giving me a spoon, as I am blind’. Comments made by relatives included ‘ They recognise the food he/she likes and try to persuade him/her to eat and they do succeed’. One relative felt that more pasta dishes should be offered and another relative who regularly joins his/her husband/ wife for a meal said that the meals were ‘excellent’. The Meadows DS0000062306.V338382.R01.S.doc Version 5.2 Page 18 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): Standards 16 and 18. Standard 18 was subject to a good practice recommendation at the inspection carried out in April 2006. Quality in this outcome area is good. The home has a satisfactory complaints process in place. Policies and procedures are in place to protect service users from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure in place and this is displayed in the entrance hall. This is considered by the inspector to be good practice. In the last twelve months the home has received ten complaints, all were upheld and resolved within twenty-eight days. The home records all complaints whether received by letter or verbally. All complaints were seen to be appropriately recorded with action taken and outcomes clearly detailed. The home also has a comments book for service users, relatives or visitors to record any issue that they want the manager to be aware of. All surveys completed by service users stated that they knew how to make a complaint about the care provided. Comments include ‘ Speak to the manager’, ‘ speak to the staff’ and my son/daughter would deal with this’, ‘ You only have to tell someone’, ‘ I would talk to the nurses’, ‘ My son/daughter gets in touch with head office’. Comments made on surveys completed by relatives included ‘ Not always anything done about complaints’ and ‘ I usually approach the staff directly in
The Meadows DS0000062306.V338382.R01.S.doc Version 5.2 Page 19 the first instance. If this is not satisfactory then I will ask for an appointment with the manager’. In discussion with service users, most said that they felt that their concerns were listened to, taken seriously and addressed. All staff receive training in the home’s policies and procedures for protecting service users from abuse and the home’s whistle blowing policy. Training is provided to all new staff as part of their induction course and then updated on a regular basis. Two refresher courses are booked for June and September and all staff are expected to attend. Staff are provided with a copy of the Oxfordshire Safeguarding Adults procedures and are required to sign to state that they have received and are familiar with the contents. Since the last inspection in December 2006, the Commission has received no information concerning complaints about the service. The Meadows DS0000062306.V338382.R01.S.doc Version 5.2 Page 20 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): Standards 19,20,21,22,23,24,25 and 26. Quality in this outcome area is excellent. The home provides safe, well-maintained and spacious accommodation for service users. The home was found to be clean, hygienic and free from unpleasant odours. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is purpose built and is maintained to a high standard. The location and layout of the home is suitable for its stated purpose. Service users expressed their satisfaction of the premises, facilities and gardens. Communal areas of the home are comfortable and well furnished. Service users have access to a safe and secure garden. Service users are involved in developing the garden and following a visit to a local gardening centre held a “jobs” day to involve as many service users and relatives with tasks in the garden.
The Meadows DS0000062306.V338382.R01.S.doc Version 5.2 Page 21 Hot water outlets in bedrooms and bathrooms are maintained at the recommended temperatures. All windows are fitted with window restrictors and radiators are covered. A call alarm system is fitted in all bedrooms, bathrooms and communal areas of the home. All bedrooms are for single occupancy and have en-suite shower, wash hand basin and toilet. Bedrooms are of a generous size and accommodate wheelchairs and aids with ease. Service users are encouraged to personalise their rooms Most have a television set and some have private telephones. Communal bathrooms and toilets are fitted with appropriate aid and adaptations to help maintain independence. All areas of the home were seen to be clean, well maintained and free from unpleasant odours. From discussion with housekeeping staff on duty, it was evident that staff take pride in maintaining high standards of cleanliness. The laundry is well equipped and since the last inspection a false ceiling has been installed to reduce some of the noise and vibration to the first floor bedrooms. All housekeeping and laundry staff have received training in COSHH, infection control and health and safety. Policies and procedures are in place. Staff are provided with protective clothing, such as disposable aprons and gloves for use when carrying out personal care to service users. The manager is planning to appoint a domestic supervisor to support housekeeping staff within the home and to implement documentation to record evidence of work undertaken. The Meadows DS0000062306.V338382.R01.S.doc Version 5.2 Page 22 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): Standards 27,28,29 and 30. Standards 27 and 30 were subject to good practice recommendations at the inspection carried out in April 2006. Quality in this outcome area is good. Staff recruitment procedures are robust and protect service users from harm. Staffing levels are adequate to meet the needs of the service users. Staff are well trained and competent to do their jobs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From discussion with the manager, head of care and examination of staff rosters, staffing levels appear adequate to meet the needs of the service users. However, due to staff vacancies the home continues to be dependent on the use of agency staff and although most agency staff work in the home on a regular basis this does not allow for continuity of care to service users. Since the last inspection in December 2006, the home has successfully recruited two registered nurses, a full time head of care and a full time activity organiser. These individuals are now in post and the home is fully staffed with registered nurses. Staff recently appointed include a full time care leader, three full time care assistants, a part time care assistant, a part time kitchen assistant and a part time domestic assistant.
The Meadows DS0000062306.V338382.R01.S.doc Version 5.2 Page 23 All have been interviewed and offered a post and are waiting for police clearance before commencing their staff induction. Interviews were taking place during the inspection to fill the remaining four full time care assistant posts and one full time care leader post. The manager advised the inspector that the home is recruiting to its establishment hours plus an additional 10 to cover sickness, leave and training. The inspector was advised that 66 of care staff are qualified to NVQ level II or above. All staff complete a detailed induction programme within six months of appointment. From a sample of staff files it was evident that the home has robust recruitment procedures in place. Two senior staff conduct all interviews and interview process is recorded. Each member of staff has a training and development programme. Training is well organised in the home with all staff completing mandatory training as well as specialist training as appropriate to meet the needs of the service users. Updates are provided as appropriate. In discussion with permanent members of staff it was clear that the recruitment of permanent staff is welcomed. Nursing staff said that the appointment of the head of care was seen as being very positive. Permanent staff said that OSJCT is a good employer and look after the welfare of its staff by providing accommodation. Staff said that they felt well supported and that their views were listened to. Communication systems in the home are well organised, with staff handovers taking place at the beginning of each shift. Staff meetings take place and minutes of meetings were available for examination. The inspector gained the impression that staff morale was improving in the home. In discussion with all grades of staff, staff were professional and happy to answer the inspectors questions. The Meadows DS0000062306.V338382.R01.S.doc Version 5.2 Page 24 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35,36 and 38. Standards 33 and 38 were subject to good practice recommendations at the inspection carried out in April 2006. Quality in this outcome area is good. Service users benefit from a well managed home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager was registered with the Commission in January 2007, but had been in post since August 2006 as the head of care. She is a well qualified nurse and is currently working towards the Registered Managers Award. The newly appointed head of care, who is also a well qualified nurse, supports her. To assist the manager and head of care is a full time home’s administrator and
The Meadows DS0000062306.V338382.R01.S.doc Version 5.2 Page 25 receptionist. Six nurses have recently completed a leadership and development course to support staff in the home and management. In discussion with staff all felt that the home was well managed and run in the best interests of the service users. Service users spoken to were positive about the manager and her management of the home. All staff receive formal supervision at least six times per year. Policies and procedures are in place and the manager is part of the Policy Review group, which reviews and developed policies, procedures and the organisations documentation. The home has an annual business and development plan in place. Quality assurance processes are robust and it is evident that the views of service users, relatives and other stakeholders are sought on a regular basis. A copy of the home’s Statement of Purpose and Service Users Guide are displayed in the entrance hall as well as the most recent copies of the homes inspection report and action plans. Reports written by a provider representative, following monthly visits to the home, were available for examination by the inspector. A sample of records relating to health, safety and welfare were examined and found to be up to date and well maintained. The Meadows DS0000062306.V338382.R01.S.doc Version 5.2 Page 26 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 X X 3 X 3 X 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 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 4 4 4 4 4 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 The Meadows DS0000062306.V338382.R01.S.doc Version 5.2 Page 27 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Meadows DS0000062306.V338382.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Meadows DS0000062306.V338382.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
