Inspection on 04/04/06 for The Meadows

This inspection was carried out on 4th April 2006.

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

The inspector 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 26/06/07

The Meadows 13/10/05

The Meadows 28/04/05

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE The Meadows Britwell Road Didcot Oxfordshire OX11 7JN Lead Inspector Delia Styles Unannounced Inspection 4th April 2006 09:20 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.V288027.R01.S.doc Version 5.1 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.V288027.R01.S.doc Version 5.1 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 The Orders Of St John Care Trust Care Home 68 Category(ies) of Dementia - over 65 years of age (7), Mental registration, with number disorder, excluding learning disability or of places dementia (8), Old age, not falling within any other category (68), Physical disability (45), Terminally ill (5) The Meadows DS0000062306.V288027.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Condition 1 The maximum number of service users accommodated at any one time must not exceed 68. Condition 2 The maximum number of places that can be used to accommodate service users with nursing needs must not exceed 38. Condition 3 That the categories DE, MD and LD shall apply only to those service users transferred from the existing registered care home Ladygrove at Blue Mountains. Where proposed new admissions to the home do not come within the categories of service provided, OSJCT must apply for Variation to Registration. 13th October 2005 Date of last inspection 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 Meadows DS0000062306.V288027.R01.S.doc Version 5.1 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 Meadows was an unannounced ‘Key Inspection’, and was carried out by two inspectors, Delia Styles and Kate Harrison. The inspectors arrived at the service at 09.20 and were in the home for 8 hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s owner or manager, and any information that CSCI has received about the service since the last inspection. One inspector concentrated on the ground floor facilities, including the kitchen and laundry, and Bluebell unit, and the other inspector on the first floor – Poppy and Primrose units – that provide nursing care for residents. During the inspection, the inspectors looked at a sample of residents’ care records, medication records, and maintenance and health and safety information. Staff rotas, recruitment and training records and a sample of residents’ contracts were seen. The management of the home’s financial records was discussed with the home administrator. The inspectors spoke to residents, visitors and several staff and undertook a partial tour of the home. At the end of the inspection, they discussed their findings with the home manager designate and a Care Services Manager of The Orders of St John Care Trust. This was an unannounced inspection, and the home had only just received a request from CSCI to complete a pre-inspection questionnaire and selfassessment against the National Minimum Standards for Care Homes for Older People, and to distribute comment cards to residents for completion. So some information was not available until after the inspection visit and will be considered as part of the next inspection. The standards in this care home have improved since the last inspection. The report identifies some areas that need to be developed to ensure a good standard is maintained. What the service does well: Several residents spoke to the inspector about their experiences of life in the home, and commented very positively about the qualities of the staff. A comment card received from a relative said ‘the very careful nursing care and devoted day to day attention from the ‘carers’ has been and still is appreciated by [the resident’s] family’. The Meadows DS0000062306.V288027.R01.S.doc Version 5.1 Page 6 The accommodation is of a high standard with individual en-suite rooms, attractive communal rooms and gardens. The home has a good selection of equipment and facilities to meet the needs of residents. The home has good systems to manage any monies that it holds for safekeeping for residents. What has improved since the last inspection? What they could do better: The assessment process and the care plans for residents with nursing care needs should be more detailed to make sure that the home’s staff can give the level of care needed for residents with complex problems to make sure they are not put at risk. The home should assess residents’ dietary needs by using a system that is commonly used in other social and health care settings, and is a better way of helping staff find out whether residents are at risk of malnutrition and giving information about how to help residents to have a good balanced diet. Recommendations are made to make sure the medicine storage fridges are working properly so that medicines that need cool storage are not damaged. The home should make sure that stocks of unwanted or unused medicines are collected from the home regularly for safe disposal. Staff should always complete the records of medicines given to residents following good practice advice. The Meadows DS0000062306.V288027.R01.S.doc Version 5.1 Page 7 The nurses should regularly check the equipment used for measuring the blood sugar levels of people with diabetes to make sure it is working properly and that staff are using it correctly to get accurate readings. There should be clear evidence that the variety and timing of the activities provided at the home meet the needs of the residents. The residents and relatives responses to the food quality questionnaires and suggestions books should be followed up. The menu should be updated to show the recent changes to the supper menu. There should be enough food prepared to allow for residents to choose a different dish at mealtimes if they change their minds from their original choice. The home’s procedure for reporting and recording incidents where residents are considered to be at risk of harm or abuse should be improved so that all staff are aware of the actions needed to protect residents and staff. All the induction training for new care staff about good care principles needs to be completed within six weeks of them starting employment in the home. The number of staff and the way that they are allocated in the different areas of the home should be improved so that the same group of staff as far as possible care for the same residents. All staff should make sure that they follow the home’s policies and procedures about safe moving and handling when they are helping residents, so that they do not put the residents or themselves at risk of injury. The nurse unit leaders should have enough time to carry out their extra responsibilities that include going out to visit prospective residents who need nursing care before they are admitted to the home. Staff should not work a lot of hours with not enough time off between shifts, especially if they work a mixture of night and day duties, as this could mean they get over-tired and put themselves and residents at risk. The results of The Orders of St John Care Trust’s surveys about the quality of the home and the services should be shared with the residents and included in the information about the home given to people who may want to come and live in the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Meadows DS0000062306.V288027.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Meadows DS0000062306.V288027.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Standard 6 is not applicable, as the home does not provide intermediate care. Some pre-admission assessments in relation to residents’ care needs are adequate whilst others are of a poor standard. EVIDENCE: Bluebell Unit: The inspector looked at three pre-admission assessments and spoke to the residents about their experiences. The residents were satisfied that their needs were recognised prior to admission and the inspector was satisfied that the home’s records were appropriately completed. Primrose and Poppy Units: The inspector examined the pre-admission assessment for three residents with nursing needs who were unable to discuss their care or experiences because of their mental confusion. Staff said that in one case, the resident’s problems had been understated by the hospital where s/he had been a patient, and it The Meadows DS0000062306.V288027.R01.S.doc Version 5.1 Page 10 was now increasingly difficult for the home staff to manage to give the level of care and supervision this individual needed. For another resident, there were concerns about their wellbeing and safety that had not been adequately documented in their care plans available to staff, so that potentially staff and the resident are at risk. The third resident requires a liquid diet and the lack of detail in the care plans for this person indicated that the pre-admission assessment information was insufficient. The Meadows DS0000062306.V288027.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The way in which the health and personal care needs of residents are met in the home is adequate. EVIDENCE: Bluebell Unit: The inspector saw three care plans and discussed care with five residents. The residents said they felt that staff understood their needs and that they were well cared for. The staff and residents had appropriately completed the care plan records, and staff regularly reviewed the care plans. The inspector understood from residents that they were happy with how their health care needs were met in the home. The district nurse was contacted as necessary and the inspector noted that the needs of one resident with diabetes were met, through help from the district nurse and visits to the diabetes clinic. The inspector discussed medication issues with the shift leader and checked how the medication for three residents was managed. The receipt, administration and disposal of medication, including controlled medication, are The Meadows DS0000062306.V288027.R01.S.doc Version 5.1 Page 12 appropriately recorded. The staff who manage medication have recently attended medication training. Primrose and Poppy Units: The inspector looked at three care plans and discussed care with two residents. The standard of care records has improved significantly since the last CSCI inspection, with regular reviews and more evaluation of the care given. However, there were still important omissions about residents’ care needs in the sample seen – for example, a resident with an eye infection had no care plan for this problem. Another resident, who is very confused, had no care plan with suggested actions to be taken by staff to reassure and help the person make sense of their surroundings. There was no accurate record of the extent of bruising recorded as having ‘big bruises on back and hip’ resulting from a fall in the home: the person was assessed as being at risk of falls and had had 3 falls within a fortnight (these were appropriately recorded in the home’s accident records). This resident’s mobility had deteriorated but their care plan had not been updated to inform care staff of the safest way of helping the resident to stand and walk with their help. The same resident had lost 3Kg in weight in a month. Staff were monitoring the individual’s dietary intake and recording this on a food chart. The care plan stated that the resident needed a ‘supplementary diet’ but it was not evident that this was being provided. There was evidence to show that staff had alerted the doctor to the resident’s poor nutritional intake and were awaiting a visit that day for a care review to be undertaken by the doctor. The home still uses a basic nutritional assessment tool included in a commercially produced care plan system. Staff had not completed an important part of the nutritional assessment – measuring residents’ Body Mass Index (BMI) – that can be an accurate indicator of risk of malnutrition. The recommendation for the home to use the nationally validated nutritional assessment tool – for example, the Malnutrition Universal Screening Tool (M.U.S.T)- made at the last inspection, has not been implemented. One resident did not feel satisfied with their doctor’s care and complained that some of the home’s care staff did not wash them properly. By contrast, another person was very happy with the care and attention s/he received. There was evidence of appropriate provision of disability aids and equipment – such as adjustable height divan beds and pressure relieving air mattresses and continence aids. A new standing aid hoist has been purchased. The medicine storage and administration records were looked at in Primrose Unit. The clinical rooms and medicine storage areas were tidy and securely locked. The Medicine Administration Records (MARs) were mostly correctly completed, with some exceptions where a nurse had been requested by the doctor to alter The Meadows DS0000062306.V288027.R01.S.doc Version 5.1 Page 13 the medication instructions and had hand-written the changes without having a second nurse to check and countersign the amendment. The nurse in charge said that all staff were aware of this good practice safeguard and this was a lapse in their usual practice. The medicine fridge has an integral thermometer. The inspector checked the temperature of the fridge using her probe thermometer and found the temperature to be above the recommended safe storage temperature range 2º-8ºC - for medicines requiring cool storage conditions and considerably above the temperature displayed on the fridge integral thermometer. The fridge needed defrosting, which may have affected its efficiency. The temperature should be regularly monitored to ensure it is functioning properly. The unit has 2 unused sets of equipment (glucometers) to test the blood sugar levels of residents with diabetes. The nurse said they use a glucometer supplied by the dispensing chemist. This equipment is not regularly calibrated and so staff cannot be confident that it is registering the correct blood sugar readings. It is important that all blood glucose monitoring equipment is maintained and calibrated correctly because the doctor and specialist nurses rely on accurate readings when prescribing insulin or oral medication to maintain residents’ blood sugar within the correct range to avoid complications of diabetes. It is strongly advised that all nursing staff are trained in the use of the blood glucose testing system that they have in store, and that is used by local NHS healthcare facilities, to ensure accuracy and consistency. There was an accumulation of controlled drugs (CDs) in the CD cupboard that were no longer required, and were awaiting collection for safe disposal. The nurse explained that the pharmacist supplied limited amounts of the deactivating product that renders the drugs harmless, before it can be returned to them for disposal. The home’s nursing units should have a contract with a specialist waste disposal centre to collect unwanted and unused medication from the home on a regular basis, to avoid building up a backlog of stored medication. The manager confirmed that she would look into this matter and arrange for collection. There are no shared rooms. During the inspection staff were observed to have good relationships with residents and treat them with respect and residents confirmed this. Residents have access to payphones that they can use in private. The manager told the inspectors that privacy and dignity issues are explained at induction for new staff, and the induction programme shows that the principles of care are discussed on Day One of the corporate induction. The Meadows DS0000062306.V288027.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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. The arrangements made by the home to provide suitable social and recreational opportunities for residents and to provide a varied, appealing and nutritious diet are adequate. EVIDENCE: The activities coordinator employed also works as a care assistant in the home and undertakes some training for staff in health and safety. It was not clear whether the activities coordinator has received specific training for their activities coordinator role. Since the last inspection, there has been some improvement made in the allocation of a staff member to organise and help residents in the nursing units to participate in organised activities on weekday afternoons. The minutes of a recent residents’ meeting showed that more outings had been requested: the home managers acknowledged that this was something that they hoped to provide but that more volunteers were needed to accompany residents on outings. The inspector saw the record of activities attended by residents covering part of the two weeks previous to the inspection. It showed that no activities were provided at weekends for residents and that few of the activities provided were The Meadows DS0000062306.V288027.R01.S.doc Version 5.1 Page 15 well attended. Some residents enjoy joining in exercise groups run in the Day Centre in the home. Residents’ care plans contain little information about their past hobbies and interests and what activities and social events they enjoy in the home. A comment card received from a relative was positive about the improvement in a resident’s ability to communicate (non-verbally) again since coming into the home, despite their reduced mental capacity, but the resident’s care plan did not reflect the extent to which the relative’s visits and contribution to care, together with the home’s care staff has helped to meet the resident’s needs. One resident told the inspector that he would like to go out more. Staff said that this person was often offered the opportunity to go out, but s/he usually declined. It was agreed that staff would explain and plan with the resident in advance so that they would know what to expect and may feel more confident about getting out and about more in the gardens. The home’s policy on visiting does not impose unreasonable restrictions on visitors to the home, and several visitors were in the home on the day of inspection. The front door is locked with a number code device for security and the protection of residents. The inspector saw the menu plans for the months January to March 2006, showing that three hot meals a day are offered to residents (breakfast, lunch and tea), plus a choice of snacks for supper. However the minutes of a recent residents and relatives meeting showed that about 50 of the food served is returned untouched and so a decision was made to offer only a drink and cake or biscuit to residents at suppertime. One inspector observed lunchtime in the Bluebell dining room, where some residents had chosen to have a glass of wine with their lunch. Residents told the inspector that the food was usually good, and one resident said that ‘at times it is excellent’. On Primrose Unit, two residents refused to eat the fish pie, served with green beans and mashed Swede, at lunchtime. The alternative dish was chicken casserole, but the staff were reluctant to immediately offer this to the two residents in case there was not enough to serve those who had ordered the casserole. The nurse explained that residents on the nursing units often forgot what they had ordered the day before or decided they did not want it on the day. It appeared that the amounts of food provided were just adequate for the number of residents and would not cater for any changes to the original selections. This indicated that more flexibility with portions and choices is needed so that last minute changes by residents are more easily accommodated. One resident spoken with said that the food was ‘not good at all’ in their opinion. There was evidence that the home is now routinely asking residents The Meadows DS0000062306.V288027.R01.S.doc Version 5.1 Page 16 for their opinions about the food and inviting comments from visitors too, and following up on concerns. The Meadows DS0000062306.V288027.R01.S.doc Version 5.1 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s complaints procedure and the systems in place for ensuring staff have training in adult protection issues are adequate. EVIDENCE: The home’s policy on addressing complaints was displayed in the home’s foyer, showing that complaints are taken seriously and addressed within 28 days. Residents told the inspector that they knew whom to address concerns to, but one visitor told the inspector that she had concerns about the care of her mother and was not certain how to address the issues. There have been no complaints received by the home or by CSCI since the last inspection. An inspector noted from the care records of a resident that there had been a recent incident of verbal and physical abuse of a resident in the home that had raised further concerns about their wellbeing and safety at times when they receive a visitor. The nurse unit leader was unsure whether the adult protection adviser had been informed of the incident in line with the Oxfordshire Adult Protection procedures. Staff on duty at the time had alerted the duty social services care manager and the home manager. CSCI had not received notification of the incident as required under regulations. This was pointed out to the manager and a written notification was submitted to CSCI. The resident’s care plans did not identify the potential risk for the resident and The Meadows DS0000062306.V288027.R01.S.doc Version 5.1 Page 18 the agreed staffing action to be taken to reduce the risk of further incidents. There was no written record of the incident in the home’s accident/incident record. It is important that all the home’s staff are aware of the lead role of Social Services in investigating allegations of abuse and the importance of maintaining accurate and contemporaneous records of untoward incidents and the actions taken by staff to protect vulnerable adults, their staff colleagues and visitors to the home. The Meadows DS0000062306.V288027.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The internal and external environment of this home is good. The home is clean, hygienic and free of unpleasant odours. The home provides attractive and comfortable accommodation for the residents. EVIDENCE: The building was purpose built and completed in 2004. The inspector visited the kitchen and laundry areas and saw all areas of Bluebell wing, including private and communal areas. The inspector also spoke to the cleaning supervisor who maintains a thorough cleaning schedule. All areas were clean and well kept and several residents told the inspector that they liked their surroundings, especially their rooms. The inspector visited the home’s laundry and was satisfied that the appropriate equipment is in use to minimise the spread of infection. Staff confirmed that The Meadows DS0000062306.V288027.R01.S.doc Version 5.1 Page 20 they had adequate supplies of protective clothing – disposable gloves and aprons – for use when carrying out personal care for residents. The Meadows DS0000062306.V288027.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff in the home are just adequate to meet the needs of residents in the home at the time of the inspection. EVIDENCE: The manager designate reported that approximately 15 new staff had been recruited since she took over in January 2006. All staff had been asked if they would be willing to cover shifts for colleagues’ absences so that the manager now has a list of staff who can be called upon before using agency staff. This has reduced the need to use agency staff, so that residents are cared for by the home’s own staff wherever possible. One resident on Primrose Unit told the inspector that there were too few staff and said that because so many did not speak English as their first language, they did not understand his or her requests or conversation. There was evidence that staff also have expressed concerns about there being too few staff, especially on Primrose Unit: although there are fewer residents, many of them are dependent and need two carers to help them. The allocation sheets showed that some carers work for an hour on one unit and then on another in the morning shift. Minutes of the staff meeting show that care staff have requested to alternate between Poppy and Primrose units as one is perceived as busier than the other and Poppy has more residents. Care staff The Meadows DS0000062306.V288027.R01.S.doc Version 5.1 Page 22 provide direct personal care to residents and also assist with meals and drinks service to residents. One care staff member is allocated to help with activities with residents on weekday afternoons on Primrose unit. It is important that the deployment of staff is done in such a way that individual resident’s care needs are understood and met fully, and that residents have continuity of care. Since the last inspection, the management structure in the home has changed and two registered nurses have been appointed as Unit Leaders to the nursing wings. The role of the Unit Leaders means that they need additional time away from direct care of residents in order to advise and supervise staff, assess prospective residents with nursing needs before they are admitted to the home and liaise with the home manager. No supernumerary time is indicated for the Unit Leaders on the sampled week of duty rota: one Unit leader was scheduled to work a total of 60.45 hours and the other 48.30 hours. They both worked a night duty as well as daytime shifts in the week. The inspector considers that there is currently too little supernumerary time allocated for the Unit Leaders and the total hours worked are excessive. The inspector randomly assessed the personal files of three members of staff. All the files contained evidence that all the required recruitment checks had been made and were satisfactory. The home has an induction procedure for new staff, which includes training at the Trust’s office away from the home. The home’s policy states that the Trust training will take place within the first three months of employment, and the inspector is concerned that as the topic ‘Understanding the Principles of Care’ is discussed during the Trust training, that the length of time working at the home without this training may be excessive. The inspector recommends that all the induction training regarding care principles be undertaken and completed within six weeks of starting employment. Staff are encouraged to start NVQ Level 2 training and the induction process is linked to the NVQ training. The manager told the inspector that 18 carers are undertaking NVQ Level 2 training at present. By the autumn when all have completed the training, the home expects to meet the minimum ratio of 50 trained members of care staff, excluding trained nurses. The Meadows DS0000062306.V288027.R01.S.doc Version 5.1 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management approach and organisation of the home are adequate and the home promotes the safety and welfare of the residents. EVIDENCE: The Orders of St John Care Trust (OSJCT) has appointed a manager who has considerable experience in managing care homes for older people and has been the registered manager for another OSJCT home in Oxfordshire in the past. The OSJCT has proposed that she applies to the CSCI and completes the required assessment process, to become the registered manager for The Meadows. The manager said that she feels well supported by all the staff and they have worked well as a team since she took over as manager in January this year. The Meadows DS0000062306.V288027.R01.S.doc Version 5.1 Page 24 There is evidence of regular meetings between the manager, staff, residents and relatives. Several staff told inspectors that they felt ‘things are slowly improving’ and that communication with each other and management has got better. The home has introduced a programme of quality assurance measures that includes regular audits, and questionnaires to residents and their representatives about their views about the home. There are no published results of the quality surveys available to residents or prospective residents, or CSCI, to date. Residents and any interested parties should be provided with information about service users’ views of the home in the ‘service users’ (residents) guide. The inspector discussed the home’s financial and accounting systems with the home’s administrator. There is evidence that where the money of individual residents is handled, that the home has good systems in place to make sure that proper records and receipts are kept up to date. The home has a recently updated policy statement for maintaining safe working practices, showing that staff are expected to take part in the health and safety training provided by the home. Mandatory training is provided during induction, including first aid, infection control, administration of medication, food hygiene, moving and handling and adult protection. The home is said to operate a ‘no-lifting’ policy: staff must use hoists or mobility aids when assisting residents, to avoid injuring themselves or residents. This should be highlighted to all staff as an inspector observed one incident of poor moving and handling of a resident without the use of appropriate equipment. The inspector brought this to the attention of the senior member of staff on duty. The fire records show that checks are appropriately carried out, including weekly fire system testing but only one fire lecture was provided for staff in the year ending December 2005, when staff should have attended two. The member of staff responsible for fire safety checks told the inspector that two lectures were planned for the present year. The inspector saw the home’s contracts with gas and water companies to maintain the safety of equipment and both had recent certificates. The Meadows DS0000062306.V288027.R01.S.doc Version 5.1 Page 25 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 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 3 17 X 18 2 3 X X X X X X 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 2 X X 2 The Meadows DS0000062306.V288027.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? NO 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. 1. Refer to Standard OP3 Good Practice Recommendations Improve the standard and detail of pre-admission assessment of residents, particularly those with nursing needs, to demonstrate that the home can meet the assessed needs of all individuals admitted to the home. Continue to develop and improve residents’ care plans to ensure that they are accurate and up to date. Improve the information about how residents’ social and psychological care needs will be met. * Use an evidence-based nutritional assessment such as the MUST tool, to accurately identify and treat those residents who are at risk of malnutrition. * Use the blood glucose monitoring equipment that is available in the home that provides additional calibration safeguards, to ensure consistency and accuracy of results. * Staff should always follow good practice guidelines when requested by a doctor to make handwritten amendments DS0000062306.V288027.R01.S.doc Version 5.1 Page 27 2. OP7 3. OP8 4. OP9 The Meadows 5. OP12 6. OP18 7. OP27 8. OP30 9. 10. OP33 OP38 to residents’ Medication Administration Record sheets. * There should be reference to additional records kept when prescribed skin preparations or eye drops are administered at times other than shown on the residents’ MAR sheet, so that staff can demonstrate that the prescription has been followed and the treatment can be evaluated. * The home should ensure that the correct systems are in place for the collection and safe disposal of unwanted or unused medication from the home. The timing and variety of individual and group activities organised for residents should be further developed. Residents’ individual preferences and wish to participate in activities should be discussed and recorded in their care plans. Improve the procedure for the reporting and recording of all allegations and incidents of abuse in accordance with local Protection of Vulnerable Adults (PoVA) guidance and CSA regulation. Improve the number and skill mix of staff in the nursing units to allow sufficient supernumerary time for Unit leaders to carry out their role effectively. The total hours and alternation of night and day duties worked by staff should be monitored and reduced, so that residents and staff are not put at risk by overtired staff. All new staff should receive induction training to the National Training Organisation specification, including training on the principles of care, within 6 weeks of appointment to their post. The OSJCT should publish the results of quality assurance surveys and make them available to residents and other interested parties in the Residents (Service Users) Guide. Staff should adhere to the home’s ‘no lifting’ policy and use the correct moving and handling techniques and equipment to protect residents and themselves from injury. The Meadows DS0000062306.V288027.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South, Cowley Oxford OX4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Meadows DS0000062306.V288027.R01.S.doc Version 5.1 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. 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