CARE HOMES FOR OLDER PEOPLE
The Meadows 88 Louth Road Grimsby North East Lincs DN33 2HY Lead Inspector
Theresa Bryson Unannounced Inspection 6th January 2006 09:30 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 DS0000002822.V275831.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 DS0000002822.V275831.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Meadows Address 88 Louth Road Grimsby North East Lincs DN33 2HY 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) 01472 823287 Shire Care (Nursing and Residential Homes) Limited Mrs Marilyn Robinson Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places The Meadows DS0000002822.V275831.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12th July 2005 Brief Description of the Service: The Meadows is a 30-bedded care home providing care for people with general problems of old age. It is situated on one of the main roads into the fishing town of Grimsby, in a residential area, with access to local ameneties. The accommodation is on ground floor level and many rooms have en-suite facilities. There are adequate numbers of bathroom and toilet facilities. The home has a large communal dining room and several other sitting areas. There are gardens around the home and adequate car parking facilities. Staff working in the home have their own rest area and the manager her own office. There is also a kitchen with storerooms and a purpose built laundry area. The home has the advantage of belonging to a small local group of homes, with the support of other managers, who are also professionally trained nurses, as The Meadows manager and a Director of Operations who is also a nurse. The Meadows DS0000002822.V275831.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over one day in January 2006. To find out how the home was run and if the people who lived in the home were pleased with the care they got, the inspector spoke to the manager, some staff and some people who live there. Records kept in the home were also seen to make sure that the checks to make sure staff are safe to work in the home had been done. And that they had been trained to do their job safely. Paperwork was also looked at to make sure the home and the things in it were safe and checked often. The manager, Mrs.Robinson was present throughout the inspection visit. What the service does well:
The staff were friendly and very well presented in their uniforms. This gave the people who live there the confidence to be looked after. The home was clean and tidy and records showed it was a safe environment to live and work in. The information available to give to people before they come into the home was clearly written and available at all times. It gave a good overview of the services provided. The procedures written for staff to follow are in clear language and available for all staff to see and read. They covered all aspects of running the home and looking after the people who live there and those that are employed. The home ensure that all people who live there are included on the local electoral role and that they can exercise their legal and civic rights. The records showed that all adequate checks are made to ensure staff are safe to work with the people who live there and have updated training to meet the current needs of those people. The Meadows DS0000002822.V275831.R01.S.doc Version 5.1 Page 6 The company has a robust quality assurance system, which ensures it, and external companies audit the processes of the home on a regular basis. This ensures the people who live there that the home is safe. What has improved since the last inspection? What they could do better: The more service specific training could be more detailed and happen on a more frequent basis. The manager needs to ensure that this is included in the staff supervision records, so individual needs can be met. The owner of the company must ensure that an up to date business and financial plan is open for inspection to ensure that the company is planning and monitoring the home and is financially viable.
The Meadows DS0000002822.V275831.R01.S.doc Version 5.1 Page 7 The manager must ensure that all signatories for the residents fund only include names of staff currently employed to prevent fraudulent use of funds, 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 DS0000002822.V275831.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 DS0000002822.V275831.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): 1,2,4 and 5. The company provides comprehensive documentation to enable prospective service users to make informed choices about the home prior to admission. EVIDENCE: The home was able to produce a copy of the statement of purpose and service users guide, which are on display in the main reception area. This remains unchanged since the last inspection and it gives a good overview of the services provided by the home to enable prospective service users to make informed choice concerning their stay at The Meadows. Visits to the home are encouraged and there is no charge for a day’s stay in the home. This enables those coming into care to get a feel of living in the home. The staff training records showed that some service specific training had taken place in the last year, but this needs elaborating on the planner for the forth coming year.
The Meadows DS0000002822.V275831.R01.S.doc Version 5.1 Page 10 The Meadows DS0000002822.V275831.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): 10 and 11. Staff were seen to approach service users with dignity and respect, up holding their privacy, ensuring the service users were living in a calm environment. EVIDENCE: Staff were observed during the visit assisting service users with a variety of tasks. These were completed in a calm and dignity manner, up holding each person’s dignity and respect. The policy for looking after the dying person has just been revised by the Company. This covers all aspects of looking after a person at this time and gives the staff detailed procedures to follow for both expected and unexpected deaths. Thus ensuring each person is treated with respect and sensitivity. The Meadows DS0000002822.V275831.R01.S.doc Version 5.1 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 the following standard(s): 14 and 15. Staff ensure that procedures are in place to ensure that service users can exercise control and choice in their lives, depending on their specific needs. The home offers a varied menu to ensure that service users have a good nutritional balance in their daily meals. EVIDENCE: The company asks service users and their families to complete regular surveys to ensure they are receiving the correct services by the home. The last one was on food. This has enabled the home to provide a varied menu, with choices at each mealtime plus being able to provide for specific dietary requirements of each person and their individual likes and dislikes. Service users are also able to exercise their independence by making choices about their daily lives, what activities they want to partake in and how they want to decorate their own personal bedrooms. a variety of likes and dislikes are recorded in the care plans for each person, to ensure all staff are aware of each person’s wishes and specific needs.
The Meadows DS0000002822.V275831.R01.S.doc Version 5.1 Page 13 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): 17. Service users are encouraged to exercise their legal and civic rights to maintain their independence. EVIDENCE: The manager was able to produce a copy of who she has notified should be on the local electoral role, to enable service users to vote and exercise their legal and civic rights. A full set of policies was in place to assist staff with this task. Including policies on; - access to rights and records, rights to vote, advocacy and choice. At the time of the visit no one was using an independent advocate, but leaflets were available in the reception area. The manager was also aware that a couple of service users had power of attorney documentation, which was held by their family members. It was recommended that the manager ensures she knows the detail of this documentation in case a person’s condition deteriorated and she needed to access this information quickly. The Meadows DS0000002822.V275831.R01.S.doc Version 5.1 Page 14 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): 20.21.22.23 and 26. The home was clean and tidy and presented as a relaxed environment in which the service users could live. EVIDENCE: The manager accompanied the inspector on a brief tour of the building, where all communal areas were seen and a selection of bedrooms. Each area was clean and tidy and there was evidence that some redecoration had taken place. This in included a new main sitting room carpet and chairs and this area had been redecorated. The main corridor carpet was due to be replaced the following week. New folding doors had been put in place in the main sitting room to allow one area to be closed off if any service users were admitted who wished to smoke. The Meadows DS0000002822.V275831.R01.S.doc Version 5.1 Page 15 There was evidence in the individual rooms that service users were able to personalize their own space, which they said had helped them to settle into the home. The laundry is outside in the garden area, in a separate building. All equipment was in working order and the area was very clean and tidy. There appeared to be ample supplies of linen, which was all in a good state of repair. The staff meeting minutes stated that a problem had arisen with the use of disposable sacks for soiled linen, but the manager assured the inspector that since the meeting, no further occurrences had happened. A carer has now been assigned to check the water temperatures and these were seen to have been recorded on a regular basis. The home has a friendly and relaxed feel, making it a pleasant environment I which to live. The Meadows DS0000002822.V275831.R01.S.doc Version 5.1 Page 16 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 and 30. Service users needs are met by a competent and trained workforce, who have been checked to ensure they are safe to work with this client group. EVIDENCE: The staffing levels had been revised and the numbers on duty appeared to meet the needs of the current dependency of the service users. No issues were raised to the inspector during the course of the visit. There is also a manager or Director of Operations on call 24hours a day, seven days a week. There was only one vacancy as the time of the visit, for the Activities Organiser. This role was currently being managed by the staff group and there appeared to be no decrease in the activities being offered to service users. The amount of sickness appeared minimal as recorded on the duty rotas. This has ensured that there are enough staff on duty to meet the current needs of service users. 3 staff had completed their NVQ level 2 awards, 2 were still completing and 9 had recently put their names forward. The manager is aware of the target date for having 50 of staff completing NVQ and is currently now with a new training provider. The manager was able to present to the inspector a new training matrix and folder of staff training details. This has been a vast improvement since the last
The Meadows DS0000002822.V275831.R01.S.doc Version 5.1 Page 17 inspection. The inspector was able to track the detail of each training course, which staff had attended and what has been planned for the future. All mandatory training had taken place and records were now up to date. Also some service specific training such as stroke awareness and MRSA. This will ensure that the staff employed have been trained to meet the needs of current service users. The Meadows DS0000002822.V275831.R01.S.doc Version 5.1 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 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): 32,33,34,35 and 37. The company has a robust quality assurance system in place to ensure the home and the staff who work in it are safe to work with this client group. EVIDENCE: Minutes of recent meetings between service users and staff and the management team were seen. A variety of topics were discussed and there had also been provision for each group to voice their concerns. The managers in the Company also meet 6 weekly and discuss issues as a whole. All meeting dates had been fixed and were on display for 2006. The Company has its own quality assurance scheme and surveys all groups using the home on a regular basis. The last survey to service users was on meals. The home is currently working towards the Investors in People award. For staff, the managers were going to discuss job descriptions at their next meeting. The written evidence of staff meetings showed this type of topic for
The Meadows DS0000002822.V275831.R01.S.doc Version 5.1 Page 19 the managers meeting is later discussed with staff. The systems in place show the Company is looking to the best interests of service users by auditing its systems regularly and ensuring it is a safe environment to live and work in and meets current needs of service users. The responsible person must produce a revised business and financial plan to show the CSCI that they are currently aware of any needs the home may have and that it is financially viable. The manager stated that to her knowledge there were no bad debtors at this time. Records of the service users personal allowance funds were checked. 3 in detail. All appeared to be correct and showed that the manager audits these on a regular basis. Records were kept in a secure environment and accessed on a need to know basis only. The residents fund details were also checked and records of actual balances in cash and in the bank appeared to be correct. The manager must ensure that only staff employed by the home have access to these funds and the signatories need changing to ensure there is no fraudulent use of funds. A full set of policies and procedures are in place, some as individual policies and some in folder format. There was evidence that these are up dated on a regular basis, ensuring staff have sound and up to date procedures to follow. The Meadows DS0000002822.V275831.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 X 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 X X 3 3 3 3 X X 3 STAFFING Standard No Score 27 3 28 2 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 3 2 2 X 3 X The Meadows DS0000002822.V275831.R01.S.doc Version 5.1 Page 21 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. 1. 2. 3. Standard OP4 OP34 OP35 Regulation 18.1.c.i. 25.1. 25.1. Requirement The registered person must ensure that all staff receive service specific training. The registered person must have open for inspection an up to date business and financial plan. The registered person must ensure that only current members of staff manage the residents’ fund. Timescale for action 30/03/06 30/03/06 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard OP28 OP17 Good Practice Recommendations Continue to work towards a minimum ration of 50 trained members of care staff to NVQ level 2 by 2005. The manager is recommended to have all details on those service users whose families or others have power of attorney documentation. The Meadows DS0000002822.V275831.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 DS0000002822.V275831.R01.S.doc Version 5.1 Page 23 - 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!
