CARE HOMES FOR OLDER PEOPLE
The Meadows Nursing Home 94 Loughborough Road Thringstone Coalville Leicestershire LE67 8LR Lead Inspector
Lesley Allison-White Unannounced Inspection 19th July 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 Nursing Home DS0000001920.V304173.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 Nursing Home DS0000001920.V304173.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Meadows Nursing Home Address 94 Loughborough Road Thringstone Coalville Leicestershire LE67 8LR 01530 223800 01530 223833 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) Park Care Homes (No 2) Ltd Mrs Anne Elizabeth Pyecroft Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34), Physical disability over 65 years of age of places (34) The Meadows Nursing Home DS0000001920.V304173.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Room G9 to be used only as specified in detailed letter from the National Care Standards Commission dated 22 April 2002 15th September 2005 Date of last inspection Brief Description of the Service: The Meadows Residential and Nursing Home is a care home providing accommodation for up to thirty-four service users with Nursing needs. It is located in the village of Thringstone near Coalville, Leicestershire. The home can be accessed by car from Loughborough, Coalville and Ashby de la Zouch. Bus services run regularly through the village. Local beauty spots include Charnwood Forest and Bradgate park. The home is within easy access of the M1 and M42 motorways. The building itself is a modern purpose built property set in its own grounds and is located in a residential area. Accommodation is available on ground and first floors. A passenger lift provides access to the first floor. All areas of the home and grounds are accessible for people with limited mobility. Fees range from £412.50 to £681.78 per week. The Meadows Nursing Home DS0000001920.V304173.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care inspection is on outcomes for residents and their views of the service provided. The inspection took place on a Wednesday. It took seven hours to complete. This home provides care for up to thirty-four residents, there were thirty in the home on the day of inspection, some with a physical disability. Discussion was held with four residents. However other residents were observed in their daily routine. Three residents were spoken with in great detail. Four resident’s relatives were spoken with and a visiting friend of a resident. The primary method of inspection used was “case tracking”. This involved speaking to the residents who use the service provided, looking at three residents care plans, making observations, talking to them, observing care practices. All the required key standards were inspected during this visit. There were no areas of concern raised by the last inspection report. The Registered Manager and Assistant Manager were on duty during the inspection and facilitated this inspection. What the service does well:
No resident moves into the home without having their needs assessed and assured that these will be met. The three case files examined showed that there were individual plans of care that were explicit and gave clear instructions to staff about how care needs were to be fulfilled. There were thorough risk assessments carried out and cross referenced in the care plans. The inspector was able to talk to a visiting Community Nurse. The Nurse explained that she was able to leave instructions and have them carried out. Staff are allocated as escorts during the care visit. Staff will ask for advice on both Residential and Nursing residents to ensure good care practices and the staff were good at communicating any issues with the residents. The Meadows Nursing Home DS0000001920.V304173.R01.S.doc Version 5.2 Page 6 Residents spoke about the freedom of friends and family to visit whenever they wanted to. “These girls are very nice to us”. “Any problems go to **** don’t have to make an appointment home does it for you.” This was said when speaking about personal care appointments with external health care staff. “Everybody is approachable”. Relative’s comments included “Mum gets bathed every day, staff seem very friendly, nice bedroom, mum seems happy since she has been here, my brother and sister say the same” Mother stated “these (meaning the staff at the home) are good to me.” One relative stated that they saw a member of staff getting down on their knees to be able to communicate with some of the residents, the relative thought it to be a nice gesture. “The meals are good here”. Other relative’s comments included “staff here are quite good”. “Mum is in a safe environment”. “No smells from the dressing.” At previous places this had not been so. The five visiting relatives for different residents confirmed that they felt welcomed by the home and felt that if they were unhappy with the care their family member received they would know who to contact to make a complaint. Whilst balancing the clinical needs of nursing residents, the home provides a comfortable and homely environment. The management style of the home creates an open positive atmosphere. A regular monthly visit is done on behalf of the company to ensure that the home is being operated in a satisfactory manner. From observations of practice it is evident that the organisation creates equal opportunities for staff and residents. The staff are given feed back through their staff meetings of the quality assurance reviews of the service. Staff records for three people demonstrated that there had been full recruitment procedures including Criminal Record Bureau checks, induction and foundation training. Staff said that they had had induction shifts where they were supernumerary initially working with someone, supervision sessions took place every two months. What has improved since the last inspection?
The Meadows Nursing Home DS0000001920.V304173.R01.S.doc Version 5.2 Page 7 The staffs are given feed back through their staff meetings of the quality assurance reviews of the service. The Manager told the inspector that they had started an activities committee to which residents were invited although so far none had attended it. The Registered Manager told the inspector that there were organisational changes and already things were being improved. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Meadows Nursing Home DS0000001920.V304173.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Meadows Nursing Home DS0000001920.V304173.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. No resident moves into the home without having their needs assessed and assured that these will be met. EVIDENCE: As part of this key inspection process three residents were case tracked. Other residents and visitors also spoke to the inspectors. There had been a new admission and the there was evidence of a needs assessment carried out prior to admission. Other residents’ case tracked during this inspection also had their assessed needs documented in their care plans. There was evidence of other outside professional judgments, which formed part of the assessment process. The Meadows Nursing Home DS0000001920.V304173.R01.S.doc Version 5.2 Page 10 Some residents spoke of their admission process, as being direct from hospital with little involvement from them but on arriving at the home they were made to feel very welcome and the staff were able to meet their needs. The home’s Manager explained that some residents were offered a trail period before deciding if they wanted to accept a place at the Meadows Nursing Home this helped people to settle at the home better. The home does not offer intermediate care. (Standard 6). The Meadows Nursing Home DS0000001920.V304173.R01.S.doc Version 5.2 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 good. This judgement has been made using available evidence including a visit to this service. The home is successful in delivering appropriate care to individual residents. EVIDENCE: The three case files examined showed that there were individual plans of care that were explicit and gave clear instructions to staff about how care needs were to be fulfilled. There were thorough risk assessments carried out and cross referenced in the care plans. Health care needs were clearly identified and potential areas of risks such as pressure sores had been identified and successfully monitored and treated. Residents identified as being at risk of falling are routinely monitored by staff. Care plans (a written plan of how care is to be given) covering nutrition were in place, periodically residents weights were monitored and action taken to oversee dietary intake. It was a hot day and extra fluids were given or offered to the residents.
The Meadows Nursing Home DS0000001920.V304173.R01.S.doc Version 5.2 Page 12 The system for administering medication was checked and found to be satisfactory. A discussion took place about a residents name on the typed medication forms no mention of persons preferred name which is actually used every day, this could lead to confusion especially as there are no photographs in place yet. A Nurse spoken to was able to show the inspector that these measures were already being done and would be in place very soon. On discussion with the Registered Manager it was also mentioned that one of the residents case tracked did not have their allergies recorded on the medicine document. The Manager said that she would ask her Nurses to check that allergy details are recorded so that the Pharmacist can type these onto the resident’s medicine records. A blister pack (tablets sealed in foil) system for administering medications was used at the home. The controlled drugs system was checked and fine. One of the residents case tracked on large amounts of analgesia was able to talk happily to the inspector an appeared relatively pain free at periods during the day. “Night care very good there’s a pair of them that set me off laughing” This resident also told the inspector that they often asked for a cup of tea during the night and they fetched it for them. Residents spoke about the Dentist that will visit, Doctors, Chiropodist or Hairdressers. Residents told the inspector that when they went to the hospital the staff went with them whist they had their check ups and the said they felt well cared for. The inspector was able to talk to a visiting Community Nurse. The Nurse explained that she was able to leave instructions and have them carried out. Staff are allocated as escorts during the care visit. Staff will ask for advice on both Residential and Nursing residents to ensure good care practices and the staff were good at communicating any issues with the residents. From observations of care practices it was clear that staff treat residents with respect and sensitively ensure that privacy is given during personal care. The Meadows Nursing Home DS0000001920.V304173.R01.S.doc Version 5.2 Page 13 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home succeeds in meeting the identified daily and social needs and the outcome is positive for the residents. EVIDENCE: Residents spoke about the freedom of friends and family to visit whenever they wanted to. “These girls are very nice to us”. “Any problems go to **** don’t have to make an appointment home does it for you.” This was said when speaking about personal care appointments with external health care staff. “Everybody is approachable”. They spoke about the choices that they made for example bed time preferences or choice of meals, this was seen by the inspector as a member of staff went round with a menu in the morning asking residents to choose from the selection offered on that day. Two hot meals are offered each day but salads or other light choices are offered also. A hot sweet is usually offered. The inspector visited the kitchen and checked the records kept on fridge and freezer temperatures, cleaning programmes and records of menus. It was
The Meadows Nursing Home DS0000001920.V304173.R01.S.doc Version 5.2 Page 14 noted that the kitchen was very hot and the air conditioning units were broken. An engineer was later seen repairing them. The lunchtime meal was observed where the choices offered were served. A diabetic resident was offered a cold choice no hot choice being made available. Meal times were well organised but it was noticed that the waiting time between courses was longer than expected and more staff are needed at this time of the day as there are residents who need assistance so that they can enjoy their meals. A resident was seen being transferred in their specialised chair from the lounge to the dining room by a single carer. It was unclear how the residents legs were protected and secondly how does this comply with homes moving and handling policy. This is something that the homes Manager should address. During the inspection it was noticed that there were no planned activities in the morning but an activities person arrived after lunch and done paintings with the seven residents who wanted to take part. Some residents went in to the activity room independent of staff help. The Registered Manager explained that the home had recently employed an activities coordinator to organise activities everyday but that they were currently on annual leave. Residents told the inspector that they did go out on trips occasionally and there were photographs of activities with dates on but in the main not many activities took place on a daily basis. The Manager explained that staff members also gave their personal time to take residents out in the evenings on a one to one and the activity coordinator role was to be reviewed to encourage this. In the down stairs lounge music played in the background. Relatives comments included “Mum gets bathed every day, staff seem very friendly, nice bedroom, mum seems happy since she has been here, my brother and sister say the same” Mother stated these (meaning the staff at the home) are good to me.” One relative stated that they saw a member of staff getting down on their knees to be able to communicate with some of the residents, the relative thought it to be a nice gesture. “The meals are good here”. Other relative’s comments included “staff here are quite good”. “Mum is in a safe environment”. “No smells from the dressing.” The Meadows Nursing Home DS0000001920.V304173.R01.S.doc Version 5.2 Page 15 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has robust procedures for dealing with complaints and protection. Residents, relatives and staff spoken to knew who to go to and what to do if they had a complaint giving protection to the residents. EVIDENCE: The Commission for Social Care Inspection have received a recent complaint concerning the health and personal care of residents in the home. The Registered Manager has dealt with this issue. The inspector is satisfied with the manner in which this has been undertaken. The five visiting relatives for different residents confirmed that they felt welcomed by the home and felt that if they were unhappy with the care their family member received they would know who to contact to make a complaint. One case file evidenced that legal arrangements had been made regarding the affairs of the individual resident. On talking to four staff, all were able to fully demonstrate awareness and understanding of the Protection of Vulnerable Adult issues. One staff member explained that the company had a policy whereby a person can make a complaint anonymously. The details are posted in the staff room.
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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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a safe, hygienic and comfortable environment. EVIDENCE: Whilst balancing the clinical needs of nursing residents, the home provides a comfortable and homely environment. The lounges and other communal areas were clean and tidy although some areas of the home could be redecorated. A bathroom that the inspector saw had specialised equipment including an assisted bathing chair. The room was clean and tidy. Individual residents had their own wheelchairs as necessary. Footplates were noted on all wheelchairs for the safe use of residents.
The Meadows Nursing Home DS0000001920.V304173.R01.S.doc Version 5.2 Page 18 Bedrooms were seen. Residents had personal items of furniture and photographs in their rooms. Some rooms were spacious. There were no unpleasant smells in the home. All areas were clean and hygienic. The Meadows Nursing Home DS0000001920.V304173.R01.S.doc Version 5.2 Page 19 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a robust recruitment procedure. Supervision of staff at regular intervals ensures that the home provides a competent qualified staff team that meets the needs of and protects residents. EVIDENCE: Staff rotas were inspected and reflected good deployment of both nursing and care staff to meet the needs of current residents. Staff can be asked to cover days or nights. Additional staffing for meal times should be considered for the highly dependent residents. Staff in interview said that they had been given thorough training including health and safety, moving and handling, fire safety, person centred care, A training matrix was seen and many of the staff were either training or had already achieved a care qualification (a National Vocational Qualification) at level 2,3 or 4 (48 of the staff had achieved a care qualification). Staff records for three people demonstrated that there had been full recruitment procedures including Criminal Record Bureau checks, induction and foundation training. Staff said that they had induction shifts where they were supernummery initially working with someone, supervision sessions took place every two months.
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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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is being run in the best interests of residents. EVIDENCE: The management style of the home creates an open positive atmosphere. A regular monthly visit is done on behalf of the company to ensure that the home is being operated in a satisfactory manner. From observations of practice it is evident that the organisation creates equal opportunities for staff and residents. The staff is given feed back through their staff meetings of the quality assurance reviews of the service. The Manager told the inspector that they had started an activities committee to which residents were invited although so far none had attended it. The Registered
The Meadows Nursing Home DS0000001920.V304173.R01.S.doc Version 5.2 Page 22 Manager told the inspector that there were organisational changes and already things were being improved. Individual case records and the home’s required records were up to date, clear in their content and safely stored. Records concerning the health, safety and welfare of residents and staff were examined and found to be up to date and current. The home evidenced that service contracts and maintenance visits are completed for electrical, fire safety, water safety, specialist equipment, lifts and hoists. The home’s procedures for the management of domestic chemicals and cleaning materials are sound. Regular fire drills are held, emergency lighting checks are done and fire safety equipment serviced. Notifications are made to CSCI of accidents, incidents and events where necessary. The Meadows Nursing Home DS0000001920.V304173.R01.S.doc Version 5.2 Page 23 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 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 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 X X 3 The Meadows Nursing Home DS0000001920.V304173.R01.S.doc Version 5.2 Page 24 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 OP38 Good Practice Recommendations Safe moving and handling practices should be followed in the home. The Meadows Nursing Home DS0000001920.V304173.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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