CARE HOMES FOR OLDER PEOPLE
Meadows Nursing Home, The 656 Birmingham Road Spring Pools Bromsgrove Worcestershire B61 0QD Lead Inspector
Sandra J Bromige Unannounced Inspection 23rd May 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 Meadows Nursing Home, The DS0000004124.V291798.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. Meadows Nursing Home, The DS0000004124.V291798.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Meadows Nursing Home, The Address 656 Birmingham Road Spring Pools Bromsgrove Worcestershire B61 0QD 0121 453 5044 0121 453 0212 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) Worcestershire Care Group Limited Mrs Dorothy Mutsvanemoto Care Home 36 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (36), of places Physical disability over 65 years of age (36), Terminally ill (4) Meadows Nursing Home, The DS0000004124.V291798.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The Home may also accommodate three persons under 65 years with a learning disability. The Home may also accommodate a maximum of three people aged between 55 - 64 years with a physical disability. The Home may also accommodate 1 person aged between 50 - 64 with a physical disability. 21st November 2005 Date of last inspection Brief Description of the Service: The Meadows Nursing home is one of two homes owned by the Worcestershire Care group. It is registered to accommodate a maximum of 36 residents. The home is divided into three units, Pine, Beeches and Willows. Pine and Willow units are on the ground floor and the Beeches unit is located on the first floor and caters for residents who have dementia related illness. A passenger lift provides access to first floor rooms. With the exception of one bedroom all rooms are single occupancy. The home is situated in a rural setting near to the Lickey Hills and is also only five minutes from the motorway. The current range of fees is £520 - £615 per week. Meadows Nursing Home, The DS0000004124.V291798.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over 1 day by 2 Inspectors. The purpose of this inspection was to assess the outcomes for residents against the key National Minimum Standards. Information to inform the inspection has been sought from many sources. The Commission gathers information from the date of the last inspection to inform the next inspection. This information comes from notifications that the home sends into the Commission including the monthly visit reports from the Provider and/or a representative of the organisation, any concerns, complaints or allegations, written feedback from relatives and a visit to the home. The Commission has received one complaint since the last inspection. This was passed to the home to investigate and the records seen during this visit show that it was dealt with appropriately by the home. The home has reported a recent allegation of alleged physical abuse. Correct procedures have been followed by the home including reporting the incident using the local procedures for Protection of Vulnerable Adults. A thorough investigation has been carried out including appropriate disciplinary action in relation to the staff member concerned. All staff were very pleasant and most helpful throughout the visit to the home. What the service does well:
Prospective residents are assessed prior to admission to ensure that the home is able to meet their individual care needs. Written feedback from a relative of a recently admitted resident confirms that they were “able to visit the home twice before making a decision and found it to be efficient and friendly and received a folder with information about all aspects including copy of compliments, comments and complaints forms”. Care records are in place for each resident providing staff with the information they need to enable them to meet the individual residents needs. Residents seen appeared well cared for and many pleasant exchanges were seen to take place between staff and residents. Residents who have dementia related illnesses were not able to give any meaningful comments on their care. Observation of these residents indicated that they were showing signs of well being as they were making contact with the staff, showing signs of warmth and affection, a sense of humour and enjoyment and pleasure from being with the staff. Written feedback from a relative confirms, “they are very happy with the care”. Periodic internal reviews are carried out for each resident with the involvement of the resident, manager, key workers and the residents’ next of kin. An action plan is developed according to the outcome of the discussions.
Meadows Nursing Home, The DS0000004124.V291798.R01.S.doc Version 5.1 Page 6 The medicine charts were clear and well documented. This means that there is a record to show that medicine prescribed by a General Practitioner (GP) for a resident is recorded. In addition there were good procedures and double checks in place to make sure that all residents received the correct medicine at the right time. Residents’ privacy is respected. Relatives can visit at any time and see the residents in the privacy of their rooms. Residents receive a good quality varied diet and residents are consulted regarding food preferences and choice of menu. The home is generally clean & tidy and the management of odours is good. Residents are able to bring some of their own personal possessions into the home. A good range of equipment is provided such as ceiling hoists, electrically operated height adjusted beds, manual handling aids and small equipment to help residents to eat their meals e.g. plate guards. Residents have access to a robust, effective complaints procedure and are protected from abuse. The deployment & numbers of staff on duty in the home are sufficient to meet the needs of the residents. Residents were complimentary about the staff in the home. The procedures for the recruitment of staff are robust offering protection to people living in the home. The arrangements for the induction of staff are good with the staff demonstrating a clear understanding of their roles. Staff are trained to fulfill the aims of the home and meet the changing needs of the residents. The management and administration of the home is based on openness and respect, they have an effective quality assurance system and a qualified and competent manager in post. The homes records for the management of residents’ monies are transparent and auditable safeguarding residents financial interests. The health, safety welfare of residents, staff & visitors to the home are promoted and protected. What has improved since the last inspection?
A new format for the planning and recording of individual residents care needs has been implemented. There has been considerable improvement in the standard and quality of the information provided in the care records. There has been considerable improvement in the overall control and management of medication within the home with good practice evident in many areas. Ceiling hoists have been installed into 5 further bedrooms for the manual handling of residents. There is an ongoing programme of redecoration, which
Meadows Nursing Home, The DS0000004124.V291798.R01.S.doc Version 5.1 Page 7 includes the lounge, conservatory and the bedrooms. The inner courtyard has been repaved and railings have been fitted to the large courtyard. Radiator guards have now been fitted to all radiators. The organisation has introduced an induction study day for new staff in addition to their current induction programme. What they could do better:
Care plans must be put into place when an acute problem is identified such as a chest infection or residents need regular pain relief, so that all staff are aware of the care that is needed and it ensures a consistency of care. Moving and handling risk assessments must be completed upon admission for all residents and reviewed every month. Staff must make sure that service users who are prescribed a short course of medicine e.g. antibiotics receive the complete course as prescribed by a GP. The curtains between the beds in the shared room must be altered to ensure that the resident in the bed nearest the door has her privacy maintained at all times when staff are carrying out personal care. The activities provided by the home must be reviewed in consultation with the residents and/or their relatives. Social activities need to be recorded in the relevant part of the care plan each day. Condiments should be provided for residents at mealtimes. When staff are assisting residents to eat they should only assist one resident at a time and should not interrupt the meal to go and answer the telephone. The menus should be reviewed in consultation with the residents. The staff rota should include the manager’s hours, the full name & designation of the staff and who is on call out of hours and at weekends. Training records should be kept up to date and should include the course content and duration. The homes records of expenditure for residents personal monies should have two staff signatures for all entries and the ledger and receipts should be numbered to ease the process of auditing these records. The foam lagging on the hot water pipes must be secured to prevent residents removing the foam and reduce the risk of them being burnt. Wash bowls must be thoroughly washed and dried after each use. Commode pots must not be stored on the floor in the sluice areas and hand washing facilities should be provided in the identified sluice on the first floor.
Meadows Nursing Home, The DS0000004124.V291798.R01.S.doc Version 5.1 Page 8 Lids should be provided for all rubbish bins. The use of bolts on the outside of toilets, bathrooms & offices around the home should be reviewed as a resident or staff member could become locked in a room. Footrests on wheelchairs must be used when transporting residents at all times. The homes fire risk assessment must be reviewed. 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. Meadows Nursing Home, The DS0000004124.V291798.R01.S.doc Version 5.1 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Meadows Nursing Home, The DS0000004124.V291798.R01.S.doc Version 5.1 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home makes available to prospective residents and their representatives information needed to enable them to choose a home which will meet their needs. They have their individual needs assessed by the home prior to admission so that the home can ensure that they are able to provide the care required. Residents are given a contract which clearly tells them about the service they will need. EVIDENCE: Care records of a recently admitted resident show that a comprehensive preadmission assessment was carried out prior to admission to establish if the home could meet the residents care needs. This assessment was used to form the basis of the care plan. Information about the home and the service it offers including the terms & Conditions of stay are provided in all of the bedrooms.
Meadows Nursing Home, The DS0000004124.V291798.R01.S.doc Version 5.1 Page 11 Contracts were in place for all residents’ records seen during this visit. Meadows Nursing Home, The DS0000004124.V291798.R01.S.doc Version 5.1 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a clear and consistent care planning system in place that provides staff with the information they need to enable them to meet the individual residents needs. The health needs of residents are well met with evidence of consultation of other healthcare professionals taking place on a regular basis. The service has a comprehensive medicine policy that reflects good practice and staff can identify through records exactly what has been given to residents. This means that residents’ medicines are stored safely and that the majority of records show that the right medicine has been given to the right resident at the right time. The principle of respect & dignity are put into practice. The curtains between the beds in the shared room do not fully protect the resident in the bed nearest the door. Meadows Nursing Home, The DS0000004124.V291798.R01.S.doc Version 5.1 Page 13 EVIDENCE: Four care records were seen. The new format for care planning has been implemented since the last inspection. Overall the care plans were clear and informative identifying the individual care needs of the residents. Some further improvement is needed as an identified care record did not have a care plan in place for two acute areas of need. With the exception of one care plan they were being reviewed each month. Agreement to the content of the care records has been sought from the resident or their next of kin. Risk assessments are in place for skin integrity, nutrition, manual handling, falls and other risks specific to the individual resident. Some further improvement is needed with the care records to ensure that all areas including the risk assessments and care plans are being reviewed each month. Social care plans are in use and daily activities should be recorded for each resident, although this is not happening in all records seen. A good range of equipment is provided to maintain skin integrity and for manual handling. A keyworker system is in place. Care staff have access to the care records to enable them to know what to do for each resident. Care staff spoken with had a good knowledge of the care needs of the residents. The medicine policy was detailed and reflected how medicines are handled in the home. The receipt, administration and disposal of medicine were recorded including the date of opening of medicine containers. This means a full medicine audit could be done to ensure that medicine had been given to residents as prescribed by the GP. The majority of the audits done were accurate, however the medicine records for two residents on a short course of antibiotics showed incomplete documentation. This means that the health and welfare of residents on short courses of antibiotics could be at risk of not receiving the full prescribed course. Nursing staff can call in a General Practitioner to review residents’ medicine on a regular basis. The General Practitioner is asked to document any medication changes or information relating to the healthcare needs of residents in the care plans. This is noted as good practice. Four residents care plans were looked at. All of the care plans were up to date with current medication details. The privacy & dignity of residents was observed as being respected by all staff seen during the visit. The shared bedroom has privacy curtains, although they do not totally enclose the bed nearest the door. Meadows Nursing Home, The DS0000004124.V291798.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. Residents are able to keep in contact with family and friends. Social & recreational activities do not meet all residents’ needs & expectations. Residents receive a good quality varied diet and residents are consulted regarding food preferences and choice of menu. EVIDENCE: The home has 2 full time posts for Activity Co-ordinators. One post is currently vacant and the other post is held by someone who has been off sick since April 2006. Monthly activity meetings are held by the manager with the staff, as care staff are assisting to co-ordinate activities in the home in the absence of a designated Activity Co-ordinator. During the time of the visit to the home residents were observed watching television in the lounge area or in the privacy of their bedroom. Appropriate music was playing in the communal areas. A number of residents in one unit were engaged in a group activity in the morning and in the afternoon. Feedback from residents report that there are insufficient activities taking place and some activities are not suitable. Meadows Nursing Home, The DS0000004124.V291798.R01.S.doc Version 5.1 Page 15 Social care plans are in place for residents giving an outline of the residents background, meaningful people in their life and identifying their individual interests and hobbies. There is an area in the care records for recording social care, but this is not being completed each day for all residents’ records seen during this visit. Reviews of care including social care needs of residents are formally discussed at internal care reviews. These reviews are done with the involvement of the resident and/or their representative. A recent care review of an identified resident highlighted the need for more activities within the home and to access facilities in the community. This is being actioned by the home for this resident. Visitors are made welcome at the home. Regular group meetings are available for relatives to attend in the home with minutes recorded and made publicly available. Residents’ relatives are also consulted about the service as part of the homes system of measuring the quality of the service provided. Menus are seasonal and consist of a 4-week rolling menu. Residents have a choice of 2 main courses each day; there is also soup, salad & sandwiches available in addition every day. Residents are offered a choice of meals by the care staff, which is also available in a pictorial format. This is good practice. When residents are admitted to the home they are asked about their individual likes and dislikes of food and then periodic consultation of residents takes place regarding the menus provided. On the day of the visit residents were observed eating lunch in one of the dining rooms or in the privacy of their bedroom. Tables were laid for lunch, although there were no condiments on the table. Blue aprons were being used on residents to prevent spillages on their clothes. Lunch was served at 12.30 hrs and was chicken a la king or cornish pasty with potatoes, frozen swede & green beans, with a desert of strawberry & coconut sponge & custard. Meals were of an adequate portion size. Staff were observed sitting next to residents assisting them to eat & talking to them making it a social occasion. In another part of the home, staff were also observed assisting residents to eat and getting up to help another resident in the room and also being called away twice to the telephone whilst assisting a resident to eat. This is poor practice. In the same unit meals were being portioned by the care staff in the kitchen from the hot trolley and then taken to the resident on a tray uncovered, thus not preventing the food from loosing its heat before it gets to the resident. A tray of puddings was brought into the lounge by a carer uncovered and a skin had formed on the top of the custard. Some residents were observed to eat all of their lunch & pudding and some to eat only a portion of it. Comments received about meals varied and overall indicated that the food was not bad, but could be better. Meadows Nursing Home, The DS0000004124.V291798.R01.S.doc Version 5.1 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. Residents have access to a robust, effective complaints procedure and are protected from abuse. EVIDENCE: The homes complaints record show that they have received 2 complaints since the last inspection. Appropriate investigations had been carried out by the home in response to the complaints with records of the complaint maintained. Residents spoken with were aware of the homes complaints procedure and felt able to use if the need arose. Staff spoken with had all received abuse training and indicated that they would report any concerns they had to the manager. A recent adult protection issue has arisen in the home and the manager took appropriate action in reporting and dealing with this incident. Meadows Nursing Home, The DS0000004124.V291798.R01.S.doc Version 5.1 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. Further improvement to the décor and parts of the home is needed to improve the appearance and safety of the environment for the people living and working there. EVIDENCE: The accommodation is in single rooms with the exception of one double room on the first floor. Only 2 bedrooms do not have en-suite toilets. The bedrooms are generally pleasant and personalised. Residents stated that they were pleased with their rooms and encouraged to bring personal items with them. One resident’s room was being refurbished and had recently had the washbasin moved to another part of the room to enable a built in wardrobe to be built. The resident has chosen the new paint colour for the walls. The home has a maintenance programme and since the last inspection they have fitted 5 further ceiling hoists into the bedrooms downstairs, the conservatory & lounge has been repainted, the inner courtyard has been
Meadows Nursing Home, The DS0000004124.V291798.R01.S.doc Version 5.1 Page 18 repaved and the radiators guards have a been fitted to all radiators. Parts of the home are still in need of redecoration and some corridor carpets are well worn. Hot pipes around the home are covered with foam lagging, although this is not secure and can be easily removed. Some toilets, bathrooms, sluices & a small office have bolts on the outside of the door. It is the Inspectors opinion that these are a potential hazard as a resident or staff member could become locked in one of these rooms. The home is generally clean & tidy and the management of odours is good. The laundry is well equipped and maintained. A colour-coded system is in place for the management of infection control in the laundry. There are plenty of gloves & aprons available and hand wash soap dispensers and paper towels are provided. Residents’ rooms contained washbowls in the en-suite areas. Some of these were noted to have grime on the inside and in the shared room they were stacked together, were wet and dirty and were not individually named for the residents. This is poor practice. An identified sluice did not have any hand washing facilities for staff and the commode pots were being stored on the floor. A rubbish bin in the upstairs kitchen & bathroom did not have a lid Staff spoken with were aware of good practice & procedures for the prevention of cross infection. Meadows Nursing Home, The DS0000004124.V291798.R01.S.doc Version 5.1 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The deployment & numbers of staff on duty are sufficient to meet the needs of the residents. The procedures for the recruitment of staff are robust offering protection to people living in the home. The arrangements for the induction of staff are good with the staff demonstrating a clear understanding of their roles. Staff are trained to fill the aims of the home and meet the changing needs of the residents. EVIDENCE: Staffing rotas are produced for all three units showing trained and care staff designated to work in these units each day over a 7-day period. The staff rotas indicate that for 36 residents in total they have 2 registered nurses & 10-11 care staff on the early shift and 2 registered nurses and 6-8 care staff on the late shift. At night there is a registered nurse and 3 care staff. The manager’s hours are supernumery and not included in these numbers. The manager is not shown on the off duty and the off duty only includes the first names of the staff. There was no on-call rota available. In addition to the care team there is a team of catering, housekeeping & ancillary staff on duty each day. Information provided by the manager indicates that 50 of the care staff have achieved qualifications of NVQ level 2 or above. Meadows Nursing Home, The DS0000004124.V291798.R01.S.doc Version 5.1 Page 20 Three staff files were seen during this visit and they all contained the information required by the regulations. The home employs a training manager, although at this present time she is away on maternity leave. Discussion with 2 recently recruited staff confirms that they have received a 2-week induction upon commencement of employment. Staff confirmed that there is plenty of opportunity to attend training on various subjects related to the care needs of the residents and core training e.g. fire training is mandatory for them to attend. Some of the staff spoken with have received individual supervision. Staff appraisals have not yet commenced. Training records for individual staff are not up to date and would be much improved if the record included the course content and the duration of the course. Meadows Nursing Home, The DS0000004124.V291798.R01.S.doc Version 5.1 Page 21 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 and administration of the home is based on openness and respect, has effective quality assurance systems and a qualified competent manager. The homes records for the management of residents’ monies are transparent and auditable safeguarding residents financial interests. The health, safety welfare of residents, staff & visitors to the home are promoted and protected. EVIDENCE: The manager was registered with the Commission in March 2006. She is a registered nurse and updates her skills & knowledge through attending monthly meetings organised by the Primary Care Trust who have recently provided speakers on palliative care & diabetes, reading nursing magazines & accessing information on the Internet. She has also attended recent courses on MRSA, Infection Control, pressure area care & COSHH. She is currently
Meadows Nursing Home, The DS0000004124.V291798.R01.S.doc Version 5.1 Page 22 studying with the Institute of Chartered Secretaries & Administrators and intends to start her Registered Managers Award in September 2006. She is only responsible for the day-to-day operations of this home and receives support & supervision from the Provider & Director of Care & Quality. The home employs a Director of Care & Quality who is responsible for monitoring the quality of the service. The organisation has monthly quality meetings where they review the audits from the previous month. All staff become involved with the audits that are carried out in the home. Unannounced visits are carried out to the home and recorded and a copy is sent to the Commission each month. Information is sought from relatives & residents through questionnaires and the results are published on the notice board in the home. The home produces a newsletter and also has a quality group, which is attended by a relative of one of the residents. The results from the homes audits shows areas for the home to improve and the action taken in order to achieve improved quality of service. The home is audited each year by a local City Council who award a Star Rating based on the outcome of the quality of the audit. The Provider acts as appointee for one resident. These monies are now held in a bank account in this person’s name. Records are maintained of all expenditure with receipts provided. Two residents have monies paid into the organisations business account by a local City Council in respect of their personal allowances. The local City Council acts as a corporate appointee for both of these residents. A nominal account is maintained for these residents within the business accounts. The Inspector is seeking further guidance from the Commission in relation to monies being paid into the business accounts by local councils relating to residents personal allowances. Small amounts of money are managed locally within the home on behalf of residents. These records are all transparent with receipts obtained for items of expenditure. The records of receipts & expenditure for residents in the home are either not signed or only initialled by one member of staff. Discussion with staff confirmed that they have received recent training in relation to manual handling, fire, and health & safety, although this was not able to evidenced in all of the staff files, as they were not all up to date. The home provides a good range of equipment for the moving and lifting of residents and staff are using them appropriately, although a resident was observed being transported in a wheelchair without any footrests in use. This is poor practice. Information provided by the manager prior to the inspection and records held in the home confirm that routine checks & maintenance are being carried out for the electrical, heating, water, & gas systems and equipment in use in the home. Policies and procedures are in place for the management of health & safety in the home and they have been reviewed in the last 12 months. A fire risk assessment was seen dated July 2004, but there was no evidence that this document had been reviewed. Accidents and incidents involving residents and staff are being well documented by the home.
Meadows Nursing Home, The DS0000004124.V291798.R01.S.doc Version 5.1 Page 23 Meadows Nursing Home, The DS0000004124.V291798.R01.S.doc Version 5.1 Page 24 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 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 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Meadows Nursing Home, The DS0000004124.V291798.R01.S.doc Version 5.1 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Care plans must be put into place when an acute problem arises to ensure that staff are aware of the care that is required to resolve the residents acute needs. Moving & handling risk assessments for all residents must be completed upon admission and reviewed each month. The registered manager must ensure that short courses of medicine e.g. antibiotics are administered to the service users as prescribed by a clinician. The curtains between the beds in the shared room must be altered to ensure that the bed nearest the door is fully enclosed when personal care is being carried out for this resident. The activities provided by the home must be reviewed in consultation with the residents and/or their next of kin. The covering on the hot water pipes must be secured to ensure that the residents cannot remove
DS0000004124.V291798.R01.S.doc Timescale for action 01/07/06 2 OP8 12, 13 01/07/06 3. OP9 13(2) 01/07/06 4 OP10 12 01/07/06 5. OP12 16 31/08/06 6 OP19 13 01/07/06 Meadows Nursing Home, The Version 5.1 Page 26 7 OP26 13 8 9 10 OP26 OP38 OP38 13 13 13, 23 them. Wash bowls must be washed after each use with hot soapy water, dried and stored on a rack or shelf. Commode pots must not be stored on the floor in the sluice, a shelf or rack must be provided. Footrests must be used at all times when transporting residents in wheelchairs. The fire risk assessment must be reviewed. Timescale of 21/11/05 not met 01/07/06 01/07/06 01/07/06 31/08/06 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 3 4 5 6 7 8 9 10 Refer to Standard OP7 OP15 OP15 OP15 OP19 OP26 OP26 OP27 OP30 OP35 Good Practice Recommendations Social activities should be recorded in the care plan each day for all residents. Condiments should be provided for residents at mealtimes. Staff should only assist one resident at a time to eat and should not interrupt this one to one time to go and answer the telephone. The menus & standard of service at mealtimes should be reviewed in consultation with residents, relatives & staff. The use of the bolts on the outside of identified doors around the home should be reviewed. It is strongly recommended that hand washing facilities are provided in the identified sluice on the first floor. Lids should be provided for all rubbish bins. The staff rotas should include the manager’s hours, the full name & designation of the staff & who is on call out of hours and at weekends. Training records for all staff should be kept up to date and should include the course content & duration. Two staff should sign all entries for receipt or expenditure of monies for residents held within the home. Entries for expenditure in the ledger & the receipts obtained should be numbered to ease the process of auditing these
DS0000004124.V291798.R01.S.doc Version 5.1 Page 27 Meadows Nursing Home, The accounts. Meadows Nursing Home, The DS0000004124.V291798.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN 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 Meadows Nursing Home, The DS0000004124.V291798.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. 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!
