CARE HOMES FOR OLDER PEOPLE
Meadows Nursing Home, The 656 Birmingham Road Spring Pools Bromsgrove Worcestershire B61 0QD Lead Inspector
Sandra J Bromige Draft Unannounced Inspection 29th June 2007 14:00 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.V360910.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. Meadows Nursing Home, The DS0000004124.V360910.R01.S.doc Version 5.2 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) Southern CC Ltd 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.V360910.R01.S.doc Version 5.2 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. 23rd May 2006 Date of last inspection Brief Description of the Service: The Meadows Nursing home is one of two homes which are now owned by Southern CC Ltd. It is registered to accommodate a maximum of 36 residents. The home is divided into two units, Pine/Willows and Beeches. 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 range of fees for this service are not published in the statement of purpose. Meadows Nursing Home, The DS0000004124.V360910.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection started at the end of June 2007 and was concluded in January 2008. The inspection was carried out over three visits. There was a delay in completing the inspection fieldwork due to a safeguarding investigation following two allegations of poor care by this service. This was a key inspection – this is an inspection where we, the commission look at a wide range of areas. To help us plan the inspection we looked at the Annual Quality Assurance Assessment completed by the home some weeks earlier, survey forms received from residents (2), relatives (0) and health and social care professionals (4). During the visit to the home care records, staff records and other records and documents were inspected. There was a tour of parts of the accommodation and interviews with staff, including the manager. Time was spent speaking privately with residents in their rooms as well as spending time out and about in the home observing what was happening and talking to residents. Mrs D Stubbs, an expert by experience, were present for part of this inspection. An ‘expert by experience’ is a person with an inspector to help them get a picture of what it is like to live in or use the service, who, because of their shared experience of using services, and/or ways of communicating, visits a service. This expert by experience spent time in the home with the residents and also observing staff and residents. The home has changed ownership in November 2007, thus some of the information in this report relates to the period with the previous owners. We have received one complaint about this service since the last inspection in October 2007. The complaint was referred to Social Services to investigate as they commission the care for this resident with the service. Since the last inspection the home have reported two allegations relating to alleged physical and financial abuse. Correct procedures have been followed by the home including reporting the incident using the local safeguarding procedures. A thorough investigation has been carried out including appropriate disciplinary action in relation to one staff member concerned and the referral of another member of staff to be placed on the Protection of Vulnerable Adults (POVA) list. We have received two allegations of abuse since the last inspection in April and June 2007. Both of these relate to alleged poor care of two identified residents. These have been referred to Social Services who are the lead agency for safeguarding people. One investigation has been concluded and found that the allegations were upheld. The second allegation is still under investigation by the funding authority for that resident. Meadows Nursing Home, The DS0000004124.V360910.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection?
An activity co-ordinator has been appointed to work 30 hrs each week in the home. A sensory/quiet room has been provided in the dementia care unit. The menus have been reviewed in consultation with the residents and a wider choice is now available for breakfast. The environment has been improved through redecoration of a large number of bedrooms. The dementia care unit has been redecorated and carpets replaced with laminate flooring. The privacy curtains in the shared room have been altered to ensure they provide complete privacy at all times for both residents. More furniture has been purchased for the conservatory and garden areas. More ceiling hoist have been installed and additional specialist profile beds have been purchased. Redecoration has started downstairs and some of the corridor carpets have been replaced with laminate flooring. The home has maintained the minimum of 50 of care staff with NVQ level 2 or above. The fire risk assessment has been reviewed and an action plan developed. Meadows Nursing Home, The DS0000004124.V360910.R01.S.doc Version 5.2 Page 7 What they could do better:
The homes statement of purpose and service user guide should be available in other formats e.g. audio, large print. Residents need to be given information about any nursing contribution payments and the amounts and the date when they will be refunded to them by the home. Residents need to be given a statement of terms and conditions on the day that they are admitted to the home to ensure that they are fully aware of their conditions of occupancy and any related fees. Risk assessments need to be done before bedrails are used to ensure that they will be safe for the resident. Signed consent needs to be sought prior to use as they are seen as a form of restraint. Moving and handling risk assessments need to be completed on the day residents are admitted and reviewed regularly so that staff have the correct information to ensure the safety of the resident and themselves. Residents need to receive appropriate care and treatment in a way that respects their choice, privacy and dignity. Residents need to be consulted about their plan of care and it needs to be kept under review and revised as the persons needs change. Clear action plans need to be written so that care staff know what to do for each resident. Residents need to be given their medication as prescribed by the Doctor. Creams and ointments should not used unless the Doctor prescribes them and the tubes should be labelled. Care plans need to be written when using medication on a ‘when necessary basis’ to ensure that it is being used consistently by staff. If eye drops are prescribed for both eyes, two bottles should be used to prevent cross infection. Residents taking anti coagulants should have a ‘yellow’ booklet that contains up to date information about the current dosage of the medication they are taking. Handwritten medication administration records should be checked by a second trained nurse to ensure that they are accurate. The home need to provide more stimulation for residents through group and one to one activities. Social care plans needs to be developed for each resident. Residents eating in the dining room should be observed discreetly by a member at all times to ensure that they receive the assistance they need. The homes complaints procedure should be reviewed to include the timescales for investigating a complaint. Some of the lagging on the hot water pipes is still loose and needs securing. The home should consider boxing in these pipes to improve the ambience and make it easier to keep clean. Washbowls should be washed with warm soapy water after each used and thoroughly dried. They should not be stacked together or stored on the floor. Hand washing facilities for staff should be
Meadows Nursing Home, The DS0000004124.V360910.R01.S.doc Version 5.2 Page 8 provided in the sluice on the dementia care unit. The rubbish bin should have a lid. The staffing levels need to be reviewed to ensure there are enough staff on duty at all times to meet the needs of the people living in the home. Two written references should be obtained for all new staff prior to employment. The home should request a reference from their most recent employer and ask the reason why the person left that employment. Staff should not start work in the home until they have received at the very least a PoVAfirst check. All qualified staff working in the home should received training on syringe driver management to ensure that they can meet the potential needs of people receiving end of life care. Footrests need to be used at all times when transporting residents around the home. Records of any maintenance checks for bedrails and window restrictors should be held by the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Meadows Nursing Home, The DS0000004124.V360910.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Meadows Nursing Home, The DS0000004124.V360910.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents who may use the service and their representatives do not have all the information needed to enable them to choose a home that will meet their needs. They have their needs assessed prior to admission but are not given any written terms and conditions which clearly tells them about the service they will receive. EVIDENCE: The service has developed a statement of purpose, which sets out the aims and objectives of the home, and includes a service user’s guide, which provides basic information about the service and the specialist care the home offers. The guide is only available to individuals in a standard format. The home is not operating in line with aspects of their statement of purpose. A relative of a recently admitted resident confirmed that they had not received any written information from the home prior to admission of their mother to the home, but they had visited the home.
Meadows Nursing Home, The DS0000004124.V360910.R01.S.doc Version 5.2 Page 11 There was no information for one of the resident’s case tracked to demonstate that the home had undertaken a pre-admission assessment or received a care summary prior to admission to the home. A pre-admission assessment was seen for another resident, although the date of the assessment was unable to be identified from this document. The service user guide contains a sample contract. This needs reviewing to ensure that it includes more detailed information, which is now required about the payment of the nursing contributions and how these are managed by the home. The home had not provided a written statement of terms and conditions to either of the two residents case tracked. The relative of a resident stated they had not received a statement of terms and conditions from the home. Written comment cards received from two residents both state they did not have a contract. Meadows Nursing Home, The DS0000004124.V360910.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is not being based on their individual needs. Care records are not person centred, they do not accurately reflect care needs and are not being reviewed as needs change. This has the potential to place residents at risk. Not all medication is being managed safely and according to the homes policies, which places residents at risk. Privacy, dignity and choice for residents are not being maintained at all times. EVIDENCE: The delivery of health care does not reflect the home’s statement of purpose or the home’s self-assessment of the service. The two care plans seen were of poor quality. They were not based on a person centred approach to care. One care plan had not been discussed with the resident and/or their representative. The healthcare review of an identified resident did not take place at the interval stated in the statement of purpose (4 weeks after admission) as the resident was admitted in July 2007 and did not receive a healthcare review until November 2007. Care plans are not being reviewed monthly and/or
Meadows Nursing Home, The DS0000004124.V360910.R01.S.doc Version 5.2 Page 13 changed based on changing care needs. One resident’s care plan had not been reviewed for two months. Staff do not adequately record health care issues within individuals care plans. A resident’s care review, which took place in November 2007, identified a need for 3 staff when giving continence care. The care plan had not been updated to reflect this information. The care plan identified a need to reassess the resident’s continence needs as the present products were unsuitable, although there was no evidence that this had taken place as there was no continence risk assessment and the care plan did not state the type and size of continence products required. The action plans did not contain sufficient detail to enable care staff to deliver consistent care to these residents. An identified resident did not have a moving and handling risk assessment until 3 days after admission. This has the potential to place the resident and staff at risk of harm as staff may not be aware of the level of the resident’s mobility and the incorrect equipment may be used when assisting the resident to mobilise. Bedrails were in use for this resident, although a risk assessment had not been done to identify any possible risks to the resident. The medication for an identified resident had not been recorded when carrying out the pre-admission assessment. Upon admission the medication administration record had been handwritten by the trained nurse and had not been checked for accuracy by a second trained nurse. It was evident from the hospital discharge summary and the prescription signed by the Doctor that one prescribed medication was not being given as prescribed. The home were giving the medication four times each day instead of four times each day when required. There was no care plan for this ‘as required’ medication. An entry on a medication administration record was seen for a ‘controlled drug’. This entry was handwritten and had not been checked by a second nurse for accuracy. Staff were using one bottle of eye drops to administer medication to both eyes of the resident. This is not good practice. Blood tests were being carried out as the intervals prescribed by the Doctor for a resident taking an anti coagulant. The ‘yellow’ anti coagulant therapy book for this resident was not being kept up to date as the last entry was October 2006. This must be kept up to date as this book should be with the resident when they are out and about from the home. This practice is not in line with the homes medication policy. Cream was being applied to an identified resident. The tube of cream in use had no label and was not on the medication administration record for this resident. The curtains in the shared room had been altered since the last inspection to ensure that they protect the privacy of the people in this room. Staff in the home are not always treating residents in a way that respects their privacy, dignity and choice. A resident had dirty clothes and bits of food in their lap, another resident was being brought to the lounge with dirty trousers which the
Meadows Nursing Home, The DS0000004124.V360910.R01.S.doc Version 5.2 Page 14 Inspector brought to the attention of the manager who had to instruct the carer to assist the resident to change their trousers for a clean pair. A carer was observed walking into a residents room without knocking and tapping the resident whilst they were asleep, making them jump. One resident was washed dressed and left in bed all day. When asked why they did not go to the dayroom, they replied ‘I was not asked’. Meadows Nursing Home, The DS0000004124.V360910.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ interests are not routinely being recorded prior to and upon admission to enable formulation of a social care plan to enable opportunities for stimulation through leisure and recreational activities. There is a lack of social/recreational care opportunities provided by the home. The food in the home is of a good quality, with choice, is well presented and meets the dietary needs of the people who currently use the service. Some care staff are not sensitive to the needs of residents who find it difficult to eat and require assistance with their meals. EVIDENCE: No social care plan had been formulated for one resident case tracked. The second resident case tracked had a social care plan although it had not been reviewed since November 2007. The activity folder did not contain any evidence that the two residents case tracked had been part of any activities in the home. One resident had not been given the opportunity to get out of bed on one day of the inspection visit as the staff ‘ran out of time’. The resident told the Inspector ‘I was not asked’ if she wished to go to the dayroom. This is a poor outcome for this resident. The home employs an activity co-ordinator
Meadows Nursing Home, The DS0000004124.V360910.R01.S.doc Version 5.2 Page 16 for 30 hours each week for all three units. This person has not been able to carry out this role for the last two weeks as they have been working as a carer. Nine residents were observed sitting in the lounge downstairs at 11.30hrs. There was no stimulation for them and no carers were in this area. On the dementia unit upstairs a new sensory room has been created in the area that used to be the dining room. Staff advised that it is currently not in use as they are waiting for more furniture. On the afternoon of the inspection visit residents were observed sitting in the lounge downstairs with no stimulation or activity except the television, which was on, although no one appeared to be watching it. Another resident was sitting in their room. They told us they liked watching television, but there was no television in the room. There was no interaction between staff and residents except a student nurse who was playing cards with one of the residents. Upstairs on the dementia unit, all the residents were asleep except two. One resident was sitting at the dining table with a carer with a book in front of them, although there did not appear to be any communication between them. The home has revised their menus since the last inspection. They have a 6week rolling menu which offers a variety and choice for breakfast, lunch and supper. The service of breakfast was observed. They have a good choice of a cooked breakfast, cereals, porridge, toast and bread and butter with fruit juice, tea and coffee to drink. Residents are able to eat in the dining room or in the privacy of their bedroom. A resident was observed eating their breakfast in the dining room. The resident was only able to use one arm. They were served breakfast and a plate guard was put on their plate to enable them to maintain independence whilst eating. The plate guard came off. Two care staff were in and out of the dining room. Neither of them were observing the residents sitting at the dining tables. One carer after a period of time went up to the resident to place their toast back on their plate. They did not reposition the plate guard. The chef had to point out to the carers that the resident was in need of assistance. The carer stood next to the resident and was assisting them with eating and only after a period of time did they sit down next to the resident. This is poor practice and an example of staff not responding to residents’ needs when required in a discreet and sensitive manner. A resident told us that the drinks were always luke warm. All residents spoken with told us they enjoyed the food and there was a choice of meals. Meadows Nursing Home, The DS0000004124.V360910.R01.S.doc Version 5.2 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns and have access to the homes complaints procedure. Residents are not fully protected from abuse. EVIDENCE: The home has a complaints procedure which is published in the statement of purpose/service user guide. This needs revising to include the timescales for dealing with complaints. Complaint, compliment and comment forms are located at the entrance to the home. Staff spoken with were aware of the homes procedures for handling complaints and the location of a suggestion box in the home. Written feedback from 2 residents confirmed they knew how to complain, although one resident spoken with did not know who to speak to if they had a problem. The home records show they have received and investigated 5 complaints since the last inspection. We have received one complaint since the last Key Inspection relating to the care of a resident. The complaint was passed to Social Services to investigate. Staff did not request to see our identification prior to inviting us into the home. A staff file seen showed that the carer started work in the home prior to receipt of a POVAfirst or full Criminal Records Bureau disclosure check. A resident had bedrails in use without a risk assessment or signed consent to the use of bedrails.
Meadows Nursing Home, The DS0000004124.V360910.R01.S.doc Version 5.2 Page 18 We have received two allegations relating to poor care of two identified residents in the home since the last inspection. These have all been referred to the Social Services who are the lead agency for safeguarding people. One allegation has been upheld and the other outcome of the investigation is pending. Staff spoken with have received training on the recognition of abuse. Meadows Nursing Home, The DS0000004124.V360910.R01.S.doc Version 5.2 Page 19 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made to the décor of the home and further equipment has been purchased to provide a more homely and comfortable environment. EVIDENCE: Improvements have been made to the environment since the last inspection as parts of the home have been redecorated and carpets have been replaced with laminate flooring. More ceiling hoists have been installed and further specialist profile beds have been purchased and are in use throughout the home. The dining room on the dementia unit has been converted to a sensory/quiet room, equipment is in place but staff reported they are awaiting more furniture before it can be used. The existing lounge area is now a lounge/dining room. This has impacted on the layout of the room giving less space for the lounge furniture. Staff reported that additional communal space is planned for this unit as part of the proposed extension to the home.
Meadows Nursing Home, The DS0000004124.V360910.R01.S.doc Version 5.2 Page 20 Equipment has been serviced in the home in the last twelve months. The lagging to hot pipes has been secured, although there were two areas in the home where the lagging was not secured. This is a potential hazard to residents. The manager was advised of these concerns. In our opinion it would improve the ambiance of the home if the pipes were boxed in and would be easier for staff to keep clean. The home was clean and fresh. The only area where there was a strong smell of urine was in the lift. The laundry room had sufficient equipment for the current number of residents living at the home. There was only one wash hand basin in the laundry. The manager stated that no clothes are hand washed so the current basin is only used by staff to wash their hands. The sluice on the dementia unit has no hand washbasin and there was no lid for the rubbish bin in the kitchen. There appeared to be plenty of gloves and aprons for staff to use to prevent cross infection. The privacy curtains in the shared room upstairs had been altered to ensure the privacy of both residents is maintained at all times. This room had a toilet en-suite. Two washbowls were seen on the floor of the toilet stacked together and there was a small amount of water in one of the bowls. This is poor practice regarding the management of infection control for these two residents. Meadows Nursing Home, The DS0000004124.V360910.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are not sufficient staff on duty to meet the health and social care needs of the people living in the home. The procedures for the recruitment of staff are not robust and do not offer protection to people living in the home. EVIDENCE: Poor outcomes were seen for residents. One resident was left in bed all day as ‘I was not asked’ if she wanted to get up. Staff told us they ‘ran out of time’ and that is the reason why the resident was still in bed. The same resident did not get their breakfast until 11.00am. The relative commented on this when they visited. Residents were not being supervised in the dining room during breakfast. One of the catering staff had to ask a carer to assist a resident who had a left sided weakness, as the care staff were coming in and out of the dining room but did not stop to assist the resident who needed help with their breakfast. There were no activities provided for the residents as the activity co-ordinator has been working as part of the care team. Residents were seen sitting in the lounge downstairs with no stimulation and no staff in the vicinity. The quality of the care records is poor and they are not being kept up to date as residents needs change. The numbers of care staff on duty downstairs in the morning were not in line with the numbers stated in the homes statement of purpose, as there were 3 care staff on duty. A student nurse was also on placement in the home, but
Meadows Nursing Home, The DS0000004124.V360910.R01.S.doc Version 5.2 Page 22 their hours should be supernumerary to the numbers of staff. The student nurse was seen working with another carer as part of the team that morning. Upstairs there were 2 care staff on duty in the afternoon. This is not in line with the numbers stated in the homes statement of purpose. 11 staff employed in the home have NVQ level 2 or above. 5 of these staff are qualified nurses or a social worker overseas. A comment card from a healthcare professional stated that the home could improve by training ‘all their qualified nurses in syringe driver management’. The manager stated that they were offering end of life care but are not accepting people who need use of a syringe driver at present as a lack of training has been highlighted. Two staff files were seen. One person had started work prior to receipt of their POVAfirst check. There was no information to show that the home had established why they left their previous employment and no employment reference had been obtained. The second person, there was only one reference on file, there was not a reference from their most recent employer. Both staff had received induction training. The list of induction topics seen on the certificate for one person did not include any reference to training for abuse, complaints and moving and handling. The second person confirmed they had completed their induction, although the trainer or inductee had not completed the paperwork seen on file. Meadows Nursing Home, The DS0000004124.V360910.R01.S.doc Version 5.2 Page 23 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a registered manager and the management is based on openness and respect. They have a quality assurance system to enable them to monitor the standards provided. The homes records for the management of residents’ monies deposited for safekeeping are transparent and auditable safeguarding residents financial interests. The safety of residents, staff and visitors to the home are in the main promoted and protected. EVIDENCE: There has been no change of manager since the last inspection, although there has been a change of ownership of the Company in November 2007. A Clinical manager has been appointed to support the manager’s role. Meadows Nursing Home, The DS0000004124.V360910.R01.S.doc Version 5.2 Page 24 The previous owners carried out an audit of quality of care in August 2007 and the outcome of this audit is on display in the home. The administrator holds small cash deposits of money for a number of residents. A random check was made of these. We recommend that receipts are issued to residents/relatives when receiving or returning sums of money. The manager prior to commencement of the inspection fieldwork completed an Annual Quality Assurance Assessment. This was well completed including data provided. The findings from the inspection are that the delivery of health care does not reflect the home’s statement of purpose. Staff spoken with have received the mandatory core training in relations to health and safety and safeguarding residents. There were incidences seen where the health and safety training was not being followed as we saw residents being transported in wheelchairs without the use of footrests. The safety of all residents is not being maintained and promoted at all times as an identified resident had bedrails in use and there was no risk assessment or written consent for the use of bedrails and an identified medicine for this resident was not being given as prescribed by the Doctor. Residents are not being fully protected as staff did not request to see our identification prior to inviting us into the home. A staff file seen showed that the carer started work in the home prior to receipt of a POVAfirst or full Criminal Records Bureau disclosure check. There are no records in the home to show that they are carrying out maintenance checks on bedrails and window restrictors. It is strongly recommended that these records are maintained by the home. The fire risk assessment has been reviewed since the last inspection. The action plan needs reviewing to check compliance with the action plan from the risk assessment. Meadows Nursing Home, The DS0000004124.V360910.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 1 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 3 29 1 30 2 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.V360910.R01.S.doc Version 5.2 Page 26 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 OP2 Regulation 5A(2), (5)(a)(b), Requirement Residents must be issued with information about any nursing contribution payments and a statement of terms and conditions on the day of admission to ensure that they are fully informed of their conditions of occupancy and the services included in their fees. Residents health and social care needs must be assessed and reviewed as circumstances change to ensure that their health and welfare needs are identified and an action plan is put into place to meet them. The use of bedrails must be subject to a risk assessment prior to use and with signed/written consent to ensure residents are not at risk of harm or of inappropriate restraint. An immediate requirement was made. Residents must receive appropriate care and treatment in a manner which respects their choice, privacy and dignity to ensure that their individual
DS0000004124.V360910.R01.S.doc Timescale for action 31/03/08 2 OP7 14(2)(a) (b) 31/03/08 3 OP7 13(4) and (8) 25/01/08 4 OP7 OP8 12(1)(2) (3) and (4) 31/03/08 Meadows Nursing Home, The Version 5.2 Page 27 5 OP7 14(2) 15(1) and (2) 6 OP7 15 7 OP8 12, 13 8 OP9 12(1)(a) and(b) 13(2) 9 OP9 13(2) 10 OP27 18(1)(a) health and welfare needs are met. Residents and/or their representative must be consulted about their care plan. The care plan must be kept under review and revised at any time when it is necessary to ensure that their care needs are identified and a clear action plan is put into place for staff to follow and prevent residents from harm. 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. Timescale of 01/07/06 not met. The date given is the last day of the inspection. Moving and handling risk assessments for all residents must be completed upon admission and reviewed each month to ensure that appropriate equipment is available and used by staff at all times. Timescale of 01/07/06 not met. The date given is the last day of the inspection. Residents must be given their medication as prescribed by the Doctor to ensure their healthcare needs are met and they are not at risk of harm. An immediate requirement was made. Creams/ointments in use for residents must be prescribed and labelled and a record kept of their administration to ensure the staff are applying them as prescribed. There must be sufficient staff on duty at all times to ensure that the residents receive the care
DS0000004124.V360910.R01.S.doc 31/03/08 28/01/08 28/01/08 25/01/08 31/03/08 31/03/08 Meadows Nursing Home, The Version 5.2 Page 28 11 OP29 19(1), schedule 2 19(1), schedule 2 13(4) 12 OP29 13 OP38 and support that is needed to meet their individual health and social care needs. Two written references must be obtained for all staff prior to commencing work at the home to ensure that residents are protected from harm. Staff must not commence work at the home until a minimum of a POVAfirst check has been received to ensure that residents are protected from harm Footrests must be used when transporting residents in wheelchairs unless a risk assessment suggests otherwise to ensure that residents are protected from harm. Timescale of 01/07/06 not met. The date given is the last day of the inspection. 31/03/08 31/03/08 28/01/08 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 OP1 Good Practice Recommendations The homes statement of purpose and service user guide should be available in other formats to meet the needs of the residents and should be given to all prospective residents and their representatives. A care plan should be written for medication prescribed on an ‘as required’ basis to ensure it is being given consistently. When administering the same eye drops to both eyes, two bottles should be used one for each eye to prevent any cross infection. For residents on anticoagulant medication, their ‘yellow’ book should be completed to reflect their current dose of medication. A second trained nurse should check and sign handwritten
DS0000004124.V360910.R01.S.doc Version 5.2 Page 29 2 3 4 5 OP9 OP9 OP9 OP9 Meadows Nursing Home, The 6 7 8 9 10 11 12 13 14 15 16 OP7 OP12 OP15 OP16 OP19 OP26 OP26 OP26 OP29 OP30 OP38 medication administration records to ensure they are accurate. Social activities should be recorded in the care plan each day for all residents. The activities provided by the home must be reviewed in consultation with the residents and/or their next of kin and in consideration of care plans. Residents should be discreetly observed whilst eating in the dining room and staff should assist residents to eat in a discreet and sensitive manner. The complaint procedure should be revised to include the timescales for investigating a complaint in line with Regulation 22 of the Care Homes Regulations 2001. The protection on the hot water pipes should be checked to ensure that it is secure. It is strongly recommended that hand washing facilities are provided in the identified sluice on the first floor. Infection control practice should be reviewed relating to how washbowls are cleaned and stored. A lid should be provided for all rubbish bins. The reason why staff left their previous employment should be obtained when requesting references. One reference should be from their most recent employer. All qualified staff should receive training on syringe driver management. Records of maintenance checks for bedrails and window restrictors should be maintained to demonstrate that these safety checks are being done. Meadows Nursing Home, The DS0000004124.V360910.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Meadows Nursing Home, The DS0000004124.V360910.R01.S.doc Version 5.2 Page 31 - 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!
