Inspection on 06/07/05 for The Meadows Nursing Home

This inspection was carried out on 6th July 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Meadows Nursing Home 22/07/08

The Meadows Nursing Home 29/06/07

The Meadows Nursing Home 23/05/06

The Meadows Nursing Home 21/11/05

The Meadows Nursing Home 12/12/04

The Meadows Nursing Home 10/07/04

The Meadows Nursing Home 08/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE The Meadows Nursing Home 656 Birmingham Road Spring Pools Bromsgrove B61 0QD Lead Inspector Mandy Burton Announced 6 July 2005 07:00 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 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 E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Meadows Nursing Home Address 656 Birmingham Road Spring Pools Bromsgrove Worcestershire B61 0QD 0121 453 5044 0121 453 0212 Telephone number Fax number Email 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 Ltd Care Home with Nursing 36 Category(ies) of DE(E) Dementia (over 65) - 18 registration, with number OP Old Age - 36 of places PD(E) Physical Disability (over 65) - 36 TI Terminally Ill - 4 The Meadows Nursing Home E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 The Home may also accommodate three persons under 65 years with a learning disability. 2. The Home may also accommodate a maximum of three people aged between 55 - 64 years with a physical disabliity. 3. The Home may also accommodate 1 person aged 50 - 64 with a physical disability. Date of last inspection 7th December 2004 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 illnesses. 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 away from the motorway. The Meadows Nursing Home E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors undertook this inspection. This inspection was unannounced and started at 07.00 am. It took place over a period of eight hours. The main focus of this inspection was to assess care practice and to review progress made by the home to address requirements made at the previous inspection on 07.12.04. It was not however possible on this occasion to review all previous requirements, and these will re-evaluated at the home’s next inspection. A partial tour of the home took place and a selection of care and staff records were examined. During the course of the inspection three residents, five members of staff and three visitors were spoken to. What the service does well: What has improved since the last inspection? What they could do better: At the time of inspection the home had experienced a change in leadership. The new home manager expressed a commitment to improving standards. This report highlights a significant number of issues to be addressed, efforts should be concentrated on all aspects which have the potential to place residents at risk which include, care planning and health care, meeting nutritional needs, medication administration, staff deployment and training, and health and safety practices. Please contact the provider for advice of actions taken in response to this The Meadows Nursing Home E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 Page 6 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 E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection The Meadows Nursing Home E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 Page 8 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 standard(s) 1, 3 and 4 The home’s service user guide does not provide sufficient information to new and prospective residents, about the home, and residents’ rights and obligations, and fails to ensure residents make a fully informed decision to stay at the home. Resident’s individual needs are assessed prior to them moving into the home in order to ensure they receive the appropriate care and services required when they move into the home. Systems for communicating information about the home and the individual needs of residents to agency staff are poor and have the potential to place residents at significant risk. EVIDENCE: The service user guide, which was available in individual rooms, gave out of date information about the staffing in the home, contained no detail of the complaints procedure, no sample copy of the contract and was missing comments from residents. Individual records are kept for each resident. A selection of pre-admission records were examined and each included an assessment carried out by a trained nurse prior to the resident’s admission. The Meadows Nursing Home E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 Page 9 An agency carer reported for duty at the home. At the time of their arrival shift handover was already in progress. There was no evidence that the carer received an induction. When asked how they knew which residents were in each room for the purposes of asking call bells, the carer stated that they did not know and had not been given this information. The carer reported that they had been assigned to work with a carer but the carer concerned was giving out breakfasts and they had been assigned to certain residents to provide personal care. The carer concerned did not know where individual care plans were being kept and what specific plan of care was required for the people they were caring for. The Meadows Nursing Home E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 Page 10 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 standard(s) 7, 8, 9 and 10 Care planning and recording in the home is inconsistent and places residents at risk. Systems in place for health care screening are not always carried out and there is therefore no assurance the health care needs of residents will be identified and appropriate care provided. Personal support is not always offered in ways, which promote the privacy and dignity of the residents. EVIDENCE: Admission sheets used by the home to record basic observations at the time of entering the home were not completed consistently or fully. The care records of seven residents were examined. The quality of records seen was poor and a number of shortfalls were evident which included: • Not all care plans had been reviewed and updated at least once a month and when any significant changes had occurred. • Care was not being provided in accordance with care plans, with particular regard to the monitoring of blood sugar levels for residents with diabetes. • One resident had a standardised care plan relating to access to call bells and personal safety. The plan stated that ‘all staff to be made aware of situation at handover’ and further stated that staff must check the The Meadows Nursing Home E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 Page 11 • • • • • resident every fifteen minutes. This information was not reinforced/ passed on in accordance with the plan and agency care staff were not made aware. Information about a resident vomiting during the night was passed onto day staff during shift handover, but had not been recorded. Records seen for the resident concerned referred to an uneventful night. Records relating to the care of residents with diabetes were unsatisfactory. Care plans lacked sufficient detail and accuracy in relation to the management of diabetes. Staff were recording individual’s blood sugar levels in several documents and there was no consistent method for recording. There was no evidence that the normal blood sugar ranges for each resident with diabetes had been recorded. Records seen showed that recordings for one resident frequently recorded outside of what would be considered to be normal/safe ranges. There was no evidence that staff had taken further action on these occasions. There was a lack of risk assessments in relation to skin care, nutrition and moving and handling. The content of some risk assessments seen was noted to contradict supporting care plans. One resident was at a high risk of developing a pressure sore on admission but no risk assessments were in place. There was inadequate recording of wound care assessment and management. One resident had multiple wounds. It was not possible from the records to establish details of each wound, where it was located, the condition of the wound and the treatment that was currently to be given. Wound assessments had not been completed in respect of each wound and any recordings were infrequent. No recent photographs had been taken in respect of the wounds. There was limited information about the social and emotional needs of the residents. One residents’ assessment form indicated that a resident did not like watching television. When visited in her room the television was left on. She said she did not like it. A recent emotional trauma suffered by a resident had not been recorded on her care plan. Daily progress notes are recorded for each resident. Records seen were generally very informative. There was some evidence that residents on the ground floor nursing units, or their representatives had countersigned care plans. On Beeches unit care plans, which were seen, had not been signed by residents or relatives. Since the last inspection the home has introduced a new nutritional screening tool. The tool has been introduced for all residents. Discussion took place about the need to ensure the previous screening tool is no longer in use. The Meadows Nursing Home E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 Page 12 The home has it’s own physiotherapist who visits the home and provides advice and support to both residents and staff. Medication administration records (MAR) were examined. A number of serious concerns were noted and an immediate requirement notice was issued as a result. • A significant number of gaps were evident in recording, where medication had been dispensed from blister packs and had not been signed for by the person responsible. Other medication had been omitted and there was no reason given for the omission. • A number of MAR charts showed that amendments or additions had been made to the original prescription and that there was no reason or authorisation given for the change and the changes had not been signed or countersigned by the people responsible. • Records seen for one resident showed that their medication was not being given in accordance with the original prescription. • The records for one resident showed that night sedation had not been given and code F recorded which was documented to be interpreted as both ‘out of stock’ and ‘refused’. There was no evidence of any stock for this resident being available in the home. • The MAR chart for one resident documented the medication to be given ‘as directed’ and the packet containing the medication also stated ‘as directed’ . There was no evidence to determine the original prescription for the residents • The regime for one resident on anti-Parkinson medication required review as the resident concerned was regularly missing a dose late in the evening. Staff were prompted to initiate a review. • Medication for one residents had been dispensed by the pharmacist in accordance with the prescription to have medication in the morning but staff were dispensing it to them at to night there was no evidence to support this change in prescription. • A ‘staff medication book’ was seen which recorded entries for nonprescription medication that had been issued to staff on request. The most recent entry being January 2005. Inspectors had previously brought this same issue to the home’s attention during an inspection on 10th July 2004 and were advised at that time, that the practice would cease. It was noted that nurse in charge did not finish administering medication prescribed for 08.00hrs until after 10.45hrs. This delay has potential risks to residents in the home. One relative spoken to raised concerns about delays in providing personal care to residents. They commented that their relative was regularly not given assistance with washing until midday, and that they found it difficult to access staff especially at weekends. In addition to this they reported that in their opinion the standard of oral hygiene and nail care is inadequate. As staff were The Meadows Nursing Home E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 Page 13 not always fulfilling these duties and family members were reportedly doing it for the resident when they visit. Residents who were spoken to gave different points of view about the care provided. One resident stated that a night carer had been impolite to them following a call during the night. Another female resident had stated that she did not wish a male carer to give personal care. This information was not recorded in the care plan and she had been sent a male carer to help her get dressed. Another resident said that the staff were “lovely” and “kind” and they felt respected. A visiting health carer when asked, said that she thought the home was “alright” and had no concerns. On the Beeches unit, staff were observed to speak to the residents appropriately and inform them of what they were doing when helping them. A member of kitchen staff was heard to speak disrespectfully about a resident. The Meadows Nursing Home E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 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 standard(s) 12 and 15 There was little evidence that activities are offered in a way that satisfies the individual social needs of the residents. The food provided in the home is of poor quality and does not provide the residents with any choice. EVIDENCE: The list of activities available for the month of July indicated that very few activities were to take place. The list is in small type and is not easily accessible to residents to see. The home currently has two activities organisers and one came on duty at 8.00 am on to Beeches unit. They spent some time chatting with residents and kicking a football around in the lounge. There were no activities observed downstairs during the inspection. There was no evidence that all residents were offering a drink on waking. There were jugs of cold drinks in each room, but not all residents were able to access these. One of the night staff said that they gave residents a drink when they were attending to them if required but did not routinely offer drinks to residents. A resident who was asked at 8.30 am said that their last drink had been at 8.00 pm the previous evening. They did have a soft drink available to them on their table. At 8.35 am a resident was heard calling out to staff for a drink, they were still calling at 9.15am at which point staff came to take them to have breakfast. The Meadows Nursing Home E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 Page 15 The breakfast routine on Beeches unit was observed. A cooked breakfast was available to all residents as preferred. There were three carers on duty who also had to give out breakfasts as well as prepare some of the breakfast and get residents up and dressed. One resident was wheeled into the dining room at 8.45 am and did not receive their breakfast until 10.00 am. Nor did they receive any further attention until that time. Staff said that up to six residents needed assistance to eat on Beeches unit. The tables did not have any condiments on them, nor was there any opportunities for residents to help themselves or see what choices there were for breakfast. The room looked functional and uninviting. The lunchtime routine was observed. The food served to residents was of poor quality and there was no evidence that the majority of residents were being offered choice at lunchtime. The menu displayed on a blackboard was of a set meal with no details of any alternative menu options. The service users guide clearly states that there choices available each day. Staff were observed placing meals in front of residents and failing to tell the resident what was being offered to them and determining if it was satisfactory. In addition to this the kitchen was not clean and schedules had not been adhered to. An immediate requirement notice was issued in relation to this. Care staff were observed sitting in the lounge on the ground floor supervising a group of residents. The staff concerned made little or no interaction with the residents and were sat reading magazines. The Meadows Nursing Home E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 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 standard(s) These standards were not inspected. EVIDENCE: The Meadows Nursing Home E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 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 standard(s) 19, 20 ,22 ,25 and 26 The standard of the environment essential maintenance undertaken pleasant and safe place to live in. The Beeches unit remains poorly provide the residents with a homely within this home needs improving, and to provide residents with a comfortable, painted and functional, which does not environment. EVIDENCE: A partial tour of the home took place during which a number of issues were highlighted for attention: • Not all radiators were guarded or had low surface temperatures. There has been some action to address this since the last inspection, however more work is necessary to ensure residents are not at risk. • The lounge/conservatory fire door had been taken out of use and screwed shut due to a rotting frame creating a potential risk to all those accessing this area. The home had reportedly taken action in accordance The Meadows Nursing Home E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 Page 18 • • • • • • with the fire officer to disable the door until remedial work had been undertaken. Chairs were seen without cushions or covers. Tiles were missing from the dining room floor. A linen cupboard marked keep locked was open Oxygen was being used in one bedroom; there was no warning sign on display on entry to the room. Chemical products were observed in communal areas The kitchen was not clean and schedules had not been adhered to. Immediate requirement notices were issued in respect of all of these matters. There was evidence that equipment for moving and handling had been maintained and serviced. A number of corridors and a communal lounge were in need of redecoration. This issue was outstanding from the previous inspection in December 2004. Wheelchairs were being stored in the dining room in the Beeches unit. Staff were observed using aprons and gloves when carrying out personal care tasks. The Meadows Nursing Home E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30 The deployment of staff in the morning does not ensure care staff can meet the needs of residents in this home. Arrangements for the induction of agency care are poor and have the potential to place residents at significant risk. Training records in relation to moving and handling and fire safety do not provide assurance that all staff have the necessary knowledge and skills to ensure the ongoing safety of residents. Residents are protected by the home’s thorough recruitment procedures. EVIDENCE: At the start of this visit the home was staffed by night staff, which comprised of a trained nurse, an adaptation nurse and two carers. There were a total of 36 residents residing in the home, of which 14 residents were upstairs on the beeches unit, and 22 residents were residing on the ground floor nursing units. Staffing rotas detail the staff on duty 24 hours a day. A white board in the main reception also details the staff names each shift and the person in charge. Concerns were raised during the visit with regard to the deployment of staff particularly in relation to mealtimes (see findings in relation to standard 15) and the provision of social and recreational opportunities (see findings in relation to standard 12). The Meadows Nursing Home E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 Page 20 The relative of one resident commented that fluctuating staffing levels resulted in delays in staff washing their relative who was being nursed in bed, and at times this has been done after midday. They said they were often unable to access staff and this situation was worse at weekends. An agency carer arrived for the day shift. The carer did not get all handover information as it had already started before they arrived. The carer had reportedly not worked at the home for several years. There was no evidence of any induction being given to them. When asked how they knew who was in what room when a bell rang etc. told did not know. They said they were assigned to a carer but the carer was giving out breakfasts and they were providing personal care to assigned residents. They did not know where care plans were being kept and what specific plans of care residents may have. Both the home manager and a trained nurse went to attend a meeting off site, which would have left one, trained nurse. When asked, they said they were going to arrange for cover. The nurse who came on duty was not contacted until shortly before the meeting was due to commence. It was reported that a deputy manager has been appointed and was due to commence duties in the near future. Worcestershire care Group now has a new off site training centre. A training coordinator is now employed part time for the home. Individual staff training cards were seen which showed that one carer had only received training in fire safety and moving and handling, another carer’s records showed that they last had fire training and moving and handling in 2003. A carer on night duty had not had moving and handling training and fire safety training since 2003. The home currently has a number of care staff attending a 20-week in house training course, which takes place at the training centre and through the 20 week period covers all aspects of care practice. It is hoped that over time all staff will get the opportunity to participate in the training. Since the last inspection a member of staff has been designated as the induction coordinator for the home. The manager reported that she is trying to access training in relation to care of residents with learning disability. In addition to this she reports that it is hoped that some staff can spend some time with the learning disability team within the local community to develop a greater understanding of needs of residents who may have a learning disability. Two staff files were seen both provided satisfactory evidence that appropriate recruitment procedures were being carried out at the home. The Meadows Nursing Home E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 37 and 38 The home has experienced a change in leadership and some significant effort is now required to promote and safeguard the health, safety and welfare of residents living in this home. EVIDENCE: Since the home’s last inspection there has been a change in the management of the home, with the former deputy manager taking on the position as Home Manager. Some staff who were spoken to were concerned that there seemed to be a lack of communication throughout the home. During the month of July there were nine management type meetings, which in itself is commendable, but given the numbers of issues and concerns raised during this inspection the manager may need to concentrate more on the practical application of care for a short while. A partial tour of the home took place during which a number of heath and safety issues were highlighted for attention: The Meadows Nursing Home E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 Page 22 Not all radiators were guarded or had low surface temperatures. There has been some action to address this since the last inspection, however more work is necessary to ensure residents are not at risk. • The lounge/conservatory fire door had been taken out of use and screwed shut due to a rotting frame creating a potential risk to all those accessing this area. The home had reportedly taken action in accordance with the fire officer to disable the door until remedial work had been undertaken. • Oxygen was being used in one bedroom, there was no warning sign on display on entry to the room. • Chemical products were observed in communal areas • The kitchen was not clean and schedules had not been adhered to Immediate requirement notices were issued in respect of all of these matters. In addition to this it was noted that: • A fire evacuation notice by a ground floor lift was incomplete. • A linen cupboard with a sign saying ‘keep locked’ was open. • The sluice room had external bolts. These bolts are unsatisfactory and present a risk that a person could be locked in the room. • A ‘staff medication book’ was seen which recorded entries for nonprescription medication that had been issued to staff on request. The most recent entry being January 2005. Inspectors had previously brought this same issue to the home’s attention during an inspection on 10th July 2004 and were advised at that time, that the practice would cease. Since the last inspection a new brick waste store has been constructed within the grounds. The standard of record keeping in the home was variable, specific concerns were raised in relation to care documentation, medication administration records and training records. • The Meadows Nursing Home E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 x 15 1 COMPLAINTS AND PROTECTION 2 2 x 2 x x 2 2 STAFFING Standard No Score 27 2 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 2 2 x x x x 1 1 The Meadows Nursing Home E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 Page 24 YES Are there any outstanding requirements from the last inspection? 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 1 Regulation 5 Requirement A Service User Guide must be in place which contains all the information detailed in Regulation 5 (Care Homes Regulations 2001). All information included must be kept accurate and up to date . Systems must be put in place which ensure all agency staff receive an induction, and are provided with sufficient information about home and the individual needs of each residents and the care to be provided. All care plans must be reviewed at least once a month or as soon as care needs change. (Previous requirements 10.07.04 and 7.12.04 not met. ) Care must be provided in accordance with each residents current plan of care. (Previous requirement 7.12.04 not met) Care plans must be in place for each resident who has diabetees. Plans must include at a minimum: details of normal blood sugar ranges, frequency of monitoring levels, current Timescale for action 1st September 2005 2. 4, 27, 30 18(1) Immediate and ongoing 3. 7, 37 15 Immediate and ongoing Immediate and ongoing Immediate and ongoing 4. 7 12(1) 15 5. 7, 8, 37 12(1) 15 The Meadows Nursing Home E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 Page 25 6. 7, 37 15 7. 8, 37 12(1) 8. 8, 37 12(1) 15 9. 8,7,37 12(1) 10. 8,7, 37 12(1) 13 15 11. 8,37 12(1) 15 12. 9, 37 13(2) treament, action to be taken by staff in the event levels are recorded above/level normal ranges. Care plans must be in place for all residents which identify any social and emotional needs and details action to be taken by staff to support/care for the resident concerned. Accurate written records must be kept of blood sugar levels for residents with diabetees , which includes details of all action taken by staff when levels are recorded above /below normal ranges. Monitor and record the weight of all residents on a monthly basis and ensure appropriate action is taken when significant weight loss or gain is evident (Previous requirement 7.12.04 not met) Accurate written records must be kept of all significant events affecting each resident on a daily basis. Risk assessments must be documented and reviewed at least once a month for each resident in relation to skin viability, nutrition and moving and handling. Action to be taken to reduce risks identified should be included in each individuals respective care plans. A written programme of wound care management must be developed . Individual records must be kept in relation to each wound, which includes all assessments, current treatment and reviews. (Previous requirement 7.12.04 not met) Accurate written records must be kept of all medication adminstered , or if not administered a code documented Immediate and ongoing immediate and ongoing Immediate and ongoing immediate and ongoing. Immediate and ongoing. Immediate and ongoing Immediate and ongoing. Page 26 The Meadows Nursing Home E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 13. 9, 37 13(2) 14. 9 12(1) 15. 9 12(1) , 13(2) 16. 17. 9 9 12(1), 13(2) 12(1) and the reason recorded.(Previous requirement 7.12.04 not met) Any written additions or amendments to the drug adminstration records must be checked, dated and countersigned by two staff. Sytems must be in place in order to ensure that adequate stock levels of medication are maintained at all times. The morning routine must be reviewed in order to ensure that residents receive their medication at the times prescribed. All medication must be adminstered as prescribed . The medication regime for one resident with parkinsons disease must be reviewed with the relevant medical practitioner . A regular programme of social and recreational opportunities must be made available to all residents in accordance with individual needs and preferences. Residents should be made aware of planned activities and additional information displayed around the home . The Statement of Purpose must be updated in order to ensure it accurately reflects the current social /leisure opportunities available to residents. (Previous requirement 7.12.04 not met) The breakfast routine and deployment of staff on the beeches unit must be reviewed in order to ensure residents are not subjected to excessive delays at breakfast time. Hot/cold drinks must be offered to residents on waking. Immediate and ongoing. Immediate and ongoing. Immediate immediate and ongoing Immediate 18. 12,27 16 1st September 2005 19. 12, 1 4(1)(c ) Schedule 1 1st september 2005 20. 15, 10,27 12 1st September 2005 21. 15 12(1) 16 Immediate and ongoing. Page 27 The Meadows Nursing Home E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 22. 15 12(1) 16 23. 24. 15, 38 19 16 23(2) 25. 26. 27. 28. 29. 30. 31. 32. 19, 25, 38 19, 38 19, 20 19, 20 19,38 19, 38 21, 10 20, 22 13 23 16 23 13 13 12(4) 23(2)(l) A review of meals and mealtimes must take place. the review should ensure : a menu is documented and clearly displayed in the home, that all residents are aware of the menu options and alternatives , that residents are offered/served meals in ample portions, which are wholesome and nutritious and meet the needs and preferences of the residents. The kitchen must be thoroughly cleaned and cleaning scheduLes adhered to. Redecoration must be undertaken to corridors identified .(Previous requirement 7.12.04 not met) All radiators must be guarded or have guaranteed low surface temperatures. The fire door in the conservatory must be replaced and made safe and operational All armchairs must be fitted with suitable cushions and covers. Missing floor tiles to ground floor dining room must be replaced . Warning signs must clearly evident when entering aroom where oxygen is stored/in use. All chemical products must be stored securely . Privacy locks must be fitted to all en suite facilities .(Previous requirement 7.12.04 not met) Appropriate storage must be made available for equipment which avoids the use of communal areas.(Previous requirement 7.12.04 not met) . The home must be staffed by 1st September 2005 Immediate and ongoing 1st September 2005 1st September 2005 1st August 2005 1st September 2005 1st September 2005 Immediate and ongoing. Immediate and ongoing. 1st Octber 2005 1st October 2005 33. 27, 4 12(1), 18 Immediate Page 28 The Meadows Nursing Home E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 34. 30, 37 18 35. 30, 38 18 36. 38 23(4) 37. 38 13(4) 38. 39. 40. 38 38, 9, 37 38 23 13(2) 13(4), 23(2) sufficient numbers of care staff at all times in order to ensure the individual needs of residents can be met in a timely manner . Staff training must be maintained up to date and be consistent with actual training undertaken by staff .(Previous requirement 7.12.04 not met) . A training audit must be undertaken and recorded with regard to moving and handling and fire safety training. Training must be provided where shortfalls are evident. The fire information/evacuation notice must detail up to date information regarding the action to be taken in the event of a fire alarm sounding. External bolts on sluice room doors must be removed and replaced with a coded number door entry pad . The linen cupboard must be kept locked when not in use . The staff medication book must be taken out of use. Health and safety risk assesments must be reviewed and updated and systems put in place to ensure subsequent reviews take place on a regular basis and any issues identified for action are followed through. (This previous requirement was not inspected.) and ongoing. 1 st September 2005 1st September 2005 Immediate 1st September 2005 Immediate and ongoing. Immediate 1st September 2005 41. 42. 43. 44. The Meadows Nursing Home E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 Page 29 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. Refer to Standard 7 12 32 38, 9 Good Practice Recommendations Systems should be introduced which enable each resident or their representative to become involved in the care planning process from the point of admission . Information about planned activites and events should be displayed in the home in an appropriate format, which is acessible to all service users. Review existing systems for communicating with staff and seek to improve. All staff should be advised that the staff medication book is to be removed and the reasons for this made clear to them to prevent repeated occurrences. The Meadows Nursing Home E52 S4124 The Meadows NH V236090 060705.doc Version 1.40 Page 30 Commission for Social Care Inspection The Coach House John Comyn Drive, Perdiswell Park Droitwich Road Worcester WR3 7NW 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. 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