Inspection on 27/01/09 for WCC - Lower Meadow

This inspection was carried out on 27th January 2009.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

WCC - Lower Meadow 08/03/07

WCC - Lower Meadow 05/03/06

WCC - Lower Meadow 26/09/05

WCC - Lower Meadow 25/02/05

WCC - Lower Meadow 14/10/04

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: WCC - Lower Meadow Drayton Avenue Stratford upon Avon Warwickshire CV37 9LF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sandra Wade     Date: 2 7 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: WCC - Lower Meadow Drayton Avenue Stratford upon Avon Warwickshire CV37 9LF 01789268522 01789414521 paulgaskell@warwickshire.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Warwickshire County Council, Social Services Department care home 35 Number of places (if applicable): Under 65 Over 65 35 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 Warwickshire County Council manages Lower Meadow. The home is a local authority care home registered to provide personal care and support for up to 35 Older People. Lower Meadow is situated about one mile from Stratford Upon Avon town centre where all community and health facilities offered in the town can be found. There is a bus service to the town every 15 minutes. The entrance to the home is though the main lobby which is spacious and accessible for people with mobility difficulties or wheelchairs. There are 15 bedrooms on the ground floor and 20 on the first floor, all bedrooms have ensuite facilities consisting of a wash-hand basin and toilet. Two of the bedrooms have a shower facility. There are several communal bathrooms with mechanically assisted baths but no showers. There is a shaft lift for residents to access the first floor. There is one large dining room where all meals are served and this has recently been refurbished to a high standard. There are three lounges that residents can choose from and two of these have a kitchenette with facilities to make a drink. One of the lounges is on the ground floor and two on the first floor. All lounges have a Care Homes for Older People Page 4 of 36 Brief description of the care home television amd music system. There is a dedicated hairdressing salon on the ground floor and the hairdresser visits twice each week to provide this service to the residents. Day care for older people living in their own homes is provided within a dining/sitting area with attached conservatory area. There is a car park to the front of the building with six car parking spaces, there is also off road parking if required. The home is surrounded by an extensive open plan garden the rear of which, is suitable for wheelchair users. At the time of this inspection the fees were confirmed in the Service User Guide as a maximum of 387.00 pounds per week. This amount can be subject to change. Copies of the Service User Guide are available in the foyer of the home. Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The last key inspection took place on 8 March 2007 when no requirements for action were issued. An Annual Service Review was then carried out on 12 May 2008 when the service was found to continue to provide good outcomes for residents. This inspection took place between 7.40am and 6.45pm. Care Homes for Older People Page 6 of 36 Three people who were staying at the home were case tracked. The case tracking process involves establishing an individuals experience of staying at the home, meeting or observing them, discussing their care with staff and relatives where possible, looking at their care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Records examined during this inspection, in addition to care records, included staff training records, staff duty rotas, kitchen records, accident records, financial records, complaint records, quality monitoring records and medication records. Residents were observed in the lounge and dining room to ascertain what daily life in the home is like. A tour of the home was undertaken to view specific areas and establish the layout and decor of the home. A completed Annual Quality Assurance Assessment (AQAA) was received from the service prior to the inspection detailing information about the care and services provided. Questionnaires were also sent out to residents within the home to ascertain their views of the service. Information contained within the AQAA and outcomes of surveys have been included within this report as appropriate. What the care home does well: What has improved since the last inspection? The dining room has been recently refurbished to a high standard making this a pleasant area for residents to meet and socialise at lunch time. There have also been some areas redecorated and new chairs purchased to benefit residents. There are various support groups set up to support residents and their families which enable them to be more involved in decisions relating to the management of the home. Information in care plans has been improved to make this more person centred with two new documents called All About Me and a Support Summary being introduced. These help in providing additional information to enhance staff understanding of the residents. Care Homes for Older People Page 8 of 36 New social events have been implemented including a weekly Dominoes club, weekly prize Bingo and weekly Reminiscence group. A new piece of equipment called a stair climber has been introduced. This can be used to transport residents up and down stairs in the event of lift failure or emergency evacuation. What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 9 of 36 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 36 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have access to sufficient information about the home to allow them to make an informed decision on whether to stay. Comprehensive systems are in place to allow for a full assessment of need for each resident to ensure these needs can be met effectively upon their admission. Evidence: There is a Service User Guide available to prospective residents which contains information about the care and services provided to help them make an informed decision on whether to stay. The copy given to the inspector did not contain a summary of the inspection report but it was evident this document is being updated to contain more comprehensive information. Copies of the last key inspection report as well as the more recent Annual Service Review completed by us were available in the lobby of the home for any visitors to read. Care Homes for Older People Page 12 of 36 Evidence: Three care files were reviewed two of which were for people recently admitted to the home. It was established that each person has two files, one to keep the assessment and archived information and one as the current working file. One of the files could not be located for a resident recently admitted so it was not possible to confirm they had been assessed regarding their needs prior to their admission. Staff did however give assurances this would have been done. Other files viewed contained both an assessment of the persons needs by the Social Worker as well as the manager of the home. Assessment information was sufficiently detailed to enable staff to formulate suitable care plans to ensure their needs are met. A care plan was in place for the person who did not have an assessment file. More recently the home have introduced a new process whereby all prospective permanent residents are invited and expected to spend a whole day at the home. This enables them to get to know the home, staff and residents in a relaxed and unhurried way and to feel more comfortable about their proposed admission to the home. A relative spoken to during the inspection commented that they were very happy with the home and when their relative was admitted they were met at the door by a member of staff with a big smile and hello and they found this very welcoming. They stated their relative was taken to their room and they were told all about the home. A comment card received by us states I visited on behalf of my mother and saw rooms and spoke to staff. The manager also came and interviewed my mother in another home. Care Homes for Older People Page 13 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of residents are set out in a plans of care to ensure they are met and residents look well cared for. Evidence: It was evident that each resident had a care plan which detailed their care needs and the staff support required to meet these needs. Medical histories had been recorded to ensure any risks associated with these could be considered and managed appropriately. Three care plans were viewed as part of the case tracking process. One person was reported by staff to be not eating well. Care plans in place showed staff actions required to address this to ensure the resident received sufficient nutrition. Medical advice had also been sought. On reading the care file for this resident it was noted that in the daily records they had a broken skin area to their foot. This information had not been transferred into a care Care Homes for Older People Page 14 of 36 Evidence: plan to show how this was to be managed by staff and the risk assessment for pressure ulcers also had not been updated to reflect this change. However, daily records showed the district nurse had visited the next day to treat and dress the wound because it had become infected. Daily records following this visit did not report any further improvements or deterioration of the wound. This was discussed with the manager who agreed to address this matter by the implementation of care plans specifically for the management of skin as appropriate. A second care plan viewed showed that the resident had been ill and was recovering in bed and also had a pressure sore. Again there was no specific care plan for how this was to be managed. Despite this it was identified within the care records that the resident had a pressure sore and they were being cared for on a specialist mattress and hospital bed. Records also stated that the resident was to be tilted every two hours. Staff were recording each time they tilted the resident to relieve the pressure to the skin. Medical assistance had been sought and the district nurse was involved in their care. A visiting relative reported that they thought the wound was healing and that the resident had improved generally. The resident was observed to be on a specialist mattress and looked clean and well cared for. Staff had used pillows to make the resident comfortable while in bed and they were able to communicate with the resident to establish their needs. The relative said the home was wonderful and they had been pleased that staff had managed to get their relative to take the fluids and medication. A third resident who had recently been admitted to the home was still getting used to the new routines, staff and environment. Staff said that this person was independent in many ways and this was confirmed when reading their care records. At lunchtime this resident sat with two other residents who had been in the home for sometime. They all had a chat and the two longstanding residents suggested that the new resident join them in the lounge after lunch which they agreed to. There were some records on this persons care file that had not been completed such as the falls risk assessment and nutritional screening tool. It was however evident from the records that the resident could mobilise around the home using a frame and handrails providing staff advised the resident where to go. The resident looked well and ate well at lunchtime suggesting there were no immediate concerns regarding their nutritional intake. The manager advised work was being undertaken to update all of the care files in the Care Homes for Older People Page 15 of 36 Evidence: home and this included all of the care files viewed by the inspector. This should ensure that any omissions identified will be addressed as part of the review. All residents seen looked well cared for and were positive in their comments about the home. Relatives spoken to were equally positive. One person said the difference in X this week is incredible referring to how they had improved since they had been admitted to the home. They also confirmed that any requests made of staff are carried out promptly, they gave examples of how staff had promptly arranged the cutting of the residents nails and for them to have their hair done. Comment cards received by us from seven residents show that four feel they always receive the care and support they need and three feel they usually do. One has commented Managers are very aware of my needs and make every effort to see that they are met. A comment written by a relative on a resident comment card states I cannot speak highly enough about the care the people here give X. Five residents have indicated that they always receive the medical support they need and two have said they usually do. One resident has commented always GP on time or nurse any problem. A review of medication was undertaken. This was found to be managed very well with the Acting Manager undertaking regular audits to ensure this continues. Medications are stored in two trolleys which are taken around the home when medications are due. The exception to this is controlled drugs which were found to have suitable separate storage facilities. A controlled drugs register was also in place to record any medications received or given. This was viewed and was found to be accurate as required. The Medication Administration Records MARs were checked for those residents case tracked as well as others. All medications received, given and remaining had been documented and were found to be accurate. The only issue that needed to be addressed was a handwritten change to a medication. This had not been signed or dated to suggest the GP had agreed this. This applied to Paracetamol which had been prescribed two four times a day. A member of staff had written on the MAR - PRN which means as required which is not how the medication had been prescribed. Some of the MARS also had red pen used on them which is not recommended as this can fade and does not copy well if the record should be needed by another professional. The Acting Manager agreed to address these Care Homes for Older People Page 16 of 36 Evidence: issues. No concerns were identified in regards to the privacy and dignity of the residents during this inspection. Care Homes for Older People Page 17 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have access to social activities and outings and choices in regards to their care are considered to help them maintain some independence where possible. Meals are well presented and some choices are given to ensure residents enjoy the meals provided Evidence: There is no specific Activity Organiser employed by the home but there are social activities provided. The notice board in the lobby of the home detailed various events and activities. This included an outside entertainer, dominoes and card club every Friday, bingo every Tuesday and a friends and family evening which was planned to be Chinese themed. Large print books were seen in a bookcase in this area to help those residents with impaired sight read more easily. There was also a Summer Holiday advertised which all residents were invited to attend in June to Brean Sands. On the day of inspection there was a quiz taking place in the upstairs lounge with some of the residents. The manager advised that there was usually a social activity Care Homes for Older People Page 18 of 36 Evidence: that took place in the home each day around 11am. He also stated that there was a reminiscence group that met every Thursday and they were trying to get a knitting circle started. Residents spoken to said they have a sing song sometimes and one said love that, dont have often enough they also said enjoyed last night referring to an outside entertainer who had been in the home. Two of the residents who were in the home at Christmas said they didnt do much at Christmas and they could have done a bit more. One person said we all have relatives that come and go. A member of staff asked about social activities said that some of the residents played bingo in the afternoon and if this takes place they will help. They also said if there are a few people in the lounge they will sit at a table with them and get the dominoes out. Comment cards received by us from residents show that two out of seven feel there are always social activities they can take part in, one of these has stated play bingo and dominoes, once a month we have singalongs. Four residents have said there are sometimes social activities they can take part in. One these has stated they are not always well and prefer to stay in their room. The other states they are not mobile and they have a medical condition which restricts them in joining in activities provided. They have however commented that they enjoy musical entertainment when it is provided. One resident has stated that there are no activities provided they can take part in and says my disabilities make most activities arranged impossible. Care records for residents case tracked did not fully reflect social interactions or activities they may have participated in including any one-to-one time that care staff may have spent with the less able residents. A visitor to the home commented that they would like to see more social activities provided. At lunchtime the manager made a predinner announcement known as the Managers Daily Bugle whereby residents are given updates about any residents who may be in hospital, what is planned in terms of entertainment, social events and any other information relevant to them about the home. Residents clearly appreciated this information and it did result in conversation amongst the residents over lunch about issues raised. Residents were asked what was for lunch, they all said they did not know. It was Care Homes for Older People Page 19 of 36 Evidence: noticed that the menu for the day had been written on a blackboard near the entrance of the dining room. Residents are also asked each day what they would like from the choices available. Weekly menus showed there are two choices of main meal on some days but not others. A cooked breakfast is offered on a Sunday but the rest of the week cereals and toast are provided. Menus should allow for at least two hot choices for the main meal each day and a varied menu in regards to breakfast such as cooked items. However it was evident that staff ask residents on a regular basis about the food to ensure this is to their preference and liking. The inspector joined three residents at lunchtime. One of the residents said I havent been here long but the food is good, its plain we like plain food. Carers were observed to go round to each table asking what drinks they would like, some had squash, some had water and they were also offered sherry. Dinner was served from a hot trolley and consisted of fish fingers with chips or mashed potato, cauliflower and peas or liver and mash with vegetables and gravy. Pudding was bread and butter pudding, cheese and biscuits, fruit or yoghurt. Staff also were seen to offer ice cream. Meals looked appetising and were clearly enjoyed by the residents. One of the residents asked for a bit of both so they had fish fingers, liver, mashed potato and chips all of which they ate. Portions offered were appropriate but a carer did go around the tables asking if they wanted more chips. Carers were sitting amongst the residents at the tables to prompt and assist if necessary. Residents sitting with the inspector were asked if they liked the food and all said it was nice. One said its not a load, not too much otherwise it puts you off. Carers also went around each table with tartare sauce to ask who wanted it. Comment cards received by us from residents show that two always like the meals, one person has stated always fresh, nice, tasty, they always ask if I want more, its lovely. Three people have stated they usually like the food, a relative who has completed a questionnaire on behalf of the resident has stated there are somethings X does not like but staff know. From what I have seen and tasted, the food here is to a very good standard. There is always a choice so X never has to go without. One person has stated that they sometimes like the food. Their relative has also written a comment on their behalf stating I think the food offered is excellent although they acknowledge that their relative finds eating their main meal at lunchtime difficult because they are used to eating their main meal in the evening. Care Homes for Older People Page 20 of 36 Evidence: Staff confirmed that special diets could be catered for such as liquidised or soft diets as well as any specific food needs for diabetic residents. Since the last inspection, the dining room has been newly decorated with attractive wood panelled flooring and round wooden tables. Each table had a lime green mat in the centre with a flower decoration. New chairs also had been purchased. The dining room was bright with patio doors looking out onto the roadside of the home so that residents could see what was going on outside. Care Homes for Older People Page 21 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems in place ensure that any concerns or complaints raised are managed appropriately to protect people who use the service. Evidence: There is a complaints procedure detailed in the Service User Guide advising how residents or their representatives can make any concerns known to the home. In the lobby is also a Comments, Complaints and Compliments box where people can post their comments. Comment cards received by us show that all residents know who to speak to if they have a concern. We have received no complaints about this service since the last inspection. Records held within the home show there had been two complaints received since the last inspection. One of these referred to not enough staff being around in the middle of the afternoon and the other was about the lift being out of action with no alternative means of escape. Both of these matters had been responded to as appropriate and new evacuation equipment had been purchased for use should the lift become out of order. Care Homes for Older People Page 22 of 36 Evidence: A comprehensive policy on the protection of adults from abuse was available within the home. A file in relation to the safeguarding of residents was seen which gave clear information to staff in reporting any abuse with contact names and numbers. It was evident that all staff have also been required to sign a flier which gives information about vulnerable adults. Care Homes for Older People Page 23 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean, comfortable and homely environment which is subject to ongoing improvement for the benefit of the residents. Evidence: The home provides accommodation and care for 35 residents. This is divided into fourteen bedrooms on the ground floor along with one respite care bed, one lounge/kitchenette. Day care for older people living in their own homes is also provided within a dining/sitting area with attached conservatory on the ground floor. The first floor has twenty bedrooms along with a communal areas lounge/kitchenette, and a further sitting room. A separate large dining room is also available for use by all of the residents on the ground floor which has been subject to recent refurbishment. This home also has its own hairdressing salon on the ground floor which is regularly used by the residents and two visiting hairdressers. The home has a pleasant appearance and a homely feel although the carpets in the some communal lounge and corridor areas are worn and threadbare. The manager said that new carpets had been ordered and they were hopeful these would be fitted soon. All bedrooms contain en-suite facilities comprising of a toilet and wash hand basin. Care Homes for Older People Page 24 of 36 Evidence: Two bedrooms also contain a shower. Rooms seen were clean, tidy and homely and had been personalised by the residents occupying them. The home has a shaft lift for easy access to the first floor and there are handrails around the home to assist the less mobile. Corridors are of sufficient width to allow for easy wheelchair access. There are several communal bathrooms in the home but no communal showers. Each of the bathrooms seen were also being used as a storage area for various items including dirty laundry, coat hangers, wheelchairs, towels and linen and clinical waste. This made the bathrooms less homely and appealing. The manager agreed to look at this with a view to improving storage arrangements in the home. There is a sluice room on each floor and a fully equipped laundry to manage the laundry needs of the residents in the home. There were no unpleasant odours identified during the inspection and areas of the home seen were clean and tidy. It was found that the sink unit in the laundry was being used to soak and manage dirty clothing meaning there was no accessible area for staff to wash their hands. There was soap and paper towels next to this area. Staff working in the laundry should have access to a dedicated handwash sink with liquid soap and hand drying facilities to maintain good infection control practices. The Acting Manager said this would be reviewed. The laundry person was wearing a tabbard and advised she uses gloves when completing dirty tasks within the laundry area to maintain good hygiene. There were no concerns raised about the laundry service other than sometimes the wrong items being returned to rooms even when labelled. Care Homes for Older People Page 25 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements are sufficient to meet the needs of residents accommodated in the home. Training is provided on an ongoing basis to ensure staff are competent in caring for residents and recruitment practices ensure staff are deemed suitable to care for residents safely. Evidence: The Annual Quality Assurance Assessment (AQAA) document completed by the home prior to the inspection confirmed staffing arrangements in place. The staff team are split into service areas. The senior staff team provide daily duty manager cover between 7.30am and 10pm each day. In addition during the working week there is manager who works in a supernumerary capacity. The care staff team consist of 18 care staff who provide cover to all units between 7.30am and 10.00pm. Between 10.00pm and 7.30am, the home is staffed by two waking staff members who have the support of an out of hours senior team if required. Ancillary staff consist of one domestic person that works five days per week. At the time of inspection there was no dedicated person to clean the home at the weekends. There is also a laundry person that works seven days per week. There are also two cooks and kitchen assistants who provide a catering service seven days per week. There is also a day care facility that is run by two Day Care assistants, this is run Care Homes for Older People Page 26 of 36 Evidence: separately from the home. During the inspection it was established that the home aims to have six care assistants on duty each day and there are usually three staff allocated to each floor. On the day of inspection there were four staff working on the top floor and two on the ground floor. It was explained that this was due to the high dependency of some of the residents on the first floor. There were 32 residents in the home on the day of inspection. The way staff are deployed means that there are periods during the day between 1.30pm to 2.30pm and 4pm to 5pm when there are four care assistants and between 1pm and 2.30pm there are five care assistants. Duty rotas seen confirmed the above numbers. Carers were observed to be caring and supportive towards residents. Residents and visitors spoken to were very complimentary of the staff. One person said staff are very kind. A visitor explained how helpful they had found staff and stated that any requests they had made of them had been carried out in good grace with an instance response and they gave the impression it was no trouble at all to carry out the requests. Comment cards received by us show that six of the seven residents who responded feel staff listen and act upon what they say. One person has stated I have ticked yes because usually this is the case, sometimes I do not recognise their response because I can neither see them or hear them well. One person has responded no. Two residents state that staff are available when they need them. Four have responded that staff are usually available. One person states staff nice and friendly usually they have time for me when I need. The manager states in the AQAA that the use of agency staff is something they could manage better by employing more permanent staff. In addition to the use of agency staff, the home has a bank of seven staff who are scheduled to cover so many shifts each week. An induction to the home is provided for new staff and arrangements are made for them to attend mandatory training during the induction process. It was not evident that new staff had completed or commenced training in accordance with the Skills for Care Common Induction Standards. This training is provided over a number of weeks to allow staff to build up their competences in caring for the residents. The Acting Manager said this would be starting in February 2009. The AQAA confirms that all new staff are supernumerary until confident and competent in their role. The manager has Care Homes for Older People Page 27 of 36 Evidence: also stated that the length of this period depends on the individual. It was established that mandatory training completed by staff is documented on each individual staff file as opposed to an at-a-glance schedule. This made it difficult to evidence that appropriate training is up-to-date for all staff. The Acting Manager confirmed that some staff were due to complete their Moving and Handling training and there were also some staff that needed to update their Food Hygiene training. The AQAA provided by the home shows that there are 28 care staff employed and 20 have completed a National Vocational Qualification (NVQ) in care, this exceeds our standard of 50 and is to be commended. Additional training linked to the care needs of the residents had been completed by some staff and some further training had been arranged. This included Parkinsons, Death and Dying, Mental Health Awareness, Dementia, Medication and Food and Nutrition. Two care staff files were viewed to confirm recruitment practices carried out are as required. These were found to contain all of the required information including two written references and details of Criminal Record Bureau checks. Care Homes for Older People Page 28 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an effective management structure in place to safeguard and promote the best interests of the residents. Evidence: The current manager has been in post since January 2004, and has considerable experience in managing social care settings. He holds the RMA NVQ4 in addition to other management qualifications. In November 2009 a decision was taken for the manager to support another home for four days per week on a temporary basis but still supporting this home one day a week in person. During this period the Assistant Manager has been undertaking an Acting Manager role to support the home. The provider has kept us informed of this arrangement and more recently have advised that from January 2009 the manager will not be in the home for a further 3 months as he will be providing full time support to the other home. Care Homes for Older People Page 29 of 36 Evidence: Long term absence of the manager can impact on the quality rating for the home. The service has recognised that this arrangement needs to be kept under monthly review and have advised the manager will return to Lower Meadow at the end of this three month period. The home has also received the support of one of the Locality Managers during this period of absence. For the purposes of this inspection both the manager and acting manager and locality manager were present. It was evident that senior staff have clear responsibilities and know what is required of them to ensure the home is run effectively. The manager was able to provide records detailing these responsibilities and these were viewed. A member of care staff spoken to about the staffing arrangements said very organised everyone knows what to do confirming that management arrangements are effective. There are several systems in place whereby the quality of the care and services provided are monitored. A folder with thank you cards and visitor comments was viewed and this showed that each month the service receive compliments from people who access the service. In September for example there were three compliments received. Compliments included you made us all feel so welcome. Another stated she couldnt have had better care anywhere else. There is a Progress Group held regularly whereby relatives can attend along with residents to discuss matters relating to the home. The August notes showed that items discussed included supporting new staff, welcoming new residents, the gardens, recycling, the environment and mealtimes. A residents group meeting is also held monthly and notes of the December meeting were viewed. It was evident that many of the residents in the home had attended. The notes of the meeting reminded residents that these meetings allowed them to influence how services are provided, be involved in decision making and are an opportunity to share news and developments within the home. Issues discussed included the arrangements for the meetings, residents and staff changes, the welfare fund, social activities, outings and comments from residents. Comments had been asked from each resident and these were recorded within the notes although comments were annonymised. Comments recorded during the December meeting were all positive with some personal requests being made such as Care Homes for Older People Page 30 of 36 Evidence: My wheelchair needs looking at. In addition to the above is the Managers Daily Bugle this information is shared with residents either in the dining room at lunchtime as a group, verbally by care staff in residents rooms (if they did not attend the lunchtime in the dining room) or by copying the sheet and offering it to any residents where this is considered more appropriate. This always reports on residents who may be in hospital or poorly, planned activities, news of the day and any specific information regarding the home that the residents would want to know. During the inspection the manager reported the above information and also made a point of asking residents their views on things so that their opinions and thoughts could be considered as appropriate. In addition to the above meetings there is also a monthly meeting held with senior staff in the home. Notes of this meeting were seen. It was evident that staff discussed in detail the residents in the home and expected admissions. They also discussed any comments, compliments and complaints received as well as training, future developments, budgets and medication management. Actions required by staff were clearly detailed with a view to ensuring a consistent quality service is provided to the residents in the home. Comment cards received by us contained a comment from a resident stating Im so pleased to be here it is my home, staff are wonderful. A comment received from a relative states I am more than satisfied with this home and believe X would say the same if X could. In regards to the management of residents monies, this is managed by the Administrator for the home. On the day of inspection the Administrator advised that she had found an error in the records and therefore was given time to re-check the records to identify any errors. These were identified and records amended as appropriate. Following these amendments, all records viewed were found to be accurate and correct. It was established that the hairdresser provides the home with a book listing the names of residents who have had their hair done. This is used by the Administrator to make payments and is then handed back to the hairdresser. There was no individualised receipts from the hairdresser showing their name and address or official stamp to confirm payment received. The same issue applied to the Chiropody receipts. The home is provided with a bill with names of people who have received this service but this is then handed back to the Chiropodist with payment so the home has no proof that the resident received this Care Homes for Older People Page 31 of 36 Evidence: service by the Chiropodist concerned. This was discussed and the administrator agreed to review this with the manager. Discussions also took place with the administrator about how money received and given out is managed with a view to making current arrangements more robust and secure. A review of health and safety checks carried out was undertaken. Records in place confirmed that checks were being completed within the required timescales with one exception. Those checks in date included the five yearly electrical wiring, gas, service of the lift, fire alarm system, emergency lighting and servicing of portable hoists. The electrical portable appliance testing record was not seen but there were stickers on products showing they had been tested. The majority of these were in date. It was noted that two of the freezers in the kitchen had 2006 dates on the stickers so it was not clear these had recently been checked. The manager said he would arrange for this to be done. Monthly checks were being undertaken on the hot water in resident areas to ensure temperatures did not exceed the recommended guidelines to prevent any scald risks to the residents. Fire drills had also been carried out with staff so they are clear on their responsibilities should a fire occur in the home. Fridge and freezer temperatures were being taken daily and were within the recommended guidelines although some of the freezer temperatures were below guideline temperatures. Food in fridges was stored appropriately in that it was dated and sealed. The majority of dried foods were sealed or were in appropriate containers, there was however a bag of sugar, parsley sauce mix and curry sauce mix that was found open. All dried food produce should be kept sealed to keep them fresh and pest proof. Care Homes for Older People Page 32 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 33 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 It is recommended that specific care plans are devised for the management of any skin conditions to ensure there is a consistent approach to how these are managed. It is recommended that any future reviews of menus includes a choice of hot main meal each day as well hot choices for breakfast during weekdays. This is to ensure the home can demonstrate a varied menu is being offered as well as offering them a sufficient choice. It is advised that social activities provided each day are clearly documented showing those residents who have participated or declined to demonstrate all residents in the home have the choice to access to some form of social interaction each day. It is recommended that consideration is given to the provision of a communal shower. This is to both to enable residents to have a choice between a bath or shower as well as provide staff with another option in how they manage the personal hygiene for the residents. A review of storage arrangements in the home should be undertaken to ensure bathrooms are accessible and remain pleasant and homely for residents to use. 2 14 3 14 4 21 5 22 Care Homes for Older People Page 34 of 36 6 26 It is recommended that a dedicated handwashing facility is provided in the laundry so that staff have easy access to handwashing facilities to maintain good hygiene. New staff should complete induction training upon their employment that is linked to the Skills for Care Common Induction Standards. Training records should demonstrate this is happening. It is recommended that the home develop an at-a-glance training schedule so that it can be easily demonstrated that all staff have completed the required training to maintain the care of residents safely and appropriately. It is advised that a review of how residents money is managed in the home is undertaken to ensure the system is more robust. This includes a clear system for maintaining receipts for any transactions undertaken. All dried food produce needs to be appropriately sealed or stored in appropriate containers to ensure they remain fresh and pest proof. There needs to be clear records in place to confirm that all electrical portable appliances in the home are being regularly checked. 7 30 8 30 9 35 10 38 11 38 Care Homes for Older People Page 35 of 36 Helpline: 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 We want people to be able to access this information. 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