Inspection on 05/03/06 for WCC - Lower Meadow

This inspection was carried out on 5th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

WCC - Lower Meadow 27/01/09

WCC - Lower Meadow 08/03/07

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Lower Meadow Drayton Avenue Stratford upon Avon Warwickshire CV37 9LF Lead Inspector Yvette Delaney Unannounced Inspection 5th March 2006 14:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lower Meadow DS0000035959.V285723.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lower Meadow DS0000035959.V285723.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Lower Meadow Address Drayton Avenue Stratford upon Avon Warwickshire CV37 9LF Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01789 268522 01789 266757 paulgaskell@warwickshire.gov.uk Warwickshire County Council, Social Services Department Paul Gaskell Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Lower Meadow DS0000035959.V285723.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Managers Qualifications That Paul Gaskell achieves the required NVQ level 4 by the year 2005. 26th September 2005 Date of last inspection Brief Description of the Service: Warwickshire County Council manages Lower Meadow. The home is a local authority care home registered to provide personal care 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 ground floor provides long term care for fourteen older people; respite care is also accommodated for, with one room on the ground floor. Within this area there is one lounge/kitchenette, and there is now a separate dining area. Day care is provided within a dining/sitting area with attached conservatory area. The first floor accommodates twenty residents. Communal areas on the first floor consist of a lounge/kitchenette, and a further sitting room. The home has a pleasant appearance and a homely feel. The communal areas are well decorated and furnished attractively. All bedrooms contain en-suite facilities comprising of a toilet and wash hand basin. Two bedrooms also contain a shower. The home has a shaft lift. Car parking is provided to the front of the building. Lower Meadow DS0000035959.V285723.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on a Saturday between the hours of 2.00 pm and 21.30 pm. This was the second visit for this inspection year. A Care Officer was present at this inspection until 7pm and a Senior Carer from 5 pm. Staff in the home co-operated with the inspection. Discussions with the staff, examination of care profiles, case tracking, and residents and relatives. Records related to residents, staff, the environment and operations in the home were examined. These included maintenance, servicing contracts, care profiles, accident records and policies and procedures. Details in a pre-inspection questionnaire sent to the home prior to the inspection provided factual information on the home. Comment cards sent to the home and given to residents and relatives also informed this report. Fifteen comment cards were received from residents and eleven from relatives. Their views are detailed in the following table: Outcome of Service Users Comment Cards – 15 received The ‘Residents Independent Chairperson’ for the home supported residents’ to complete the comment card. Yes 12 14 14 14 2 11 12 13 14 1 No Sometimes 2 Comment 1 no comment 1 2 3 4 5 Do you like living here? Do you feel well cared for? Do the staff treat you well? Is your privacy respected? Do you wish to be more involved in decision making within the home? 6 Does the home provide suitable activities? 7 Do you like the food? 8 Do you feel safe here? 9 If you are unhappy with you care do you know who to speak to? 10 Do you or a relative or representative wish to speak to an Inspector about your life in the home? (If so tell us your name) No additional information given. 1 1 1 11 2 1 1 3 1 1 undecided 1 no comment 1 1 14 Outcome of Relatives/Visitors Comment Cards – 11 received Lower Meadow DS0000035959.V285723.R01.S.doc Version 5.1 Page 6 1 Do staff/owners welcome you in the home at any time? 2 Can you visit your relative/friend in private? 3 Are you kept informed of important matters affecting your relative/friend? 4 If your relative/friend is not able to make decisions, are you consulted about their care? 5 In your opinion are there always sufficient numbers of staff on duty? 6 Are you aware of the home’s complaints procedure? 7 Have you ever had to make a complaint? 8 Are you made aware of forthcoming inspections? 9 Do you have access to a copy of the inspection reports on the home? 10 Are you satisfied with the overall care provided? Other comments made include: Yes 11 11 11 11 4 7 3 7 9 10 No Comment 7 4 8 4 Not on rare occasions 1 not sure 1 no comment 1 undecided “I am lucky that my mother is living at Lower Meadow. The home and staff are lovely and there are lots of outings and activities. Sometimes very rarely there are short staffed due to illness etc., but they manage to cope.” “ It is a pity there are so many changes in support carers. It makes it difficult for people to build up a relationship with a carer. It would be great if people could be encouraged to make friends with others of similar personality.” “Occasionally there appears to be staff shortages and residents have to wait for toilet breaks.” “The choice at teatime is very poor particularly if you don’t like/eat bread.” “ The heating in the residents’ bedrooms is very unpredictable. It is often cold in mom’s room particularly after lunchtime. It is not cold in the ‘common areas.’ Mom complains regularly to us about the lack of control over her radiator.” “Staff sufficiency always an issue.” “If we asked for the inspection reports I expect we could see it.” “We are very pleased and happy with the care and attention Lower Meadow have given to my Dad since he has been there.” What the service does well: Lower Meadow DS0000035959.V285723.R01.S.doc Version 5.1 Page 7 The staff are caring and meet most of the needs of the residents. Two relatives said that the staff are always pleasant and give them the information they require concerning their relative. Prospective residents and relatives are encouraged to visit the home prior to admission. What has improved since the last inspection? What they could do better: The areas where improvement is needed include the • Accurate completion of care plan documentation. Care plans must clearly identify the care needs of individual residents and the action to be taken by staff to meet individual residents needs. Improvements need to be made to medicine practices in the home. Staff in the home must be able to demonstrate how residents are supported to make choices and that a choice of suitable food is offered at all meal times. • • Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lower Meadow DS0000035959.V285723.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lower Meadow DS0000035959.V285723.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5 Prospective residents have the information needed to help them and their families make a choice about where they live. The contracts/statement of terms and conditions available informs residents of their rights prior to signing the documents and moving into the home. Residents and or their families have the opportunity to visit the home in order to decide on the suitability, quality and the facilities of the home. EVIDENCE: The Senior Carer on duty could not find a copy of the Statement of Purpose. One of the residents spoken with showed the inspector a copy of his Service User Guide. The document was detailed and provided information on the services and facilities available in the home. The inspector was informed that all prospective residents are given a copy of the Service User Guide during their pre-admission assessment. The service user guide contains a summary of the Statement of Purpose for the home. Prospective service users are also shown a photograph album of home and details of how the home operates is explained and the opportunity to visit the home is offered. Lower Meadow DS0000035959.V285723.R01.S.doc Version 5.1 Page 10 Contracts for three residents were seen and examined, the document provides residents with the terms and conditions for moving into the home, and outlines their rights under the contract. The home provides service users with a statement of terms and conditions. A contract of residency is available for all residents, which details the terms and conditions for living in the home. Details of the fees payable and by who (service user, local or health authority, relative or another) are included in a separate document. Discussions were held with relatives visiting to view the home with their mother who may be moving into the home. They had found the visit informative and helpful. Summaries identifying the care needs of residents referred by the different care management teams namely Social Services. Evidence of ongoing care reviews for residents were also available. Lower Meadow DS0000035959.V285723.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Residents’ health, personal and social care needs were not consistently described in care plans, which could result in the oversight of care and possible harm to residents. Medicines are generally safely managed within the home. The inspection showed that some more attention to detail is needed to demonstrate that all the medicines are administered as prescribed. Residents’ right to privacy and dignity is upheld leading to a feeling of being valued and respected in the home. EVIDENCE: Four care plans were examined the contents of which show that they have improved and work is ongoing. Information available was on the whole sufficient to support staff in meeting the needs of residents. Care plans demonstrate that there is further room for improvement as staff were not consistent in ensuring that profiles are detailed and describe the specific needs of residents. Statements were read which provided evidence of an evaluation Lower Meadow DS0000035959.V285723.R01.S.doc Version 5.1 Page 12 of the care given and monthly review of residents care needs had been carried out with input from relatives and residents where appropriate. There was evidence of completed risk assessments in all the care plans examined. Risk assessments examined include determining the risk of a resident falling, nutrition and moving and handling when transferring or moving residents or supporting them with mobility. There is evidence in the care plans of access and advice being obtained from specialist nurses, which include the District Nurse, the Community Psychiatric Nurse and the GP on the care and treatment of residents. The trolley was too small for the number of medicines prescribed each month. Gaps were found on the Medicine Administration Record (MAR) chart, medicines had been administered in some instances and not recorded and in other instances not administered and reasons for non-administration had not been recorded. Variable doses had not been routinely recorded so it was not evident what dose had been administered in all instances. Unlabelled medicines were found in the trolley and it could not be demonstrated who they belonged to. Loose tablets were also found. The home has not got a dedicated medication room with secure storage within. There is a dedicated refrigerator but the maximum, minimum and actual temperatures were not recorded daily to ensure the medicines are stored within their product licences. MAR charts are marked with different colour highlighter pens to further emphasise the times that medication is due. This could be considered good practice but the charts become difficult to read and it would be better if just the times were highlighted and not also where staff have to write their initials. Plans are to store all opened prescribed topical medication e.g. creams in one area, which will carry risks of cross contamination and would not be considered good practice. It was evidenced throughout the inspection that staff address residents by their preferred name. Staff were seen to be respectful when in conversation with residents and their visitors. Lower Meadow DS0000035959.V285723.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 and 15 It was not demonstrated that residents are able to exercise informed choices about the food they eat. EVIDENCE: Suppertime was observed to be a social occasion with residents talking and supporting each other and enjoying their meal. There was no choice available to residents as to what they could have for supper. Residents were offered a choice of sandwiches only. Residents who were receiving their supper last did not have a choice of sandwiches available to them. Although a hot choice was available this was not offered. Lower Meadow DS0000035959.V285723.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18 The home has a clear and easily accessible complaints procedure, which indicates an open and positive approach to problem solving. The service ensures that resident’s legal rights are protected and have systems in place to protect them. Policies and procedures concerning the protection of vulnerable people are adequate but in the absence of attendance by staff to adult protection training does not support the service in ensuring that residents are protected from abuse. EVIDENCE: A detailed complaints procedure is available and accessible to residents, staff and visitors in the home. There have been a total of three verbal complaints since the last inspection; concerns raised include catering, attitude of staff and laundry. All complaints have been investigated and resolved in keeping with the organisations complaints procedure. Relatives spoken with advised that they would speak to the manager or her deputy if they had any concerns. Residents are encouraged and supported to exercise their legal rights. Access is available to advocacy services and leaflets/notices are available informing residents and visitors of the facilities available. A procedure for responding to allegations of abuse is available with clear guidance for staff to follow. Training records showed that some staff had attended recent adult protection training sessions. Lower Meadow DS0000035959.V285723.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These Standards were not assessed at this inspection. EVIDENCE: Lower Meadow DS0000035959.V285723.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 The skill mix of staff on duty on the day of inspection were not sufficient to meet residents’ needs and ensure that they are in safe hands at all times. EVIDENCE: There are currently only 7 of 22 (32 ) care staff with a NVQ level 2 qualification or above. A further 6 carers are undertaking the training, which when completed will increase the percentage of staff with a qualification in direct care to 59 . Lower Meadow DS0000035959.V285723.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 and 38 Records are organised, accessible and securely stored, which should safeguard residents’ rights and best interests. The maintenance of the home and operational procedures carried out in the kitchen support ensuring that the health, safety and welfare of residents are promoted and protected. EVIDENCE: Individual residents records and other personal confidential information related to staff and residents are secured in locked cabinets, in the manager’s office. Computers in the home are password protected. Records examined include maintenance, contracts and servicing documentation for electrical equipment, clinical waste and all other services supplied to the home. Residents’ aids and equipment have also been serviced, this includes Lower Meadow DS0000035959.V285723.R01.S.doc Version 5.1 Page 18 hoists and baths and maintenance work is up to date. Fire records and electrical tests are up to date. Cleaning records and fridge/freezer temperatures were available for examination following the inspection these were consistently monitored and recorded. Cleaning records had been maintained and these were up to date. was not clear but daily general cleaning records are maintained. Records were signed with initials and not signatures as required by the home’s procedures. Observation in the bathroom on the first floor of the home evidenced that communal tights/stocking are in use this practice must cease. Lower Meadow DS0000035959.V285723.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 X X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X 3 2 Lower Meadow DS0000035959.V285723.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4, 5 Requirement Care staff must be aware of how to access copies of the Statement of Purpose and Service Users Guide in the absence of the manager. Timescale for action 31/05/06 2 OP7 15 Care plans must set out in detail, 31/05/06 the action needed to be carried out by care staff to ensure all aspects of the health; personal and social care needs of the resident are met. Evidence is required to demonstrate that care plans are drawn up with the involvement of the resident and/or their representative. The MAR chart must be referred to before the administration and signed or the reason for nonadministration recorded immediately afterwards. Medicines must be replaced back into the dispensing container from which they were removed following the administration of medicines. DS0000035959.V285723.R01.S.doc 3 OP7 15(1), S.3 31/05/06 4 OP9 13(2) 31/05/06 5 OP9 13(2) 31/05/06 Lower Meadow Version 5.1 Page 21 6 OP9 13(2) 7 OP14OP15 12 8 OP38 13(3)(4), 16 The refrigerator temperatures 31/05/06 (maximum, minimum and current) must be recorded daily and all must lie between 2°C and 8°C to ensure the medicines requiring refrigeration are stored in compliance with their product licences to guarantee their stability. Evidence must be available that 31/05/06 residents are given real choice when choosing meals eaten in the home. The practice of using communal 31/05/06 stockings/tights must cease. 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 Refer to Standard OP9 OP9 Good Practice Recommendations It is recommended that only the times that medication are to be administered should be highlighted on MAR charts. The planned storage of opened topical creams and lotions in one communal space should be reconsidered. Lower Meadow DS0000035959.V285723.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lower Meadow DS0000035959.V285723.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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