Care Home: Castle Meadows

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What the care home does well We would like to thank the people at Castle Meadows, relatives, staff and the Manager for their assistance and hospitality throughout the inspection. There are thorough admission procedures, and people have good information about the home and can visit to make a decision about staying there. People in the home told us: "they let me do as much as I can myself, and then help me to do the rest, and I`m 104." "I was going downhill in hospital, but look at me now." One relative told us that Castle Meadows is "one of the happier homes, which is why we have... x... here The service has a person-centred approach, and there is a robust quality monitoring system that ensures high standards of care planning, risk assessment and recording. There are opportunities for people to make decisions about their lives, recover from illness, and take part in their care and treatment. Everyone we spoke to said that they felt happy and safe. There are good procedures to protect people and the home acts and learns from any concerns that arise. The views of people and their families about the running of the home are sought, and people help select the staff. Staff are checked to ensure people are in safe hands. Staff have the training and support they need to meet people`s needs, and their competency is checked. Health and safety is well managed, the home and grounds are well maintained, so people are safe and secure. Everyone finds the manager approachable, and the home is run with creativity and accountability. What has improved since the last inspection? A new manager was appointed and registered by CSCI. Most statutory requirements and recommendations from the last CSCI inspection have been addressed. A Residents and Families Committee was introduced, and there are monthly meetings Staffing levels have been increased at night Menus are displayed giving daily choices available House keeping and social activities have improved. What the care home could do better: The Welcome Pack needs more information about respite stays arranged through General Practitioners, so that people know what to expect, and the cost to them is clear. Medication storage needs to ensure medicines maintain their stability. Staff need guidelines on the administration of `as required` medication, medication needs to be checked into the home, and there were minor recording errors. How information is given to relatives and friends about people`s progress needs improving. Clinical waste storage bins should be locked to prevent spread of infection. Aids, better lighting and more dining space could assist people to communicate in communal areas, and to succeed at eating. Systems need to ensure that there are enough staff at all times to meet people`s assessed needs. People`s personal money should be managed so that their financial interests are safeguarded. Employment policies adopted by the company should be known and used to further ensure people are in safe hands. Staff need to understand and use a new law about people`s rights. CARE HOMES FOR OLDER PEOPLE Castle Meadows 112 Dibdale Road Dudley West Midlands DY1 2RU Lead Inspector Tina Smith Key Unannounced Inspection 10:30 1st and 2 September 2008 nd 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 DS0000066285.V368018.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000066285.V368018.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Castle Meadows Address 112 Dibdale Road Dudley West Midlands DY1 2RU 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) 01384 254971 01384 211017 castlemeadows@mimosahealthcare.com Mimosa Healthcare Group Limited Rachel Christine Daley Care Home 51 Category(ies) of Dementia - over 65 years of age (51), Old age, registration, with number not falling within any other category (49), of places Physical disability (2) DS0000066285.V368018.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users in the category PD(E) may be 51 years and over. Castle Meadows is able to provide intermediate care for up to 4 service users. 18th September 2006 Date of last inspection Brief Description of the Service: The Home developed from a three-story house, and was extended by a purpose-built wing and a large conservatory at the front of the building. There is car parking at the front and side of the home, as well as gardens and patios at the rear. The home is close to Dudley town centre, and has local amenities and public transport near by. Castle Meadows has been a care home since 1987, and Mimosa Healthcare Group Limited has ownership since 2006. Personal care or nursing care is provided for up to 51 people. There is an NHS intermediate care service provided to 4 people who need up to 28 days nursing care, which includes rehabilitation such as physiotherapy on the premises. On each floor there are lounges with dining areas; on the first floor there is a sitting room, and on the third floor is a quiet room with a pay telephone. Bedrooms are on three floors in separate wings and there is a passenger lift. There are 50 bedrooms, for single or double occupants, mostly ensuite. There are five rooms without ensuite toilets and washbasins. Throughout the home there are assisted bathing and showering facilities, and additional toilets. A physiotherapy room is on the top floor. There is a large kitchen and laundry. Fees range from £337 to £509.73 per week, depending upon the type of service and funding arrangement. The fee information given applied at the time of the inspection; up to date information should be requested from the service. DS0000066285.V368018.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means that the people who use this service experience excellent quality outcomes. Our inspections focus on the outcomes for people who live in the home and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, national minimum standards of practice, and on aspects of service provision that need further development. Before the fieldwork visit took place a range of information was gathered from the last inspection, surveys from people in the home, their relatives and staff, things the home and others told us about, and a questionnaire the home sent to us, called the Annual Quality Assurance Assessment or AQAA. This gave us some information about the home, staff and people who live there, improvements they have made and intend to make. Visits were made to the home by one inspector over two days, totalling 12 hours. The home did not know we were coming. On the first day we observed people for two hours, using a tool called a Short Observational Framework for Inspection, or SOFI. This helps us assess the quality of care in the home for people who find communication difficult, and to understand how the staff and environment affects people’s wellbeing. Two records were sampled and three people were ‘case-tracked’ to discover their experiences and outcomes of living there. This means we met or observed people and areas of the home that they use, looked at their records, medication, and equipment in detail. We checked what staff knew about them, their needs, and how care is provided. Nine people who live at the home and two visitors were spoken to, along with visiting health professionals. We looked around the building to make sure that it was warm, clean, comfortable and secure. We watched a mealtime and medication administration. Records about running the home and managing staff were seen. Five requirements from the last inspection have been met, and the sixth was replaced. There were no immediate requirements after this visit. This means that there was nothing urgent that needed to be done to make sure people stayed safe and well. There is one requirement and nine good practice recommendations made as a result of this inspection. DS0000066285.V368018.R02.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? A new manager was appointed and registered by CSCI. Most statutory requirements and recommendations from the last CSCI inspection have been addressed. DS0000066285.V368018.R02.S.doc Version 5.2 Page 7 A Residents and Families Committee was introduced, and there are monthly meetings Staffing levels have been increased at night Menus are displayed giving daily choices available House keeping and social activities have improved. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000066285.V368018.R02.S.doc Version 5.2 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 DS0000066285.V368018.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3 - 6: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available before people visit so that they can decide if the home is suitable. Everyone has an assessment. The home confirms their needs can be met and reviews this regularly. EVIDENCE: The home has a Welcome Pack, and this is in bedrooms when people come to stay. The pack includes the service user guide, statement of purpose, and a ‘Residents Charter’ that explains the range of services and facilities that are provided, and the admission process. There is up to date information about all fees and charges, terms and conditions and about the management and staff. There is also information for people’s security and on the complaints procedure. The pack now includes information about respite beds arranged through General Practitioners, although the nature of this service could be explained in more depth so that people know what to expect, the cost to DS0000066285.V368018.R02.S.doc Version 5.2 Page 10 themselves, and the transfer or discharge process. There were 152 admissions and 90 discharges over the past 12 months. On our visit there were two vacancies in a shared room. The AQAA tells us that the pack is available in Braille and on audiotape on request so that it is accessible to a wider range of people, but this is not in the pack or on a poster, and it does not appear to be available in other languages. We saw posters in the home about local advocacy services so that people could get support in making decisions. There was other helpful information on display, such as CSCI Reports. Visits are encouraged so that people and their families can view facilities, meet staff and other people who live there. The public have valuable information available to help them make an informed decision about staying at Castle Meadows. There were 47 people in the home when we visited: 19 of these have nursing care; 28 people have personal care with any nursing needs supported by District Nurses who come in as necessary. One relative told us that Castle Meadows is “one of the happier homes, which is why we have… x… here.” There are good systems in place to assess individual needs. The home has the equipment, expertise and any NHS support in place before people move in. We were told about one hospital discharge where the NHS just sent the person without an assessment – the home assessed quickly and found pressure sores they had not been told about. We saw through case-tracking 3 people that trained staff usually visit the person, and professional assessments from health and social services are used. There were letters in people’s care records confirming that their needs could be met. The admission process is flexible in other ways to cope with emergencies. For instance, we were told that a couple sharing a room who needed temporary nursing care wanted their dog to come. The home made special arrangements and even the dog had a care plan. Re-assessments are requested if needs significantly change, for instance if someone needs more nursing care than district nursing can provide. DS0000066285.V368018.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7 – 10: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good systems of care planning and risk assessment so that people are understood, as well as their needs and abilities. Competent staff use best practice so that people’s health and care needs are met. EVIDENCE: Three personal and health care records were looked at in detail at this visit, and two further records were sampled. Each person has an individualised plan about what they are able to do independently and what assistance and equipment is required for staff to help them maintain their health, wellbeing, independence and dignity. There are opportunities routinely offered for people to manage their own medication and finances safely. Care plans are detailed and kept up to date and they follow best practice guidance. There was evidence in daily and monitoring records that care plans have been followed by the staff team. DS0000066285.V368018.R02.S.doc Version 5.2 Page 12 For example, a person with diabetes preferred to eat non-diabetic food and wanted to manage their medication but was forgetful. We saw a good diabetes plan, so that staff could monitor blood levels; recognise when to call a doctor or an ambulance. After a risk assessment, it was agreed that medication needed to be administered, but choice of diet is respected. Food and fluid logs are reviewed. Another person has medication administered and stored by the home, but puts their own eye drops in. People, their visitors and professionals told us there is good quality care & skilled staff at Castle Meadows. Staff files had competency checks. Health specialists are often in the home, and they told us that their advice is followed by the home’s staff and appointments are kept. We spoke to people that came from hospital to the home to recover from serious illness; they have gained weight and quality of life. Other people and families told us that the staff support them to have a break from coping alone. People said: “they let me do as much as I can myself, and then help me to do the rest, and I’m 104.” “I was going downhill in hospital, but look at me now.” Risk is assessed using recognised tools for falls, skin integrity and nutrition. The link between these risks is recognised, and necessary equipment and monitoring measures are put in place. Social histories are completed with families if there is consent, so that staff can understand the person, who is important to them, and their interests. Care plans are agreed with people and their representatives, but are not always signed. The Manager is improving this when people first come into the home. There may be more the home can do to keep relatives up to date on individual progress, if people consent. We found four examples of families who did not know the named nurse or key worker assigned to their relative, or who wanted to be more involved in care planning. Action was taken each time to improve this, but one relationship with a family broke down. One relative told us, “…I am the only one that visits. I feed…x… her tea when I come and the only thing I worry about is whether she is eating.” We were able to reassure this relative as we had observed the person during the SOFI and at dinner that day. We saw best practice in use at the home. People who lost a lot of weight are assessed for swallowing difficulties, offered new dentures, oral hygiene plans, special diets, food likes and dislikes are noted and the cook informed to help them succeed at eating. We saw food and drink intake and output charts, pressure relieving aids to prevent sores, mobility and falls prevention plans, and weight is regularly monitored. We watched skilled staff supporting people with dementia and very frail people to eat, but we also saw feeding practice that could improve (see Daily Life). Care staff provided sensitive and discreet personal care, and maintained DS0000066285.V368018.R02.S.doc Version 5.2 Page 13 people’s dignity by adjusting their clothing, knocking on doors. However we saw a visiting therapist directing care staff, and assessing someone unable to communicate or fully cooperate to try out a standing aid in a lounge. This was in front of on-lookers and was undignified; the person and their family were distressed. This was avoidable, as the home has provided therapists with their own room. The home needs to ensure people’s dignity is maintained on their premises. Management audit care plans to make sure that people are treated as individuals, that enough is known about the person, that their religious and cultural needs are met, and choices are in their care plan. People choose the gender of staff helping them with personal care, whether they prefer a shower or bath, and how often. How to use and maintain aids and equipment, and staff actions are detailed to keep people mobile and able to express themselves. We saw plans about care of eyeglasses, hearing aids and dentures, when a person becomes unsteady on their feet through illness or falls, and what to reassure people about. Continence aids are not used if they are not needed. One activity plan seen was blank, and none of the plans seen detailed exercise or therapeutic activities that would be of benefit. Transfer and discharge arrangements are made through multi-disciplinary meetings for people to return home or go onto another service after GP respite. The home and company audit pressure sores, MRSA and Clostridium Dificile infections to ensure best practice is used. There is good infection control, staff have training and there has been no outbreak of contagious infection. The medication system, policy and audits by the Manager and local pharmacist generally protect people in the home, but there were errors seen. The two medication storage rooms were too hot at 270C, similar to the last inspection. There were gaps in the medication fridge temperature chart, and the policy does not help staff recognise when the fridge is too cold. This can pose risk to the stability of medicines stored in the home. We saw medication administered safely, and generally good recording standards have been maintained. However the controlled drug register had one subtraction error. Two medications had not been checked they were correct and initialled when received into the home, but stock was carried forward and all the tablets were accounted for. We did not find guidelines for staff about medication prescribed ‘as required’ in two care and medication records, so that staff are clear about when these are to be offered, and the maximum safe dosage per day. Staff told us they ask the person on each occasion they have medication. We are confident that management will address concerns we identified. DS0000066285.V368018.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12 – 15: Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People are offered choices to remain in control of their lifestyle, and to maintain their independence and relationships. There are individual and group activities, exercise and healthy food. EVIDENCE: Castle Meadows is a lively home, and people told us there were usually activities to take part in and that they liked the food. We found that generally people’s culture, religion, lifestyle and independence is maintained at the home, but use of community facilities could improve. The Manager is aware of this and has a plan to involve volunteers to take people out individually. We spoke to a number people and their visiting relatives and friends. They told us: “I came in first, and then my husband and we are both very happy here.” “They are having a party today for my birthday. I’m 104.” “I went shopping last week and bought some lovely clothes.” DS0000066285.V368018.R02.S.doc Version 5.2 Page 15 There are newsletters, and we saw signs on the front door about a weekly Manager ‘surgery’ so that people can see her privately. There was also a notice that “visitors were welcome anytime but please avoid mealtime”, and this seemed contradictory without a reason why. There is a part-time Activities Coordinator, who provides individual and group activities if she is not needed to cover staff absence. We were told there is a new programme every 4 weeks, and this was displayed in reception along with menus, and includes: arts and crafts, exercise, cooking, ball games, card games, bingo, etc. We toured all the lounges and saw: • people reading magazines and newspapers • choosing whether or not to have music and tv on or off • talking with each other about a programme they were watching • people moving about freely, trying out new aids with the physiotherapist, and a few others were sleeping in armchairs • the Coordinator painting someone’s nails • someone visiting who used to work in the home and said they missed the people; they had a new puppy and helped some people to hold it. A hairdresser visits the home. There are two Sunday services held in the home, Church of England and Methodist, and during the week there is singing with someone from the Jehovah Witness faith. The WRVS regularly change library books. People told us about an outing to the Black Country Museum. There was a summer fete and entertainers are arranged. In care plans we saw people’s preferences, such as type of clothing, who manages finances, dressing and bathing arrangements that detailed what the person could do themselves, and how staff should support them. In other records we saw that staff seek daily consent about personal care, food and medication, so people remain in control of their lives. Staff try to understand people and their interests through social histories and “A Day in the Life Of” story that families help write, if there is consent. Contact with relatives is promoted; there were visitors in the building much of the time and one person returned from an outing with their family. There is a pay telephone on the top floor, which provides privacy. We spoke to a person and their visitor who comes in every day. They were delighted with their recovery from illness, with the food and care that had helped them gain weight; both enjoyed the company of other people in the home, and the atmosphere. We learned through our SOFI and observation of dinner in the conservatory that there is mainly good practice in the home, and it has a positive effect on the people living there who have limited communication. Staff interactions with people were skilled, supportive or re-assuring for 85 of our observation. People responded to staff, other residents and visitors, or were engaged with a DS0000066285.V368018.R02.S.doc Version 5.2 Page 16 physiotherapist. The observed effect was that they were mainly in positive or passive states, and that staff were always available or in the room. Food is nutritious; there are healthy choices and preferences were met, even if the food wanted was not on the menu that day. Salt and pepper was offered, wherever people sat. The AQAA told us that extra snacks are available, especially for those who cannot have a long gap for their health. The cook is told people’s favourite meals, any food that can affect people’s medication or conditions, and the home caters for special diets – mashed food, pureed, diabetic. A finger food buffet and a cake was seen at the birthday party celebrated by the entire home, and there was music. Staff cut up some people’s food and they fed themselves. We saw one person whose hands shook, struggle to get the food to their mouth and as a result they ate very little. Staff sat with one person in the dining area to provide personal support and prompting. A number of people chose not to eat dinner; we were told by staff that they may have a big breakfast or prefer a meal at tea time. We saw two people fed soft diets sensitively and slowly, but we also saw less dignified practice. One worker put a bib on a newly admitted person and tried to feed them while they were asleep. There was no attempt to wake them, and eventually the person was left to sleep in peace. Dinnertime was a bit hectic, but people in the dining area would not have known this because it is in an alcove. There was not enough room for everyone in the dining area, and other people wanted to eat in their lounge armchair. A newly admitted man there for respite said he was embarrassed to ask for help, and refused this when it was offered. We saw there were sufficient staff but their efforts could have been more efficient if they were responsible for a specific group of people. We saw three staff, one after the other, try to feed one person we were told was on a weight-reducing diet - this person refused all except a yogurt for their dinner, which was respected. DS0000066285.V368018.R02.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 – 18: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good procedures in place that safeguard people from the risk of harm. Staff listen to and learn from concerns and complaints. EVIDENCE: There were two complaints since the last inspection, and the home responded within timescales. We reviewed these and found that both were not upheld, but the home learned from them and made changes that families were satisfied with. One led to staff re-training and a further competency check. We were impressed with most of the company policies and procedures examined and found they protected people’s legal rights. People are encouraged to vote and manage their own post. A local advocacy service was promoted on posters, although this did not explain what advocacy is or the role of statutory advocates for serious decisions. Staff told us they are not clear about when a statutory advocate needs to be involved, and did not know how to gain access to this service. As the home is registered for dementia and has people whose ability to consent and make decisions fluctuates, they need to demonstrate lawful practice. DS0000066285.V368018.R02.S.doc Version 5.2 Page 18 Three of the four procedures written in 2006 we examined are in keeping with the Mental Capacity Act. These protect people’s rights to manage their own affairs (medication, finances), to consent or make least restrictive decisions (restraint and covert medication). Staff need training, and there is improvement needed about seeking, reviewing and recording consent, best interest and advance decisions. We saw bedrail and bumper restraints fitted well to prevent falls from bed, but there was no recorded consent in one record, or details of how the least restrictive option had been decided. We also saw that a family signed a ‘do not resuscitate’ notice that was not legally valid and had not been reviewed with the person when they regained ability to make decisions. This may have influenced medical decisions in one situation. There is another record where the person’s wish to be resuscitated is well recorded. It is recommended that the home review their systems and documentation, especially where people have complex conditions or for end of life care. The prevention of abuse policy is thorough and staff have mandatory training to recognise abuse and use local multi-agency protocols. The policy is also linked to the home’s internal incident reporting processes, as well as to use government lists to safeguard vulnerable adults in all care services from abuse. Staff described abuse and whistle-blowing accurately to us. They understand how to respond to a concern and report it to management immediately. There were two adult protection concerns since the last inspection. One was under investigation through the council during the inspection, which the home and CSCI contributed to. No abuse or concern about the people’s care at the home was found in both matters. Good record keeping at the home helped establish this. There is some learning for the home to take forward about how they can improve their evaluation of the effectiveness of care plans, and reviewing emotional needs with people following bereavements of friendships made in the home. There are regular audits of incidents and accidents by the Manager and Area Manager, so that possible preventative action can be taken for everyone in the home and its’ environment. Everyone we spoke to said that they felt happy and safe in the home. They were confident that if they had a concern that staff would listen and act. Recruitment records sampled showed that staff are selected to ensure people are in safe hands. DS0000066285.V368018.R02.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 – 26: Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home, grounds and equipment are safe, well maintained and there is good infection control. People bring their own possessions and enjoy a comfortable, homely layout that helps people interact with each other and to have privacy. EVIDENCE: Castle Meadows is in a residential street near the centre of Dudley. It is not distinguishable as a care home. It is homely, comfortable and attractively decorated. The layout of the seating and lounges helps people to interact or have activities in small groups. Facilities, such as the large screen TV helps people with sight conditions. Hearing loops in communal areas would benefit people with hearing aids. The dining area in the conservatory was too small DS0000066285.V368018.R02.S.doc Version 5.2 Page 20 for all the people who may have chosen to eat there, and its’ lighting could improve to make food more visible and appealing. The AQAA told us that management want to improve dining areas. Upstairs the dining area is larger. We saw that the home and grounds are secure and well maintained within a planned refurbishment strategy. There are enclosed patios and sun lounges. There is enough storage space for equipment; no hazards were seen and there are window restrictors to prevent intruders and people falling. Clinical waste storage containers are away from the property and were not locked. This will need attention to prevent the spread of infection. Infection control measures include: • sufficient toilets and washing facilities • paper towels and liquid soap • a separate sluice, and soiled laundry bags for use in the washing machine • colour-coded disinfectant system • a clinical waste contract • a deep clean programme • the majority of staff have been trained in infection control There has been no outbreak of contagious infection reported in the past year. There is a link nurse who attends Health Protection Agency meetings for updating on best practice. We found the home to be clean, hygienic and free from odours. We checked and found the heating and water system are serviced and tested as bacteria free. Hot water temperatures are maintained within the safe range. Health and safety measures are audited regularly, and there are 3 fire drills a year. Equipment is serviced by the handyperson, PCT, or approved contractors and meets people’s needs. Testing electrical equipment is now complete. There are large bedrooms where people’s own wheelchairs can be stored. Each room is unique, and people bring their own furniture and mementoes. There are locks on each persons’ door. People are routinely risk assessed to manage their own keys, medication and finances safely, and each has a lockable drawer. There are curtains in shared rooms for privacy. A creative solution has been found to for another bedroom to give people an alternative to sharing. The kitchen is about to be altered to meet the needs of the home, rehabilitation needs of people staying there, and Environmental Health requirements. DS0000066285.V368018.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27 – 30: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People in the home help select new staff, who is carefully checked to ensure they are safe to work there. Staff are consistent, trained and competent, and they work well as a team to meet people’s needs. EVIDENCE: People in the home recently helped select the Deputy and Activities Coordinator, which is excellent practice, and the home take care to select people with skills that match people using the home. There is an ethnically diverse workforce. We saw records showing us that staff, young apprentices and students are checked to ensure they are safe to work with vulnerable people. The home wants to recruit volunteers. We checked the volunteer policy and saw that volunteers would also “be interviewed and selected in a similar manner to employees.” We were told that Mimosa Healthcare have a policy about renewing staff checks, to ensure people remain in safe hands. This is good practice, but we found that Castle Meadows has not yet reviewed whether their longer-standing staff need new checks. Mandatory training is provided through Mimosa Healthcare, and staff have a Skills For Care induction as well as an induction to working at the home that DS0000066285.V368018.R02.S.doc Version 5.2 Page 22 includes a person-centred approach. New staff feel supported. Qualifications are above national minimum standards - 92 of care staff have NVQ II or above. We saw a training matrix, training advertised in the staff room, training certificates and appraisals in staff files, and staff told us that “training is continuous and relevant”. Further training opportunities, we were told, will not be available until the new training provider completes a backlog of mandatory training. Plans have been made, and we would recommend training about conditions affecting the people at Castle Meadows, such as Parkinson’s Disease and Dementia. Nurses told us they also have clinical training opportunities through the NHS, and attended training on end of life care. Competence in medicine administration and management is checked annually, as well as clinical competence. People can have confidence that staff have the skills and experience that matches their needs. Professionals told us Castle Meadows is a good home because of staff skills. We found that staff are clear on their roles. There is a good skill mix, with a first aider on each shift as well as a nurse. Good handovers and communication about people’s needs were reported to us by staff. We saw from rotas that staff and managers are used flexibly to cover sickness and annual leave. Bank staff are also employed for this purpose, to provide consistency of care and familiar faces. The Activities Coordinator works part-time and is also used to cover the rota, which reduces activities available to people in the home. There is also a part-time Administrator for this busy home, and we saw a nurse managing the telephone, visitors, updating records, receiving money from relatives and giving clinical oversight in the absence of managers on the first day of the inspection. Extra staff are rota’d at busy times of day. The Manager said that staffing levels are kept under review, and we saw that there are more care staff at night than at the previous inspection: AM – 8 carers / 1 nurse PM – 5 carers / 1 nurse Night – 5 carers / 1 nurse Some staff told us the home is occasionally short-staffed because of unexpected staff sickness. We examined a rota that covered a holiday period and found that there were staff shortages on the weekend. Systems could manage sickness and to ensure that there are sufficient staff for unexpected shortfall and to ensure there are sufficient staff at all times to meet people’s needs. The Manager is trying to enhance the workforce so that people have support available when they need it, and care workers are attracted to work at Castle Meadows. Young apprentices are checked and supervised by Age Concern, and the Manager ensures they have training opportunities and clear boundaries, i.e. they are not involved in manual handling. DS0000066285.V368018.R02.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31 – 33, 35 – 38: Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The people who use this service will find that it is run in their best interests and that their health, welfare and safety will be protected. The home is managed well, with creativity as well as accountability. EVIDENCE: The home has a qualified and experienced manager registered by CSCI, who has kept up to date on best practice. She conducts monthly audits about the running of the home, complaints and incidents, and the quality of recorded care plans. The manager is supported by a Deputy, and an Area Manager from Mimosa Healthcare, who prepares quality assurance reports for the DS0000066285.V368018.R02.S.doc Version 5.2 Page 24 company and to meet care regulations, and conducts unannounced spot checks. If something needs improving it is acted upon and re-audited within two weeks. This means that there are excellent management systems in place so that people using the service have consistent quality of care at Castle Meadows. The home is well run, has a person-centred approach and seeks to continuously improve and learn. The manager is confident, enthusiastic and has creative ideas that take into account the views of people, their relatives, staff and other professionals to benefit people living there. For instance, the outcome of a complaint resulted in a new risk assessment tool for emergency planning, such as the lift breaking down. The manager said that people do not like sharing bedrooms, the home needs more refurbishment and the kitchen needs changes to comply with Environmental Health requirements. The Manager’s plan gives people more choice, staff helped design a new kitchen, and funding has been agreed by the company. There are robust systems to manage intermediate care and emergency admissions, with flexibility. A physiotherapy room was created to assist people and therapists to have privacy for rehabilitation exercise and assessments. Our inspection identified that the manager now needs to ensure that this room is used, rather than the lounge, when people’s dignity on the premises needs to be maintained. A Residents and Families Committee meets monthly to express views, and a Newsletter is published to give everyone information. Questionnaires are undertaken; the results are published and we saw these were available to people and visitors in reception. We sampled one and saw that the manager acted to improve communication with 2 relatives and shared 3 compliments with staff. There is excellent recruitment practice in choosing the right staff to work in the home, and planning for the future. Staff wear name badges, making it easier for people to recognise who is helping them on any particular day. We saw that staff induction, supervision and appraisal takes place and meets national minimum standards. Staff surveys and staff themselves told us that the Manager supports and values staff, and encourages their development: “Our new manager is one of the best manager’s we have had in a long time. She has helped me a lot in my role…“Christine is very approachable… speak with her on a daily basis…”. Staff survey comments also indicate that the manager has succeeded in embedding a person-centred approach. People, their relatives and staff told us the manager is approachable and supportive. We saw that the manager takes active steps to be visible. Her office is at the front of the home; the manager walks around the home often, and we saw that people knew her and conversed easily with her. She knew DS0000066285.V368018.R02.S.doc Version 5.2 Page 25 everyone and how their needs were met. The Manager holds a weekly ‘surgery’ so that anyone can see her privately. We checked quality monitoring reports, particularly about infection control because the AQAA did not give us the information we asked for – we found this to be very good. There is a robust system that ensures high standards of care and recording. This is used to safeguard people’s health and wellbeing, and ensures that clinical practice and competence is checked. Staff learn through team meetings as well as training and supervision. People told us they work well as a team. Immediate action was taken by the Manager to address a minor risk we found when a few people’s money in wallets did not match the home’s accounts. This was known about and pre-dated this Manager. One person’s account had not been audited since March 2008. The home’s policy required monthly audits by the Administrator, but no role for the Manager who is accountable. By the inspection end, a new system was in place to ensure that the financial interests of people are safeguarded, and the Area Manager is drafting an audit policy for the company. The manager assisted the administrator to audit monies deposited for personal spending, and there is a new log. Accounts were corrected to benefit people in the home. There was one person who did not have any expenditure since 2007; we were advised that their individual needs are met by their family. Policies and procedures are reviewed annually by Mimosa Healthcare. The AQAA dataset indicated some were missing and some had not been updated, for instance the infection control policy, since 2004, and that there is no policy on staff accepting gifts or racial harassment. This may have been an oversight in the AQAA sent to us. We sampled procedures and found, for instance, that the restraint policy 2006 was up to date and embedded new legislation and best practice, such as the Mental Capacity Act even though it pre-dates the regulations and code of practice. It does not yet include further legal changes. We have confidence that the Manager and company have excellent forward planning, and that their plans for Castle Meadows will enable improvement of the environment and policies to benefit people in their care. DS0000066285.V368018.R02.S.doc Version 5.2 Page 26 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 3 X 4 4 4 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 3 18 3 3 2 3 4 4 4 4 4 STAFFING Standard No Score 27 3 28 4 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X 2 3 3 4 DS0000066285.V368018.R02.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13(2) Requirement All medicines must be stored in compliance with their product licences to ensure their stability. Timescale for action 01/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP9 Good Practice Recommendations It is recommended that all occasional use medicines have supporting protocols to ensure they are administered as the doctor intended, endorsed by a clinician It is advised that the registered person reviews the medication policy so that the full safe range of medication refrigerator temperatures, and frequency of defrosting can be safely maintained by staff. It is recommended that the registered person reviews the medication system to ensure that medication is checked and initialled as correct upon receipt into the home. It is recommended that the registered person reviews relevant policies, procedures, access to statutory advocacy (IMCA), documentation and staff training to protect people’s legal rights in accordance with the Mental Capacity Act 2005 and Mental Health Act 2007, associated DS0000066285.V368018.R02.S.doc Version 5.2 Page 28 3. 4. OP9 OP17 5. OP20 regulations and codes of practice. In communal areas it is advised that further aids, lighting and space is considered that assists people to communicate, see and succeed at eating. It is recommended that clinical waste storage bins should be locked to prevent spread of infection and risk from intruders. It is recommended that the registered person reviews arrangements to respond to unexpected shortfalls so that at all times there are sufficient and suitably qualified and experienced staff to meet people’s needs. It is recommended that the registered person reviews roles to enable the Manager to exercise their responsibility to protect the financial interests of people in the home’s care and their monies. It is advised that the registered person reviews whether employment policies adopted by the company are known and used to ensure people are in safe hands: The management of sickness Renewing vetting checks of staff Policy about gifts to staff Harassment of staff and people living in the home, on the grounds of race, gender, disability, age and sexual orientation for equal opportunity and the prevention of discrimination and/or abuse. 6. 7. OP26 OP27 8. OP35 9. OP36 DS0000066285.V368018.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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