Care Home: Long Meadow Nursing Home

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What the care home does well The home is well run by a matron and manager who work well together and who are aware of how to continually improve the service. People are provided with a good standard of care in a pleasant and clean environment. The food and drink provided is appetising and appealling. There is a good choice and much of the food is home made. People know how to complain and are kept safe in the home. There are a range of activities to participate in this can enhance people`s quality of life. What has improved since the last inspection? Aspects of the environment have improved. This includes creation of a shower room and a family room. More specialised beds for people with nursing needs have been obtained. New divan beds, bedroom furniture, carpets and bedding have also been obtained. A new care plan system has been purchased with the focus being on Person Centred Care. This is due to be implemented fully in Jnaury 2009. People are cared for by a named nurse and a key worker. This helps to improve continuitity of care and more effective communication. The menus have been modified as a result of comments made by people. The menus are now rotated on a four weekly cycle, incorporating a wide variety of choice. The Chef seeks the views of people using the service and menus are adjusted regularly to reflect the feedback received. The activities programme now incorporates regular trips out, musical events within the home, reflexology and exercise classes. What the care home could do better: People could have more robust care plans in place which are up to date, and regularly reviewed and evaluated. People could have access to more useable bathrooms, this would help staff and allow people to have more baths. The quality assurance system could be more detailed to include all aspects of health and safety and care systems within the home. The home needs to decide who the registered manager will be and apply to The Commission to be registered. This will ensure consistency and maintenance of effective leadership in the home Inspecting for better lives Key inspection report Care homes for older people Name: Address: Long Meadow Nursing Home 60 Harrogate Road Ripon North Yorkshire HG4 1SZ     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: Jo Bell     Date: 0 4 1 2 2 0 0 8 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. the things that people have said are important to them: They reflect 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 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 25 Information about the care home Name of care home: Address: Long Meadow Nursing Home 60 Harrogate Road Ripon North Yorkshire HG4 1SZ 01765607210 01765607141 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Long Meadow (Ripon)Limited Type of registration: Number of places registered: care home 47 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability terminally ill Additional conditions: Service users in the category PD must be: i) aged 55 years or over ii) require nursing care Date of last inspection Brief description of the care home Long Meadow is situated in the Southern suburbs of Ripon and is registered as a care home with nursing for up to 47 service users. The building has been suitably adapted for its current purpose, to create modern facilities in a traditional, comfortable home setting. 0 47 3 Over 65 47 47 0 Care Homes for Older People Page 4 of 25 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: We have reviewed our practice when making requirements,to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations,but only when it is considered that people who use services are not being put at significant risk of harm. In future,if a requirement is repeated,it is likely that enforcement action will be taken. We went to the home without telling them that we were going to visit. This report follows the visit that took place on Thursday 4th December 2008. The visit lasted from 10:30 until 16:30. The purpose of the visit was to make sure that the home was operating and being Care Homes for Older People Page 5 of 25 managed in the best interests of people living there. Information has been used from different sources for this report. These sources include- Reviewing information that has been received about the home since the last inspection. The annual quality assurance assessment. This is information which details what has happened during the past 12 months. Ten Surveys from people using the service, and four health care professional survey. Notifications (Regulation 37) relating to incidents in the home affecting people using the service. Details of complaints and allegations raised by people connected to the service. Progress of the previous recommendations made at the last site visit. At the site visit one inspector spent 6.0 hours at the home. During this time observations of care practices took place. People using the service were spoken with along with some relatives. Discussions with the manager regarding meeting needs, mealtimes, protecting people and the environment took place. The lunchtime meal was observed and time was spent inspecting care plans, looking at individual rooms and reviewing a selection of health and safety information. Staffing and management issues were discussed and feedback was given to the manager at the end of the inspection. What the care home does well: What has improved since the last inspection? What they could do better: People could have more robust care plans in place which are up to date, and regularly reviewed and evaluated. People could have access to more useable bathrooms, this would help staff and allow people to have more baths. The quality assurance system could be more detailed to include all aspects of health and safety and care systems within the home. The home needs to decide who the registered manager will be and apply to The Commission to be registered. This will ensure consistency and maintenance of effective leadership in the home Care Homes for Older People Page 7 of 25 If you want to know what action the person responsible for this care home is taking 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 8 of 25 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 9 of 25 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. People are effectively assessed prior to admission, which helps to ensure individual needs can be met. Evidence: The three pre-admission assessments looked at confirmed that a senior person completes an assessment before an individual moves to the home. This is to check what type of care and support the person needs and whether the staff have the skills and knowledge to provide that care if the individual chooses to move there. The process also reassures the individual and their family that they will receive the right support. Assessments are completed if the person has a care manager or is privately funded. These detail health, personal, nursing, social and mental health needs. All the surveys completed by people living there report that people are given enough information Care Homes for Older People Page 10 of 25 Evidence: about the service and what it provides. This means they can make an informed choice about whether to move there or not. The Head of Care described the assessments that take place. The system is currently been reviewed and a new pre-admission assessment is to be fully introduced shortly. The assessments inspected showed a combination of the old style, an intermediate style and a new style. The senior staff are aware of the Homes registration categories and the client group suitable for the home. Care Homes for Older People Page 11 of 25 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. People have their health and personal care needs met in a dignified manner. Evidence: People were observed looking cleaa and well cared for. Three care plans were looked at during this visit. These describe the care and support people need to stay in charge of their own lives as much as possible. The plans looked at contained a lot of information, so that an unfamiliar carer could look at them and would be able to work out how much support they needed. There were written assessments as to whether people were at risk of developing pressure sores, of losing weight because of poor appetite or a health problem or needing help with moving and handling. Those identified as at risk had a care plan in place describing how that risk was to be managed. A new care plan system is in the process of being introduced, however staff need to ensure they keep the current plans up to date. All three plans inspected contained risk assessments which had not been reviewed regularly. One person had a moving and Care Homes for Older People Page 12 of 25 Evidence: handling assessment, nutritional assessment and an assessment for the prevention of pressure sores which had not been reviewed since June 2008. Another person who had initially come in short term did not have a specific care plan, risk assessment or current evaluation. The medication system was inspected. A secure room is used to store and dispose of medication, staff are trained in how to administer medication and the system is robust which helps to prevent errors. The home uses a blister pack system to administer medication and this was recorded effectively. It was evident that some staff did not always sign when a medication had been offered but refused. Staff need to ensure there is consistent practise in this area. Daily fridge temperatures are taken and staff know how to store and record controlled drugs effectively. It would be beneficial if the home carries out medication audits. This will show how effective the medication system is and identify any improvements that are needed. The staff in the home promote privacy and dignity. Staff were observed interacting positively with people. People are able to have their personal possessions in their bedroom and staff were observed knocking on bedroom doors prior to entering. Personal phones are available for people to use in their own rooms. Care Homes for Older People Page 13 of 25 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. People participate in a range of activities and visitors are welcomed. Staff encourage autonomy and choice, and people enjoy dining in pleasant surrounding with appealing food Evidence: People are able to participate in a range of activities. An enthusiastic and personable activities organiser works three days per week. People enjoy bingo, quizzes, entertainers, trips outside, fetes and reflexology. The Christmas fair was due to take place and the home was decorated in a festive manner throughout. There are church services in Ripon for people to attend and services can be arranged in the home. Autonomy and choice is encouraged and the daily routines are dictated by the people using the service. The lunchtime meal was observed. The dining room was light and airy, welcoming and relaxing for people. Tables for up to four or six people were available and these were laid with material table cloths, flowers, condiments and crockery and cutlery. People had a choice of drinks to choose from and a choice of two main courses. The quiche and lasagne was homemade and was served with salad or vegetables. The portion Care Homes for Older People Page 14 of 25 Evidence: sizes were good and people were offered assistance in a discreet manner. The catering staff confirmed they had completed food hygiene training and peoples likes and dislikes were documented and acted upon. There were enough staff to look after people in the dining room in an efficient manner. Care Homes for Older People Page 15 of 25 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. People have their concerns listened to and acted upon, with staff been alert to signs of abuse Evidence: The home have a complaints procedure in place which people and their visitors are aware of. This is discussed at the admission stage and a copy of this is displayed in the home. All surveys returned confirmed that people know how to complain and people felt staff listen to their concerns. Nine complaints have been received in the past 12 months, all of which were upheld. Staff spoken to were aware of the safeguarding procedures in place. Some staff have completed abuse awareness training,and staff knew about the different types of abuse and the action to take if an abusive situation occurs.The home have a policy in place and staff are encouraged to use the Whistle Blowing policy. Care Homes for Older People Page 16 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable and clean environment. Evidence: People live in a clean and welcoming home. During the past 12 months new furniture has been obtained for some of the communal areas. Some new carpets, bedding, table linen and crockery have been obtained and specialised nursing beds have been obtained. This helps make it easier to care for people in bed and it is more comfortable for people using the service. One of the bathrooms has been converted into a shower room, however three bathrooms have had their assisted bath seats removed to comply with current health and safety. This reduces the number of bathrooms available. The majority of people need some assistance getting in and out of the bath so this needs to be reviewed as soon as possible. People in the home were observed wearing clean and well ironed clothes, the laundry facilities are suitable and staff have completed infection control training. All areas of the home inspected smelt clean and fresh. Surveys returned also confirmed this. Care Homes for Older People Page 17 of 25 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. People are cared for by staff who are competent, well trained and recruited and in sufficient numbers to meet individual needs. Evidence: People are cared for by enough staff. At the time of the site visit there were thirty six older people using the service. On a morning there are generally six carers and two registered nurses (this includes the Head of Care) and overnight there is one registered nurse and two carers. This was adequate for the dependency levels of the people using the service. Call bells were answered promptly and staff attended to people in an efficient and dignified way. The Annual Quality Assurance Assessment confirmed that the duty rotas have been reviewed and now more staff are on duty at peak times. There are twenty four full time staff and four part time care staff. The majority of which are female. Thirteen care staff have completed an NVQ Level 2 in care and six people have completed the induction programme. This covers orientation to the home, care practises, training and health and safety. This is equivalent to Skills for Care. Eight out of ten surveys completed stated staff are usually available, two out of ten stated staff are always available. The recruitment procedure was discussed and three staff files were inspected. Two written references, a police check and a protection of vulnerable adults check are Care Homes for Older People Page 18 of 25 Evidence: obtained prior to a new person starting work in the home. This helps protect people from harm. The information was all available though the system for finding the information could be clearer. Care Homes for Older People Page 19 of 25 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. The home is run in the best interests of the people using the service Evidence: The home currently has a manager and a matron neither of which are registered with The Commission. The Head of Care is a registered nurse and runs the home with the manager who is skilled in business, finances and strategic planning along with the provider. The Head of Care is professional, approachable and knowledgeable in caring for older people with nursing needs. Though she has not completed an NVQ Level 4 in care. People using the service are aware of who to go to if they have any concerns and both the matron and manager complement each other well. People in the home are able to express their views and opinions through a yearly questionnaire which was completed in October 2008. The outcome of this was positive and has given the home some areas for improvement. For example most people were aware who their named nurse was but were unsure what the role of the key worker Care Homes for Older People Page 20 of 25 Evidence: was and who this related to. Some audits take place but these are not formalised (medication and care plan audits). The provider needs to complete a monthly visit form, known as Regulation 26. This helps identify what the home does well and what improvements are needed. The home have a health and safety group though no audits currently take place in this area. People can keep personal money in the home. This may be used for chiropody, hairdressing, clothes or toiletries.Well-maintained records are kept of all transactions and invoices are available which confirm the money coming in and going out. Health and safety was discussed and a selection of policies were inspected. A fire risk assessment is in place though this is not fully completed or implemented. Staff had a good understanding of the action needed in the event of a fire. Staff receive fire, moving and handling, infection control and food hygiene training. Specific training is also given relating to older peoples conditions. Water temperatures are taken and both the electrical wiring certificate and gas safety checks are in place. This helps to keep people safe in their environment. The home needs to ensure training records are kept up to date so it is clear exactly what training is needed. Care Homes for Older People Page 21 of 25 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 22 of 25 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 1 31 9 The home must have a 04/03/2009 registered manager in place. This will ensure one person is accountable for the running of the home. This will allow consistency and continued improvements to be made. 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 9 Staff need to be consistent in the way they record medication which has been offered but refused. A medication audit would be beneficial Staff should review the use of wheelchairs at the dining table. A review of the number of usable bathrooms needs to take place. The Quality Assurance system needs to be fully implemented to include audits for care systems and health and safety. Training records need to be up to date and clear so it is evident which mandatory training staff have completed. 2 3 4 15 21 33 5 38 Care Homes for Older People Page 23 of 25 The fire risk assessment needs to be fully implemented. Care Homes for Older People Page 24 of 25 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. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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