Care Home: Meadow Bank House

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What the care home does well Residents at the home were being cared for and supported well by the registered manager and her staff. Residents spoken to said the quality of care provided was very good. Residents said staff spoke to them respectfully and maintained their dignity, particularly when personal care was being given. Comments made included: `the staff are very kind and pleasant`, `I have always been spoken to with respect`, `I am happy here and am cared for well by friendly and caring staff`, `all my needs are catered for by the staff in a proper way`, `I am able to choose when I get up in the morning and when I go to bed`, ` I decide what activities I take part in`, `You are able to stay in your room for some privacy or go to the lounge - it is up to you`, `I decide what clothes I am going to wear and what meals I want`, ` The staff always ask me what I think or want to do and try to respect my decisions`. The home was being managed effectively. What has improved since the last inspection? The requirements made at the last inspection have been complied with. An ongoing programme of re-decoration and refurbishment continues to be implemented (we were informed a major refurbishment of the home is planned for the near future) and the registered manager has been active in measuring how effective the service provided to residents is. The views of residents, relatives and staff are actively sought and changes implented if needed. Since the last inspection the home has introduced the Gold Standard Framework programme at the home. This seeks to drive up the quality of care and support provided to residents towards the end of their life. In the final assessment of the Gold Standard Framework the home was awarded `beacon` status (the highest grade awarded). This is to be commended. What the care home could do better: There are no requirements or recommendations as a result of this inspection. Discussion with the registered manager, responses in the AQAA document referred to above, and the outcomes of checks (audits) conducted at the home indicate that areas where improvement can be made are continiously identified and acted upon appropriately. Key inspection report Care homes for older people Name: Address: Meadow Bank House Green Lane Bolton Lancashire BL3 2EF     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Michael Murphy     Date: 0 2 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 21 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 21 Information about the care home Name of care home: Address: Meadow Bank House Green Lane Bolton Lancashire BL3 2EF 01204366258 01204366257 meadowbank@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Ltd care home 47 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category/ies of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 47 Date of last inspection Brief description of the care home Meadow Bank House is situated in the Great Lever area of Bolton close to all local amenities and bus routes. It is a purpose built home providing nursing on the ground floor and residential care on the first floor to services users of either gender. There is lift access to all floors. The mininmum weekly fee at the time of this inspection was £378.66 and the maximum weekly fee was £628.00 (information provided by the service at the time of inspection. Please contact the registered manager for further details. 0 Over 65 47 Care Homes for Older People Page 4 of 21 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: three star excellent 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: This inspection included an unannounced visit to the home on the 8th of June 2009 between 9am and 5pm. During the visit we talked to residents, relatives, staff and the registered home manager. We also looked at documents and records the home have to keep such as residents care records, medicine records, written policies and other records. Before the inspection, we also asked the registered home manager to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helps us to determine if the management of the home sees the service they provide the same way that we see the service. We felt this form had been completed in sufficient detail and provided useful information. Care Homes for Older People Page 5 of 21 What the care home does well: What has improved since the last inspection? What they could do better: 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 6 of 21 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 7 of 21 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. All prosective residents were properly assessed prior to admission to ensure their care and support needs could be properly met following admission. Evidence: All prospective residents are thoroughly assesed prior to being admitted to the home. The homes registered manager (a qualified nurse) conducts the pre-admission assessment. This assessment is very important to ensure the home is able to judge if the prospective resident can be cared for and supported properly should they be admitted. Residents and relatives spoken to said that they felt they were appropriatly consulted and involved in relation to their admission to the home. A detailed record of the pre-admission assessment is kept in each residents care records file. The preadmission assessments carried out by the home manager were supported by assessments conducted by social workers and/or health professionals such as doctors and specialist nurses. Care Homes for Older People Page 8 of 21 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were satisfied they were being properly supported to ensure their health and personal care needs were being met appropriately. Evidence: Residents health, personal and social care needs were being set out in an individual plan of care. We looked at the care records of four residents on this occasion. These were well organised and properly maintained. Care plans described what action needed to be taken by the nursing and care staff to ensure that residents care and support needs were being properly met. Care plans had been developed in a way that were very particular to the resident as an individual person. The care records also contained risk assessments that identified possible threats to a residents health and safety and described things that needed to be done to keep them safe at the same time as maintaining their freedom and independence. For example risk assessments had been done with regard to residents mobility, nutrition and moving and handling needs. Care records had been kept up to date. Arrangements had been made to register all residents with a local GP. Information in the care records and discussion with residents, their relatives and staff indicated Care Homes for Older People Page 9 of 21 Evidence: residents were able to access health care services appropriately. A record of all such access was kept. Residents medicines were being looked after safely and securely. The qualified nurses managed residents medicines on the nursing floor and appropriately trained senior care staff did so on the residential floor. A medicine record was kept in respect of each resident. These had been completed properly. The registered manager regularly conducted checks (audits) to make sure the way residents medicines were being looked after continued to be safe. Residents spoken to said that the nursing and care staff treated them respectfully and maintained their privacy and dignity, especially when they were being provided with personal care. They said that staff knocked on bedroom doors before entering and spoke to them in a proper manner. Comments made included: the staff are very kind and pleasant, I have always been spoken to with respect, I am happy here and am cared for well by friendly and caring staff, all my needs are catered for by the staff in a proper way. Residents were assured that at the time of their death staff would treat them and their family with dignity, respect and sensitivity. The home manager and her team have introduced the Gold Standard Framework since the last inspection. The purpose of this is to ensure the home is able to deliver a high standard of care and support to residents nearing the end of their life. All staff at the home were provided with a wide range of training and support to achieve this aim. In the final assessment of the Gold Standard Framework the home was awarded beacon status (the highest grade awarded). This is to be commended. Care Homes for Older People Page 10 of 21 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were supported to enjoy a stimulating lifestyle and access a wide range of social and leisure activities. Residents were encouraged to make as many personal choices in their daily lives as possible, and the general view of food provision was positive. Evidence: The routines of daily living and the social activities available were flexible and varied and meet residents expectations, preferences and capacities. Residents were supported to access a wide range of social and leisure activities and entertainments. Forthcoming events, activities and entertainments are prominently displayed. Residents said they enjoyed the programme of activities available. Relatives and friends of residents are actively encouraged to participate in all the social and leisure activities available. Residents were able to follow their own religious practices and as in other areas of life in the home were are able to exercise their own personal choices in respect of this. Residents and relatives spoken to said there were no unreasonable restrictions on visiting at the home. Residents may receive their visitors in the privacy of their own room or quieter lounge areas of the home if preferred. Residents also said they were able to exercise choice and independence in their daily lives. Comments made included: I am able to choose when I get up in the morning and when I go to Care Homes for Older People Page 11 of 21 Evidence: bed, I decide what activities I take part in, You are able to stay in your room for some privacy or go to the lounge - it is up to you, I decide what clothes I am going to wear and what meals I want, The staff always ask me what I think or want to do and try to respect my decisions. Menus were displayed throughout the home and were varied, balanced and provided choice. Residents said they can always request an alternative from the menu if they wish and are comfortable to do so. Comments regarding the food included: good quality, tasty and plenty of it, quite good and they will always give you something else if you want something different, the food is quite good and there is always plenty to eat. Lunch was observed on the day of inspection. This was a hot and substantial meal. Staff served and assisted residents appropriately and sensitively. The dining areas were comfortable, suitably furnished and appropriate for residents to take their meals in. Some residents chose to take their meals in their own room. Care Homes for Older People Page 12 of 21 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. There is an accessible and clear procedure in place to deal with complaints. Staff have been provided with recent safeguarding training and there are procedures in place that describe how to protect residents and keep them safe. Evidence: Information on how to make a complaint was prominently displayed in the home. This information detailed who to contact and how the complaint would be dealt with. A complaints record is kept by the home. Complaints appeared to have been dealt with properly. Discussion with residents and relatives indicated that manager or senior staff are always available and that any issues raised are dealt with promptly and rarely need to become formal complaints. The home operates safeguarding and whistle-blowing policies (including those developed locally and operated by Bolton social services) that seek to keep residents safe. Staff spoken to were aware of the importance of safeguarding and protecting residents and described their role in doing so. They confirmed they have been provided with recent safeguarding training. Inspection of training records revealed that safeguarding training has been provided to all staff at the home. In relation to the Mental Capacity Act the registered manager informed us that no people living at the home were suject to a deprivation of liberty authorisation and that no one living at the home was having their liberty deprived without authorisation. Care Homes for Older People Page 13 of 21 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. The home provided a suitable, safe and well-maintained environment for residents. Evidence: On the day we visited the home was clean and free from offensive smells. There was an ongoing programme of maintainance in operation and we were informed that it was planned to refurbish the home in the near future. Lounge and dining areas were comfortably and appropriately furnished and accessible to all residents. Bathroom, shower and WC areas were suitably equipped and adapted to ensure residents could be cared for and supported appropriately and safely. Twenty eight residents bedrooms were looked at on this occasion. These were clean and appropriately furnished and equipped. Many were highly personalised. Residents spoken to said they were happy with the accommodtion provided. Comments made included: I like my room and have been able to bring in some of my own things, so it feels like home, it is very clean, warm and bright here, I like to spend time in my room during the day, but I also use the lounge and dining room too and they are good, when I visit the home is always clean, and they fix things quickly when they are broken. Suitable arrangements were in place to manage residents laundry needs. And appropriate measures were being taken to minimize the potential spread of infection within the home such as adequate hand washing facilities and the provision of protective clothing for staff as well as appropriate cleaning practices within the home. Care Homes for Older People Page 14 of 21 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. The staffing provision, staff recruitment procedure and the staff training provided at the home seek to ensure residents are cared for and supported safely and appropriately. Evidence: The home esssentially functions as two units. On the ground floor is the nursing unit on which a qualified nurse is on duty at all times. On the first floor is the residential or personal care unit. The registered manager and staff spoken to on the day of inspection were of the view that staffing levels were meeting the care and support needs of the residents. Residents spoken to said that they were being properly cared for in a timely way. We also note there were adequate staffing arrangements in place to meet the administrative, catering, laundry and housekeeping requirements of the home. The home had a proper procedure in place for recruiting new staff. This is vital to ensure, as far as possible, that residents are being cared for and supported by suitable staff. The recruitment procedure included criminal records checks and another special check regarding the suitability of the applicant to work with vulnerable people. The programme of staff training ensures that staff are provided with the skills required to care for and support residents properly. Inspection of staff training records and discussuin with staff and the registered manager demonstrated that staff training (including regular updates) is well organised and appropriate. Training is provided by Care Homes for Older People Page 15 of 21 Evidence: trainers employed by the home and the local authority training partnership. Also specialist training has been provided to all staff in relation to the Gold Service Framework programme referred to elsewhere in this report. Over 50 of the care staff have obtained a national vocational qualification in care (NVQ). The remaining care staff were undergoing this training or were expected to do so in the near future. Care Homes for Older People Page 16 of 21 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager was being managed in a very effective and well organised way. Residents, their relatives and staff are confident the home is run in the best interests of residents. Evidence: The registered manager is a qualified nurse (and has obtained a relevant management qualification) and has managed care services for older people for many years. Discussion with residents, their relatives and staff revealed that the manager creates a positive, inclusive and open atmosphere at the home and is a strong leader. Since the last inspection the manager has been particularly active in the introduction of the Gold Standard Framework at the home. This seeks to drive up the quality of care and support provided to residents (and their family) towards the end of their life. The home manager and her team have achieved beacon status (the highest grading possible) in respect of the Gold Standards Framework. This is to be commended. There is also a comitment to ensure the quality of the service provided to residents is of a high standard and that the home is run in their best interests. The registered Care Homes for Older People Page 17 of 21 Evidence: manager and owners of the home regularly obtain the views of residents, relatives and staff in respect of this. Discussion with these groups of people showed that the manager and owners listen to any issues/suggestions raised and take any neccessary action. The manager also conducts checks (audits) on how good the home is run. For example regular checks are made in respect of residents medicines, how care records are maintained and the state of the environment. The arrangements to support residents with their money (personal allowances only) were secure and appropriately documented. The arrangements for the health and safety of residents (and others) in the home were adequate and appropriate. Staff are provided with regular training in respect of moving and handling, fire safety, food hygiene and the prevention of infection. Hazardous substances were being securely stored and gas and electrical systems had been checked/certificated regularly, we were informed hot water temperatures are controlled by special valves. Procedures were in place for the appropriate reporting of accidents, illnesses and injuries. Care Homes for Older People Page 18 of 21 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 19 of 21 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 20 of 21 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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 © (2009) Care Quality Commission (CQC). 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. 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