Care Home: Meadow Bank Nursing Home

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What the care home does well There is a warm atmosphere in the home that is greatly appreciated by those who live there. Residents were complimentary about the staff and the care they receive. People are given freedom of choice of their daily routines for example one person said they were an "night owl and often stayed up reading until midnight". This person said "Its a home-from-home and I can come and go as I please". Residents can personalise their rooms, and some are like second sitting rooms with TVs, DVD players, direct line telephones, mini fridges, and pieces of peoples own furniture. The quality of food offered to residents is of a good quality and they enjoyed the variety and choice offered to them. What has improved since the last inspection? On the whole care planning has improved, and assessments once people are living in the home contain good detail to instruct staff on how to provide the right care to people. Social activities offered to people are improving and provide increased daily variation and interest for those living at Meadow Bank. The home employs an Activities Coordinator specifically to run groups and one-to-one sessions with people living in the home. One resident said that the entertainer was "very good and everyone was singing along to old tunes." The manager has delegated some tasks to the nursing staff and this has seen some recent improvements. For example one nurse oversees training and staff reported that they have been on some useful courses recently. The recent employment of a full-time nurse will also benefit the running of the home as the manager intends to spend three full days on management tasks. What the care home could do better: Due to the current management arrangements we held an urgent meeting with the Manager to discuss the issues, as she was not present at the inspection. At this meeting she submitted evidence to demsontrate how improvements had already been implemented. As mentioned, one of these that should specifically help improve the management of the home is the employment of an additional full time nurse. We felt satisfied with the plans and look forward to seeing the management of the home improve to the benfit of people living there. The following are issues raised prior to the new management arrangements being in place and are a priortiy for improvement by the new staff team: New people wishing to come to the home are not properly assessed to see if the home can meet their needs. This is particularly the case for those people paying their own fees, and these were found to be very brief. This leads to people living in the home who`s needs cannot be met by the facilities the home currently provides.Peoples care plans and other documents are not always updated which leads to inconsistency`s in care delivery and errors occurring in medications that could put peoples health at risk. The home is increasingly looking run down and some peoples needs are not being met by the facilities that the home has to offer. We have asked the manager to produce a formal, written up maintenance and renewal plan whereby a planned and targeted approach could be seen on how and when the necessary improvements would be made. There is a lack of co-ordination in the paperwork and administration procedures, and many important documents were not available on the day of the inspection. For example the Fire Risk Assessment could not be found, along with records of fire drills, tests and fire training. The person in-charge of the home must always be familiar with this document and its whereabouts, in order to take appropriate action in the event of a fire. Although training of staff is improving, recording is disorgansied which could lead to gaps in those who receive it. The file that held certificates of servicing and maintenance of equipment was disorganised and this made it difficult to evidence if these were all up to date. We have asked that these documents be sent through to us as soon as possible. Key inspection report Care homes for older people Name: Address: Meadow Bank Nursing Home Curthwaite Wigton Cumbria CA7 8BG     The quality rating for this care home is:   one star adequate 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: Elizabeth Kelley     Date: 1 2 0 5 2 0 1 0 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 31 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Meadow Bank Nursing Home Curthwaite Wigton Cumbria CA7 8BG 01228710279 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr B & Mrs L Whalley Name of registered manager (if applicable) Mrs Linda Whalley Type of registration: Number of places registered: care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category 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 Physical disability - Code PD (maximum number of places: 1) The maximum number of service users who can be accomodated is: 19 Date of last inspection Brief description of the care home Meadow Bank Care Home is an adapted Victorian House set in extensive grounds in a rural area approximately eight miles from Carlisle. Mr and Mrs Whalley are the Registered Providers of the home, and Mrs Whalley is the registered manager. Nursing Care is provided for a maximum of 19 people, but because double bedrooms tend to be let singly there are not usually that number living in the home. There are bedrooms Care Homes for Older People Page 4 of 31 1 3 0 5 2 0 0 9 0 1 Over 65 19 0 Brief description of the care home on both floors with the first floor being accessible by either the stairs or the passenger lift. There are two bathrooms; one on each floor, there is also a shower room on the ground floor. The lounge has big windows providing lovely rural views. There is a separate dining room. The weekly fees at the time of this inspection are in accordance with the local authority and include any free registered nursing care contribution entitlement. The care home has produced a statement of purpose and a service user guide for interested people. Care Homes for Older People Page 5 of 31 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: one star adequate 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: During the visit, we The Care Quality Commission, met with people living in the home, visitors and spent time with the Nurse and care staff on duty. We also met with care staff individually and talked to them as they went about their duties. The manager, Mrs Linda Whalley, completed a self assessment questionnaire called an Annual Quality Assurance Assessment (AQAA ) and sent it to us before the inspection visit. This provided us with some information about how the home is run and the managers views on what the home does well, where they have improved and plans for the future. There is also information about the people who live in the home and the staff working there. Surveys were sent out as part of this inspection to people living in the home, their relatives, care staff and other professionals involved with the home, with their views being used to formulate the judgments in this report. We also examined records relating to the running of the home that are required by Care Homes for Older People Page 6 of 31 legislation, which included care plan files that guide staff. We examined staff files and records relating to the maintenance and safety of the home. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Due to the current management arrangements we held an urgent meeting with the Manager to discuss the issues, as she was not present at the inspection. At this meeting she submitted evidence to demsontrate how improvements had already been implemented. As mentioned, one of these that should specifically help improve the management of the home is the employment of an additional full time nurse. We felt satisfied with the plans and look forward to seeing the management of the home improve to the benfit of people living there. The following are issues raised prior to the new management arrangements being in place and are a priortiy for improvement by the new staff team: New people wishing to come to the home are not properly assessed to see if the home can meet their needs. This is particularly the case for those people paying their own fees, and these were found to be very brief. This leads to people living in the home whos needs cannot be met by the facilities the home currently provides. Care Homes for Older People Page 8 of 31 Peoples care plans and other documents are not always updated which leads to inconsistencys in care delivery and errors occurring in medications that could put peoples health at risk. The home is increasingly looking run down and some peoples needs are not being met by the facilities that the home has to offer. We have asked the manager to produce a formal, written up maintenance and renewal plan whereby a planned and targeted approach could be seen on how and when the necessary improvements would be made. There is a lack of co-ordination in the paperwork and administration procedures, and many important documents were not available on the day of the inspection. For example the Fire Risk Assessment could not be found, along with records of fire drills, tests and fire training. The person in-charge of the home must always be familiar with this document and its whereabouts, in order to take appropriate action in the event of a fire. Although training of staff is improving, recording is disorgansied which could lead to gaps in those who receive it. The file that held certificates of servicing and maintenance of equipment was disorganised and this made it difficult to evidence if these were all up to date. We have asked that these documents be sent through to us as soon as possible. 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 9 of 31 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 10 of 31 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admissions process does not always ensure that peoples care needs are properly assessed, which means they cannot be sure they will receive the correct level of care and suitable accommodation. Evidence: At the last Key Inspection we discussed the admissions procedure with the manager and stressed how important it was to conduct a full assessment of capabilities before any prospective resident is admitted to the home. As there had been occasions when this has not happened, which could mean that Meadow Bank was not a suitable placement and could not meet the needs of those people wishing to live there. On this inspection there was evidence indicating that, particularly for those people who are private fee payers, that this remains the case. People who pay privately do not get the same level of assessment, if any, from Adult Social Care. This is why the National Minimum Standards set out very detailed areas that should be covered by the homes own assessment for these people. Assessments of these people were examined and Care Homes for Older People Page 11 of 31 Evidence: were found to be very brief and did not cover, for example, nutritional assessments, or reasons for admission and consequently matching of how these needs can be met. This means that people are not given an interim care plan on admission and cannot be sure whether the home can meet there needs. Consequently some people did not have the right facilities to meet their needs. All those wishing to move in are invited, with family members if appropriate, to look around and meet the staff and others living there. This home does not provide intermediate care. Care Homes for Older People Page 12 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care plans and other documents are not always updated which leads to inconsistencys in care delivery and errors occurring in medications that could put peoples health at risk. Evidence: Each resident has an individual plan of care based on an assessment of needs carried out when the person first arrives in the home. Many of these assessments are carried out in good detail, and the nursing staff have started to review and up date these when changes occur in a persons care needs. However, as mentioned in the previous section, this level of detail should be completed before any prospective resident is offered a place in the home. We looked at a sample of the care plans, which are now set out in a new improved format. Some of the care plans contained pen pictures of the residents that were written on admission to the home. It would be good practice to include in-depth personal information in each of the care plans as this information is useful in illustrating what is important to the resident and their lifestyle before they lived at the Care Homes for Older People Page 13 of 31 Evidence: home. Some of those in place had been done by family members and these were particularly good giving a real feel for the person before they required residential care. There was generally a lack of consistency between assessments and care plans. For example at times assessments were up-dated but not care plans and visa versa. Examples were also found from daily notes of changes to peoples care that had not led to an up-date of either. This has the potential to lead to inconsistencys and puts a great deal of pressure on nursing staff to constantly verbally up-date care staff. During busy periods and times such as staff returning from holiday there is not the time to do this properly. This is why care plans constantly need to be up-dated and staff should be given structured time and a system to familiarise themselves with any changes. For example a communication book or diary could be used to alert staff to go and look at a care plan that has been amended. Some care plans require more in-depth information for care staff, for example when a high protein/calorie diet was identified what this entailed on a day-to-day basis, and any specific instructions that the cook should be aware of. Similarly this was the case for a person with skincare problems that were identified but not how staff should then go onto deal with them. Nutritional screening is carried out in very basic detail and is not sufficient to instruct staff on peoples individual dietary needs. The homes scales to weigh people had been broken for several months and staff repeatedly recorded in notes that they need to be repaired. During this time a number people had lost weight, and this could not be monitored as part of their nutritional plan. The home provides aids and equipment for safe moving and handling, and for those who require specialist equipment to reduce the risk of pressure sores. The home provides everyone with a specialist a mattresses for extra comfort, and equipment to maintain skin integrity. When people are nursed in bed the home keeps records to ensure they have adequate drink and food intake, and that they are properly cared for so they do not develop skin problems. Some of these records examined were not dated and sheets were difficult to read, as they had become full and not been replaced. Overall, we found that the handling of medication had improved. However, there were still areas that needed to be addressed in order to fully safeguard residents against medication errors that could affect their health and wellbeing. Care Homes for Older People Page 14 of 31 Evidence: We looked at records for receipt, administration and disposal of medication over a period of several weeks. These records have improved. The records were signed when medicines were given and gave clear information on why medicines were not given. We counted a sample of medications and compared them with records to check if they tally and are given in the correct dosage. We saw one example where there were more tablets left than there should have been showing. For two types of innocuous medication, for thickening drinks and for reading blood sugars we found that prescription labels made out for specific individual had been torn off so they could be used for other people. This is generally poor practice and should not continue. In one case there was more left in the box than was originally dispensed indicating that boxes of medication had been combined. This practice should be stopped as it can lead to errors if tablets are put in the wrong boxes. Some medication changes were documented well but others were not clear so that we were not able to tell why medication had changed. Overall, the storage of medicines was satisfactory. At some point the medication trolley needs to be replaced as it is old, paint is chipped, the doors do not close properly and the wheels are very noisy. When the home has full occupancy it is unlikely to hold all the medications, particularly as three different types of blister packs are in use, which take up a great deal of room. People routinely have their medication taken off them on admission to the home, and sign that they agree to nurses dispensing them. However when questioned people thought they had no choice and had never considered keeping hold of their own medications. Two people in the home had recently been self-medicating at home prior to admission. When discussed with the nurse she was also of the opinion that it had to happen this way, and if people were allowed to do this then they would need locked secure storage in their bedrooms. The manager should review peoples capacity and ability to self-medicate as a means of people retaining independence and promoting dignity. Medicines liable to misuse, called controlled drugs, were checked and were in order, with a satisfactory recording book and a licensed dispensing system. The nurse on duty stated that medicines were routinely audited by the nurse on duty at night, however when these records were examined it appears this practice stopped over three years ago. It is recommend that this be recommenced to ensure safe practice and consistency. Care Homes for Older People Page 15 of 31 Evidence: Care Homes for Older People Page 16 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities and meals offered to people are improving and provide increased daily variation and interest for those living at Meadow Bank. Evidence: The home now employs an activities organiser and people were pleased with this new development and there is some form of activity on most days of the week. We saw photographic evidence of some of the outings the residents had enjoyed. Visiting entertainers also come to the home and the organiser also spends time with residents on an individual basis. One resident said that the entertainer was very good and everyone was singing along to old tunes. Routines seem to be flexible to accommodate peoples wishes and we spoke to a number of people who liked to get up early in the morning. People are given freedom to chose their daily routines for example one person said they were an night owl and often stayed up reading until midnight. This person said Its a home-from-home and I can come and go as I please. They enjoyed reading and having a daily newspaper of their choice delivered every day. They said that their wishes were nearly always accommodated and this was also supported by the recordings in daily notes and care plans. Care Homes for Older People Page 17 of 31 Evidence: However, people are spending long periods sat in the main lounge and the majority of people stay seated in their chairs for long periods including having meals in the same chair. The manager should review this and indicate in peoples care plans how each person would like to, or be encouraged to, spend their time, and the reasons why this is good practice. For example people benefiting from having a lie down in the afternoon, and a walk to their bedroom rather than remain sleeping in a chair, for health reasons as well as increasing stimulation. We noted that there was a church service every month and arrangements were in place to ensure those who wished to take Communion were able to do so. Lunch was served during our visit and the residents we spoke to said they enjoyed their meals and spoke in glowing terms of the quality of the food. On examining the store cupboards this was confirmed by the use of good quality brands. The meals and menu were judged to be of good nutritional value and people had plenty of choice. Conversations with the cook confirmed that the meals, desserts and cakes are all home cooked. Food hygiene training, levels 1 and 2 had been completed by the catering staff. Peoples preferences were known by the cook, and every effort is made to meet them. For example one person said they had requested to have croissants at weekends as she had done when living in her own home, and she appreciated this, As its my treat she said. The cooks had recently attended a course on Nutritional needs of the older people. Visitors are welcome at any time and we saw family members spending time with residents, and they were clearly at ease with being in the home and made to feel welcome. A number of family members were spoken to and they commented on the managers open and pleasant manner. Care Homes for Older People Page 18 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are policies and procedures in place, which help to ensure that those using this service are protected from harm and have their rights protected. Evidence: Meadow Bank has a clear complaints procedure, which is given to new residents when they move into the home. A copy of the complaints procure is displayed in the home and is given to residents families. The manager carries out a pre admission talk with relatives stressing the importance of having an open dialogue and speaking up to sort things out before they become larger issues. We spoke to one lady who was in her room and she confirmed that she would speak to any of the staff if she needed to but had never been given cause to complain. There is an adult protection policy and procedure in place, and recently good clear instructions have been developed to instruct staff on the steps they must take to keep people safe. Staff we spoke to during our visit confirmed they were familiar with what to look for and who to report to. Staff confirmed that they had recently completed training in Protection of Vulnerable Adults, although there was some difficulty in producing written evidence to support this. It is important to be able produce written evidence of any training completed. This was generally the case with all training and a clearer system of recording is required to be able to better co-ordinate and monitor staff training and their needs. Care Homes for Older People Page 19 of 31 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is increasingly looking run down and some peoples needs are not being met by the facilities that the home has to offer. Evidence: The home is currently looking run down and gives the impression of being neglected. For example the first impression in the driveway is a fallen down stone gate post. The entrance way is cluttered with boxes, and paint work is chipped and peeling. Posters on the door and walls are old, faded and curling up. Generally around the home many doors are marked and in the newer wing the ceiling tiles are badly stained with brown tide marks from old leaks. This includes in peoples bedrooms and cannot be pleasant when a person is in bed and looking up at this sort of stain. A downstairs toilet has a badly marked floor giving the impression that it is dirty, and ceiling tiles here are also marked, as well as paint chipped on the walls. There is no toilet roll holder instead this is placed on a very old wooden table. This is not a good material to be used in a toilet and can present an infection control hazard. There is a raised toilet seat which is chipped and this also presents a hazard to health. A plastic jug was placed to the side of the toilet, which again does not look very pleasant. The sluice downstairs next to this toilet is very small and is crowded with a collection of mops and buckets. There are no hand washing facilities in this sluice room. Which again presents difficulties in promoting good levels of hygiene. Care Homes for Older People Page 20 of 31 Evidence: Make shift signage on peoples bedroom, and other doors looks messy and unprofessional. Other posters and notices relating to staff are in public places and this is not acceptable in a home environment. The home uses low energy light bulbs in all areas and this gives off a very dim light and makes the home appear dark and dingy. The home needs to check, if they continue to use these bulbs that they are at a higher wattage. The recommended level is lux 150 to give off enough light to be safe and effective. The home has one assisted bath for use by 19 people. In addition to this a shower is available. Not everyone in the home can use these facilities and have to resort to having bed baths. One of these people said they really enjoyed having a bath but since they had arrived several months ago had only managed to have bed baths. Other infection control issues identified in this bathroom was the shared use of toiletries in the bathroom, including non labeled roll on deodorants, razors and medicated talc. This is poor practice and must stop to reduce the risk of cross infection. Many bedrooms have poor quality furniture, which does not match, is old, faded, has peeling varnish and broken handles. This gives the impression of rooms being uncoordinated and neglected. The AQAA which the manager sent into us, states that The bedroom are regularly redecorated in bright but restful colours to keep them clean and fresh. All the downstairs bedrooms have been redecorated in the last 12 months. However the ceilings have been left the same and the mish mash of furniture means that this over-rides any efforts to make them look better by just painting them. Also most bedroom doors are badly marked and at least one downstairs bedroom has badly rotting window ledges. The fire escape in this area of the building is green with moss and parts of it are over-grown with ivy. This potentially is a hazard for safe evacuation of people. Residents can personalise their rooms, and some are like second sitting rooms with TVs, DVD players, direct line telephones, mini fridges, and pieces of peoples own furniture. Many people spend most of their time in their bedroom. The homes does not have a dining room that can accommodate all people living there. The one table only seats six people, so for the majority of the time people either eat in their bedrooms or sit in the one lounge available and have their meals on pull up tables. Staff say that this is peoples own choice but the routines established do not promote this choice and this leads to people spending all day sat in the lounge with no Care Homes for Older People Page 21 of 31 Evidence: change of scenery. If the dining room was big enough to accommodate all service users the picture might be very different. In other homes it is quite normal to see the dining rooms being well used. A Fire Risk Assessment was not available at inspection and the nurse on duty was not sure what one was. In the event of a fire the person on duty must be fully aware of procedures and paperwork that is required to ensure people are kept safe. The home does not currently have a Fire Warden and again this places people at risk. Due to all these issues mentioned above the home must produce a formal, written up maintenance and renewal plan whereby a planned and targeted approach could be evidenced to meeting these deficiencys. The home is not providing value for money for people in this area as the quality of the environment has become poor. Care Homes for Older People Page 22 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although training of staff is improving, recording is disorgansied which could lead to gaps in staff receiving input, and therefore effect care practices. Evidence: There is a warm atmosphere in the home that is greatly appreciated by those who live there. Residents were complimentary about the staff. One lady who was sitting in her room told us that staff are very friendly and are always popping into my room for a chat. We observed the staff caring for the residents in a calm friendly manner and were told by the residents sitting in the lounge that all the girls were lovely and looked after them very well. The AQAA tells us: All staff receive their 3 days training each year, this is done inhouse to make it more convenient for the staff. All new staff have a structured induction course when they join us. One of our new nursing team has taken over some of the training courses which makes it much more flexible and we can have small groups. Any training that is accredited is carried out by outside training agencies. At the last inspection these comments were made: There has been some improvement in the way that staff training is recorded but there needs to be a full training matrix available in order that the manager knows exactly when updates are Care Homes for Older People Page 23 of 31 Evidence: due and new training accessed. This has been a requirement made regarding this on more than one previous occasion and this work needs now to be completed. The home uses an external training provider but there are times when evidence of completed training, such as certificates of attendance are not produced in a timely manner. The manager should ensure this does not happen in the future. Although the staff had completed fire training some months ago there was no evidence available as the trainer had not provided this. We were told by the nurse in charge that generally the amount of training offered had improved recently and that the manager had designated areas of responsibility to some of the full-time nurses. For example one nurse now co-ordinates and records training for staff, and that supervisions are now shared between the manager and this nurse. Although the AQAA states that recorded keeping had improved we didnt see evidence of this in individual files or in any general records. We saw one file that had lots of certificates held in it, but they were not in any particularly order and it was difficult to tell what training staff had received. However there was evidence around the home, in the way of posters, that staff had signed up to attend training, for example in Food safety and First aid. Records of training should be available for inspection and held in the home. The manager was not available during the inspection, and will be asked to send in a training plan and evidence of the latest training undertaken by staff. A Fire Risk assessment for the home could not be found and this usually holds evidence and plans of staff training in fire safety and evacuation. We were not clear when staff had last received this training. Care Homes for Older People Page 24 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management systems do not ensure the efficient running of this service, however the recent proposals to improve should ensure a much more efficent appraoch to running the home and will benefit standards for people living there. Evidence: At the last inspection the following issues were noted: There is however, a lack of coordination in the paperwork and administration procedures and this needs to be addressed as soon as possible. Staff files and documentation should be brought up to date and a programme of care plan audits should be introduced. The manager should also ensure that all care plans are regularly reviewed and updated by those with delegated responsible for this, in order to meet the changing needs of those living in Meadow Bank. On this inspection this picture remains very much the same with paperwork and recording being disorganised and many important documents not being available on the day of the inspection. For example the Fire Risk Assessment could not be found, Care Homes for Older People Page 25 of 31 Evidence: along with records of fire drills, tests and fire training. The person in-charge of the home must always be familiar with this document and its whereabouts, in order to take appropriate action in the event of a fire. The home needs to also demonstrate that they have the correct number of Fire Wardens. Training records and plans, were not found. The file that held certificates of servicing and maintenance of equipment was disorganised and this made it difficult to evidence if these were all up to date. Also while staff reported that people have had accidents that required hospital treatment the paperwork that should be sent into us, CQC, had not been completed. This was also the case with the reporting of deaths in the home. The home has a set of policies and procedures for staff to follow, however in this file none of the policys was newer than 2007, and the safeguarding policy although was of a good standard was not dated. This demonstrates a lack of co-ordination by the manager and highlights a need to improve the administration in the home. The manager should consider the effectiveness of getting an administration assistant to help improve this area, especially as she often works shifts as a nurse. We were able to see some changes introduced recently which gave other nursing staff delegated responsibility for certain areas, for example in organising training and this had proved successful. The manager must also send into us a copy of its Quality Assurance system, whereby they show how they seek the views of people living in the home and make improvements based on its outcome. A Quality Assurance system should also demonstrate how quality across all aspects of care and the environment are assured so that people receive good care and live in a safe, comfortable and well maintained home. This system could be used by the manager to assist her in filling in the AQQA. The current one sent into us was very brief and the quality of the evidence was poor, with sections on What the home could do Better and Plans for Improvement left blank. Due to the current management arrangements we held an urgent meeting with the Manager to discuss the issues, as she was not present at the inspection. At this meeting she discussed plans and sent int he evidence we request to demsontrate how improvements were being planned for. This included employing an additional full time nurse, which would then allow her to be freed up for three days to focus on management and adminstration. We felt satisfied with the plans and loof forward to seeing the management of the home improve to the benfit of people living there. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15 All care plans must be 30/06/2009 reviewed at least monthly to take into account any changes in residents needs. To ensure all assessed needs are recorded and met 2 7 15 All care plans should be 03/08/2009 generated from the initial assessment of needs completed prior to admission To ensure that all staff are aware of the correct level of care required to meet the needs of those living in the home. 3 30 18 (1) There must be an annual 01/07/2008 training plan in place to ensure that all staff receive the specific training they need at appropriate intervals, in order to do their job well. A copy of the training plan must be forwarded to the commission by the date specified. Previous timescale of 01/10/07 and 01/04/08 not met. Care Homes for Older People Page 27 of 31 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 3 14 A full assessment of needs and capabilities should be made before the offer of a placement is made. This is to ensure the care home is suitable for the purposes of meeting the services users needs in respect of their health and welfare. 30/06/2010 2 9 13 Records for administration of 30/06/2010 medication must be accurate to protect residents from errors. To ensure that residents receive safe and effective treatment. 3 19 23 The manager must produce a written programmer of routine maintenance and renewal of the fabric and decoration of the premises. To ensure that people live in a home which is of sound 30/06/2010 Care Homes for Older People Page 28 of 31 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 construction and kept in a good state of repair externally and internally. 4 19 23 The manager must ensure that fire escapes are well maintained and kept free from hazards. This is to ensure safe evacuation of people in the event of a fire. 5 33 24 The manager must put in place effective quality assurance and quality monitoring systems to ensure good standards in both care and in the environment. This is to ensure that the home is run in the best interests of service users, and that deficiencies identified in this report are rectified 6 38 23 The manager must make available records that demonstrate that the home is well run. This is to ensure that the health, safety and welfare of service users and staff are promoted and protected. 30/07/2010 01/07/2010 30/06/2010 Care Homes for Older People Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Care plans should to be kept up-to-date and all staff need to have regular access to them to ensure peoples needs are being met in a consistent and safe way. More detail should included in care plans when people require more specialsit input such as in maintaing skin integretiy or deitrary supplements or interventions. It is recommended that the manager undertake more thorough checks, or audits, of medication so that risks are identified and managed without delay to keep residents safe. People should be given the opportunity to manage their own medications and an assessment should be undertaken to detemine if people have the capacity keep their independentce in this area. The manager should demonstrate how the home will provide dining room facilities for all services users. The manager should demosntrate how the home will meet the needs of people who require assissted, and specialist bathing facitlites. People should be provided with a lockable storage space for medication, money or valuables in their own room and be given a key to use. The lighting in the home should be of a minmum of 150 lux to provide ensure the home is safe and bright The practice of using shared toilterres should stop as this presents an infection control hazard and doesn not promote individaulity or respect peoples dignity. The manager should produce an annual development plan for the home, which is linked to a continuos self-monitoring quality assurance system demonstrating planned improvements for service users. The manager should consider taking on an administration assistant to help improve the organisation of records and ensuring that they are kept up-to-date. 2 8 3 9 4 10 5 6 20 22 7 24 8 9 25 26 10 33 11 37 Care Homes for Older People Page 30 of 31 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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