Care Home: Meadow House

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What the care home does well The home is a pleasant place for people to live. Each person we spoke to told us they enjoyed living here. They said "I like living here it is my home". People moving into this home will have their needs assessed in full prior to this. Care plans are person centred and reflect individual`s choices and wishes in relation to their own care. There is a range of activity for people to enjoy and take part in. Meals are varied and of good quality. People have a choice of meals and the home is able to cater for specialised diets. All complaints, grumbles or concerns are taken seriously and promptly acted upon. The home is run in the best interests of the people living here. The home will consult with people about how they do this and act upon suggestions made. What has improved since the last inspection? This is the first inspection for this service. What the care home could do better: We have made some recommendations for the home to further build upon current good practice. We have said the home should be recording the temperature of the medication storage room in order to make sure medication is being stored as per manufacturer`s guidance. We have also asked the home to consider the dining facilities for some of the people living on the ground floor. The smallest dining room is cramped and does not give people much room to move about or to eat their meals in a relaxing environment. CARE HOMES FOR OLDER PEOPLE Meadow House Stroud Avenue Willenhall WS12 4ET Lead Inspector Amanda Hennessy Key Unannounced Inspection 25th September 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Meadow House DS0000071299.V371935.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Meadow House DS0000071299.V371935.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadow House Address Stroud Avenue Willenhall WS12 4ET Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01902 368 390 01902 603 372 www.housing21.co.uk Housing 21 Christine Elizabeth Smith Care Home 34 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (34) of places Meadow House DS0000071299.V371935.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 10 Old age not falling within any other category (OP) 34 The maximum number of service users to be accommodated is 34. 2. Date of last inspection New Service Brief Description of the Service: Meadow House provides accommodation for up to 34 older people. They are also registered to provide care for people who may have dementia. The home has adequate facilities for people to use. There are communal lounges, dining rooms and an activity room. Each person has their own bedroom but there are no en suite facilities in this home. The home also provides intermediate care facilities for people to access. They are supported by the local Primary Care Trust to do this. The offices for the intermediate care team are based in Meadow House. Meadow House is accessible by public transport and there are some local amenities near by. The service user guide states fees charged are £420 per week and respite care is £102.90 per week. People may be charged extra for hairdressing, chiropody services or newspapers. Readers of this report are asked to contact the service directly for more information. A copy of the most recent inspection report is available upon request from the home. Meadow House DS0000071299.V371935.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that people who use this service experience good quality outcomes. We looked at all the information that we have asked for from the service. This included: • The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. • Information we have about how the service has managed any complaints. • What the service has told us about things that have happened in the service, these are called ‘notifications’ and are a legal requirement. • The results of any other visits we may have made to the service. • Relevant information from other organisations. • We also spent time talking to the people who use the service and to the staff who support them. • We looked at the care of two people who use this service in depth. This is part of our case tracking process and helps us makes judgements about the home’s abilities to meet people’s needs. What the service does well: The home is a pleasant place for people to live. Each person we spoke to told us they enjoyed living here. They said “I like living here it is my home”. People moving into this home will have their needs assessed in full prior to this. Care plans are person centred and reflect individual’s choices and wishes in relation to their own care. There is a range of activity for people to enjoy and take part in. Meals are varied and of good quality. People have a choice of meals and the home is able to cater for specialised diets. All complaints, grumbles or concerns are taken seriously and promptly acted upon. The home is run in the best interests of the people living here. The home will consult with people about how they do this and act upon suggestions made. Meadow House DS0000071299.V371935.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Meadow House DS0000071299.V371935.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Meadow House DS0000071299.V371935.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People choosing to live in this home will have all the information they need to enable them to make choices. They can also be assured that their needs will be assessed in full before they move into the home. EVIDENCE: The home provides required information about the services they offer. The statement of purpose and service user guide have recently been updated to reflect the changes to the homes ownership and give an accurate picture of what people can expect from the service. The service user guide is given to people either when they come to visit the home or when staff go out to visit them. Meadow House DS0000071299.V371935.R01.S.doc Version 5.2 Page 9 People have an assessment of their needs carried out by a senior member of staff. People are all invited to visit the home before they make the decision that the home would be suitable for them. If people are able to visit the home the assessment is undertaken during their days visit. If people are unable to visit the home staff go out to assess their needs before a decision is made that the home is suitable for them. We looked at these assessments and found them to be comprehensively completed. The assessment of needs then forms the basis of the person’s plan of care, giving staff information about their care needs. There were letters in people’s care records confirming that following an assessment, their needs could be met by the home. The intermediate care facilities are organised and people are supported with their needs. A multi disciplinary staff group that includes, physiotherapists, occupational therapists and specialist nursing service support people in regaining their independence. We are informed that this service will cease to be offered to people in the very near future due to service reprovision. People should contact the home directly for more details. Meadow House DS0000071299.V371935.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are being met, record keeping practices are good and staff understand the individual needs of the people living in this home. EVIDENCE: We looked at the care records relating to two people during this inspection. It was pleasing to see the home is making progress with the person centred approach to care planning. Care plans we saw showed that people’s individual preferences had been recorded. For example, what time they like to go to bed and get up, how they like to be assisted whilst in the bath or getting dressed. We saw care plans for challenging behaviour for one person that had been clearly written and gave staff the direction they needed to meet this persons needs. Care plans are being updated by staff and despite some gaps all of the staff we spoke to were able to give us a verbal update of each persons needs and their preferences in relation to their care. Meadow House DS0000071299.V371935.R01.S.doc Version 5.2 Page 11 We saw evidence that shows us the home is keeping people’s medical care under review. There are risk assessments in place that assess the risk of malnutrition, risks in relation to moving and handling and falls. Each person has access to their own doctor, as they need it. The home is also supported by the district nursing service, and other community support specialists. People also have access to chiropody, dental services and opticians as needed. There may be a small charge for some of these services and people are advised to talk to the home manager for further information. People using this service told us “I always get the help and attention I need”. We looked at medication practices in the home. They are generally good and safeguard the people who live there. There are some improvements to be made such as staff signing the Medication Administration Record (MAR) when they handwrite entries on to it. Staff do consistently record the temperature of the drugs fridge, this will mean that medication requiring cold storage will be kept within recommended temperatures. We have also recommended they begin to record the temperature of the medication storage room to ensure they are keeping medication at the manufacturers recommended temperatures. People living in this home are treated with respect and dignity. We saw staff talking to people respectfully throughout the inspection. They were also seen to be knocking doors prior to entering people’s bedrooms and toilets. Staff are taught the principles of respect, dignity and privacy in their induction programme when they start working at the home. The home also has provision in place to plan for people’s end of life care. In both instances of the people we case tracked this had been recorded but it providing limited information rather than a detailed plan. The home should consider developing this planning further for people. This will ensure that people have the end of life care they want when the time comes. Meadow House DS0000071299.V371935.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have the opportunity to make choices about their life at the home and maintain relationships with friends and relatives. EVIDENCE: Peoples’ interests and choices are recorded within their care records. A life history is requested and in most cases available to give staff a good insight to peoples’ life and preferences. People told us that they are able to get up and go to bed when they wanted and spend their day how and where they choose. The home has an activity programme with activities organised on a daily basis by care staff. Activities include: sing-a-longs, movement to music, pamper sessions, games, quizzes and a reminiscence sessions. People told us that they can choose whether they take part. People told us that there are regular meetings which update them in any issues affecting the home. All people we spoke to were aware of proposed changes to the home and that they would be helped to look for other places to live. One Meadow House DS0000071299.V371935.R01.S.doc Version 5.2 Page 13 person is part of a group of people that are meeting regularly with Housing 21 to discuss their concerns and questions about the reprovision of services planned in the next 12 months. One person told us “I am worried because I don’t want to leave here, I chose to be in residential care and I want to stay in it”. Visitors are able to visit the home at any reasonable time in the day. We observed several visitors arriving and leaving during the day of the inspection. We were also told that a monthly church service is held for people to take part in as they choose. The Home has a four-week rolling menu. There are at least three meal choices available at each mealtime, although staff did say that if people do not like either choice an alternate is offered. The home has three dining rooms and we found that all but one were pleasant rooms with dining tables attractively presented at mealtimes. The smaller dining room on the ground floor is cramped and people and staff struggle to manoeuvre in there. Whilst people are dining staff have to attempt to get the food trolley, the medication trolley and hoists, wheelchairs into the room for people’s use. We are recommending the dining facilties for this group of people are reassessed so that they do not continue to experience the disruption to their meal times they do at present. People using the service confirmed that they always have a choice offered and can have their meals in the dining room or if they prefer their own bedroom. Those people who are using the intermediate care facilities are also encouraged to make themselves drinks and small snacks. There is a dedicated kitchen on the intermediate care unit for people to do this. Meadow House DS0000071299.V371935.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using this service feel confident about making their views known. Staff are trained in Safeguarding procedures and understand how to keep people free from harm EVIDENCE: The home has a complaints policy and procedure. The complaints procedure in the Service User Guide and is also displayed in the home. The home has had two complaints in the last year. Both were addressed in the required timescales and with satisfactory outcomes for the people who made them. The person in charge told us that there are appropriate systems in place should any complaints be made. The Commission for Social Care Inspection has also received no complaints about the home since the change of ownership. People are supported to maintain their political right to vote with some choosing to request a postal vote. Staff at the home receive training in Safeguarding vulnerable adults and are aware of the local authority guidance for dealing with safeguarding issues. The home has good recruitment practices and makes sure that no people are employed without the required checks against the Protection of Vulnerable Meadow House DS0000071299.V371935.R01.S.doc Version 5.2 Page 15 Adults list (PoVA) and a Criminal Records Bureau disclosure (CRB). By completing these checks the home is taking steps to prevent unsuitable workers from working with vulnerable people. There are no forms are restraint in use at this home at the time of our inspection. Meadow House DS0000071299.V371935.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is clean and tidy but dated in appearance. People do live in a well maintained environment EVIDENCE: The service is clean and tidy. Some areas of the home feel ‘dated’ and are in need of redecoration. There is a good mix of both communal lounges and dining rooms. They are of an adequate size but they feel drab and in need of brightening up. One dining room as we have previously mentioned is small and we have recommended that dining facilities are reviewed for the group of people using the small dining room. We have recommended this be considered because of the difficulties staff encountered during mealtimes moving the food trolley, medication trolley and people’s wheelchairs. Meadow House DS0000071299.V371935.R01.S.doc Version 5.2 Page 17 All bedrooms in the home are single. We found bedrooms to be clean and tidy with personal pictures etc. Whilst there are no en-suite bedrooms in the home all have easy access to toilets, most resident choose to have a commode. Aids and adaptations are available throughout the home for dependent people. We did see that some of the equipment in use in toilets is in need of recoating so that the rust is removed. Once this is done the toilet frames will offer further protection against infection to the people who live there. There is a staff call system throughout the home, a passenger lift enables people to access both floors and hand and grabs rails are also available. The home is clean and generally free from odour. There are good arrangements with the provision of gloves, aprons, liquid soap and paper towels available throughout the home to minimise the risk of cross infection. We were also told that staff are receiving infection control training. These measures will help reduce the risk of cross infection to those people living in the home. Meadow House DS0000071299.V371935.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are being recruited safely and are being given the appropriate training the need to complete their duties. Staffing levels must be kept under review to make sure that people’s needs are met. EVIDENCE: We found that generally the home is staffed with appropriate numbers and skill mix to meet people’s needs. People told us “the staff are very good I am happy here”. Staffing levels are maintained and people said that they were happy with the support they get. The home is using agency workers at present to bolster staffing levels. The person in charge did tell us however the staff from the agency have been used on a regular basis and there fore they can still offer some consistency of care to the people living in the home. Staff we met spoke positively about support and training they receive and were knowledgeable about peoples’ needs. We observed good interaction between staff and people living at the home. All of the current staff group have either completed or are in the process of completing their National Vocational Qualification (NVQ) level 2 or 3 in Health Meadow House DS0000071299.V371935.R01.S.doc Version 5.2 Page 19 and Social care. This means that staff are qualified and skilled enough to complete their duties and provide care to the people living in the home. In addition to staff having completed NVQ training some of the current staff group are qualified assessors for this award. We looked at the recruitment practices of the service. We did this to make sure that the service continues to employ people safely and is making the correct safety checks on people before they are allowed to work with vulnerable people. We saw the staff files of three new employees, all the files were up to date and it was pleasing to see the required checks such as Protection of Vulnerable Adults (PoVA) first and Criminal records Bureau (CRB) in place. Staff complete an induction as soon as they start working within the service. The current induction meets the skills for care standards and offers people a sound introduction to social care and what is required of workers. Meadow House DS0000071299.V371935.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is being run in the best interests of the people who live here. The health and safety of people is promoted and protected by the home. EVIDENCE: The registered manager for this service is currently on long term sick leave. She is both qualified and has the necessary experience to manage this service. Housing 21 are supporting the home by making sure there is management support available to assist staff at all times. The person in charge during this inspection was very informative and gave us all the information we needed to complete our fieldwork. It was obvious that given the current staffing levels all staff are very busy and do manage their time very well given the amount of Meadow House DS0000071299.V371935.R01.S.doc Version 5.2 Page 21 interruptions we observed them deal with whilst trying to care for the people living in the home. The home has a quality assurance programme. It is positive the home does audits of practice based on the National Minimum Standards. Senior cares are each given an area to review such as health and personal care, the environment and staffing assesses whether they are meeting the standards and when appropriate actions are needed which forms the development plan for the home. We were told that since there has been the change of ownership surveys are sent to all people who are discharged from the service, these surveys are sent directly to Housing 21 head office. The person in charge told us that she thinks that a report will be made of the responses to the surveys. The financial records of the organisation were assessed at the time of the change of ownership and found to be appropriate. The home does not act as appointee for people using the service. There are appropriate arrangements in place when people request it to keep small amounts of money for services such as hairdressing and chiropody. There is a record of all transactions and receipts are available to confirm the transactions. It was also positive to be see that daily checks of the safe contents is undertaken. Staff told us that they receive supervision at regular intervals, records seen showed us that it covers all aspects of practice. The home has an up to date health and safety policy for safe working practice with a range of risk assessments. Staff receive training and regular updates in all mandatory training. We were told that all staff have had training in Housing 21 policies and procedures since the change of the homes ownership. Maintenance contracts were randomly selected and were found to be up to date. Meadow House DS0000071299.V371935.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 3 3 X 3 3 Meadow House DS0000071299.V371935.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? New service STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations The home should record the temperature of the medication storage rooms. This should be done so that the home can demonstrate it is storing medication at the recommended temperatures to ensure the health and wellbeing of the people who use the service. Consideration should be given to redesigning the dining facilities for those people who use the small dining room on the ground floor. 2 OP15 Meadow House DS0000071299.V371935.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Meadow House DS0000071299.V371935.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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