Care Home: Meadow House Nursing Home

What the care home does well Prospective residents were encouraged to visit the home before they moved in so that they had opportunities to talk to other residents and staff. A member of staff told us that it helped some people to be able to talk through their concerns. Residents were not admitted unless the manager was sure that their needs could be met at the home. Staff supported residents to make choices and decisions about their daily lives, which gave them control and independence. People who were not able to make their own decisions had help from staff who knew them well and could make choices on their behalf. Residents we spoke to were satisfied with their lifestyles. One told us, "The only place better than here is home." There was a programme of group and individual activities and the staff tried to cater for the various interests and abilities of the residents. People were supported to keep in touch with family and friends. There was open visiting to make it easier for people to come at convenient times. Staff took people out into the local community. Residents Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 were offered a varied diet with choices. One resident told us, "The food is lovely and they do things that suit me." Another said, "The kitchen staff are very good, if you don`t like what`s on the menu they will do their best to get it or cook it for you." Residents and relatives told us they were happy with the care at the home. One resident told us, "I try to be independent and they just help me with the things I can`t do." A relative commented, "She always looks nice, they don`t forget the niceties just because she is disabled." Residents received good health care from the staff team, which included registered nurses and a physiotherapist. The home was clean and comfortable. One resident told us that he really appreciated the cleaning ladies because there was never a smell. There had been some improvements to the environment, with more planned. A relative commented, "They have done a fair number of improvements; it is brighter and airier than it used to be." The manager made sure that new staff all had background checks before they started working at the home. This was to make sure that they were suitable to work with residents. Staff had training to help them to understand the needs of the residents and to protect their health and safety. Over half of the care staff held an NVQ, which is a nationally recognised qualification in health and social care. What has improved since the last inspection? Following a requirement at the last inspection, there were some assessments and care plans to support residents to meet their social and recreational needs and to take responsible risks as part of everyday living. These still needed further improvements to ensure that residents` individual needs were met. Following a requirement at the last key inspection, staff had relevant guidance to help them to support residents who wished to form new relationships. Residents who were able, had the choice of administering their own medication, which helped them to remain independent. There had been improvements in the way staff managed the other residents` medicines to ensure that they were administered safely. We made a requirement at the last inspection to ensure that the complaints procedure was displayed in the home so that visitors would have the necessary information. This had been met but we have made a good practice recommendation that all residents receive a copy of the procedure in their service user`s guide. There were new systems being put into place to monitor the quality of the service, which will help to ensure that the home is run in the best interests of the residents. Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 New bedroom doors had been fitted in response to a requirement made last year by the fire officer. What the care home could do better: The service user`s guide should provide more relevant information about Meadow House and the services offered there. This would give prospective residents more meaningful information to help them decide whether the home was right for them. The care plan format has been under review for some time and there were a few different systems in place. This could be confusing for staff and has led to inconsistencies in the standard and usefulness of the plans. In order to ensure that residents` needs are met, the care plans must include directions to support residents with mental health needs. More thought should be given to storage space in the home. Equipment should not be stored where it can impact on residents` comfort or safety. In order to reduce the risk of scalds, hot water temperatures must be restricted to the recommended level unless there are risk assessments to show that this is not necessary. Key inspection report CARE HOME ADULTS 18-65 Meadow House Nursing Home Norwich Road Swaffham Norfolk PE37 8DD Lead Inspector Jane Craig Key Unannounced Inspection 26th May 2009 09:30 Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 Page 2 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 Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadow House Nursing Home Address Norwich Road Swaffham Norfolk PE37 8DD 01760 725146 01760 720597 ray@rayludford.wanadoo.co.uk 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) Healthcare Homes Limited Raymond Ludford Care Home 29 Category(ies) of Physical disability (29), Physical disability over registration, with number 65 years of age (29) of places Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered persons 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 are within the following category: Physical disability - code PD and code PD(E). The maximum number of service users who can be accommodated is 29. 4th June 2008 2. Date of last inspection Brief Description of the Service: Meadow House offers care to people with physical disability, specialising in care for people with multiple sclerosis. The premises is single storey, purpose built and offers a range of single rooms, large lounges, dining room and a separate activities centre. Meadow House is situated on the outskirts of Swaffham, near to a range of shops and other amenities. The fees for the service range from £700.00 to £1200.00. There are extra charges for toiletries, hairdressing, chiropody. Information about the home, including the last inspection report, is available on request. Meadow House Nursing Home DS0000071004.V375593.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 two stars. This means that people who use the service experience good quality outcomes. The last key inspection on this service was completed on 4th June 2008. This key (main) inspection includes information gathered since the last inspection and an unannounced visit to the home. The visit was carried out on 26th May 2009 by one regulatory inspector. At the time of the visit there were 27 people accommodated in the home. We met with a few of them and asked about their views of Meadow House. We spent time observing daily routines in the home and how staff interacted with residents. Three residents were case tracked. This meant that we looked at their care plans and other records and talked to staff about their care needs. We held discussions with the registered manager, the lead nurse, other staff and visitors. We looked around the home and viewed a number of documents and records. This report also includes information from the annual quality assurance assessment (AQAA), which is a self-assessment report that the manager has to fill in and send to the Commission every year. What the service does well: Prospective residents were encouraged to visit the home before they moved in so that they had opportunities to talk to other residents and staff. A member of staff told us that it helped some people to be able to talk through their concerns. Residents were not admitted unless the manager was sure that their needs could be met at the home. Staff supported residents to make choices and decisions about their daily lives, which gave them control and independence. People who were not able to make their own decisions had help from staff who knew them well and could make choices on their behalf. Residents we spoke to were satisfied with their lifestyles. One told us, “The only place better than here is home.” There was a programme of group and individual activities and the staff tried to cater for the various interests and abilities of the residents. People were supported to keep in touch with family and friends. There was open visiting to make it easier for people to come at convenient times. Staff took people out into the local community. Residents Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 Page 6 were offered a varied diet with choices. One resident told us, “The food is lovely and they do things that suit me.” Another said, “The kitchen staff are very good, if you don’t like what’s on the menu they will do their best to get it or cook it for you.” Residents and relatives told us they were happy with the care at the home. One resident told us, “I try to be independent and they just help me with the things I can’t do.” A relative commented, “She always looks nice, they don’t forget the niceties just because she is disabled.” Residents received good health care from the staff team, which included registered nurses and a physiotherapist. The home was clean and comfortable. One resident told us that he really appreciated the cleaning ladies because there was never a smell. There had been some improvements to the environment, with more planned. A relative commented, “They have done a fair number of improvements; it is brighter and airier than it used to be.” The manager made sure that new staff all had background checks before they started working at the home. This was to make sure that they were suitable to work with residents. Staff had training to help them to understand the needs of the residents and to protect their health and safety. Over half of the care staff held an NVQ, which is a nationally recognised qualification in health and social care. What has improved since the last inspection? Following a requirement at the last inspection, there were some assessments and care plans to support residents to meet their social and recreational needs and to take responsible risks as part of everyday living. These still needed further improvements to ensure that residents’ individual needs were met. Following a requirement at the last key inspection, staff had relevant guidance to help them to support residents who wished to form new relationships. Residents who were able, had the choice of administering their own medication, which helped them to remain independent. There had been improvements in the way staff managed the other residents’ medicines to ensure that they were administered safely. We made a requirement at the last inspection to ensure that the complaints procedure was displayed in the home so that visitors would have the necessary information. This had been met but we have made a good practice recommendation that all residents receive a copy of the procedure in their service user’s guide. There were new systems being put into place to monitor the quality of the service, which will help to ensure that the home is run in the best interests of the residents. Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 Page 7 New bedroom doors had been fitted in response to a requirement made last year by the fire officer. 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. Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4 People using the 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 admission procedures helped to determine whether or not the resident’s needs could be met at the home. EVIDENCE: The resident’s guide was part of a brochure produced for Healthcare Homes and as such contained limited information about the specialist service provided at Meadow House. The manager was revising the document to include details about the new extension and said he hoped to be able to add some more meaningful information. The guide was available in different formats. People thinking of moving into the home were encouraged to visit and spend some time with the staff and other residents before making a decision. A member of staff said, “It gives us a chance to explain about the service and provide some reassurance, because most people are, understandably, a bit scared.” One resident confirmed that they made their decision after a visit to the home. They told us, “I chose it because there was laughter here.” Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 Page 10 Anyone who was thinking of moving into the home was assessed by senior staff to make sure that their needs were understood and could be met at Meadow House. The example of the pre-admission assessment we saw did not fully reflect the resident’s complex needs. However, there was a more detailed assessment carried out on the day of admission, which was used to plan care. Assessments and other supplementary information from health and social care professionals were also on file, which helped to complete the picture of the resident’s strengths and needs. Staff said they received enough information about new residents to provide initial care. Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care documents were not sufficiently detailed to evidence that all residents’ individual needs and choices were met. EVIDENCE: The care planning system had been under review for some time and the care records we saw all followed a different format. The company were introducing another new set of care records to be used in all their services. A senior nurse was working on some alterations to reflect the specialist needs and care of people resident at Meadow View. The three sets of care plans we looked at covered each resident’s health and personal care needs but the standard of information was variable. Some plans helped staff to provide essential nursing care whilst taking account of the resident’s personal wishes and preferences. Others were standardised and Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 Page 12 contained very little instruction for staff to provide care to meet individual needs. Some attempts had been made to record this information in the review notes. A number of plans contained directions to support the resident to make decisions about their everyday care. As required, following the previous inspection, attempts had been made to develop the care plans to meet needs associated with independent living and recreation. At the time of the visit these were not of a good standard but should be helped by the new care planning system. Care plans were reviewed every few months. We were told that this was going to increase to monthly, which should help to ensure that plans are kept up to date and reflect any changes in the residents’ needs. Residents and/or their representatives were consulted about their care plans and those people we spoke with said they were happy with the level of involvement. Residents said they could make decisions and choices about all aspects of their daily lives and there were no restrictions. One told us that they felt they had complete choice and autonomy. Another said, “Staff listen; if you want something doing in a certain way they do it.” Another resident commented, “It is nice to be able to have so many choices.” Some residents were no longer able to make their own decisions. A member of staff told us that they consulted with families or make choices for residents that provided them with the maximum comfort. We made a previous requirement to alter the way residents’ finances were managed. At the time of this inspection the manager or company did not manage any of the residents’ finances. If they were able to, residents managed their own money but most were assisted by their families. To ensure that they could make impromptu purchases, the home held various amounts of money on behalf of a number of residents. In some cases this involved paying cheques into the company account before obtaining cash. The possibility of opening a residents’ account was being explored. The residents we case tracked had a set of assessments and plans to manage risks related to their health and safety, for example, associated with moving and handling, nutrition, and the use of bed rails. There was a requirement from the previous inspection to develop risk assessments and plans to support residents to take responsible risks as part of independent living. There were only a few examples of these but senior staff said the new risk assessment format should help to encourage staff to look more at this area. Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 and 17 People using the 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 majority of people received the support they needed to lead their chosen lifestyle. EVIDENCE: Residents living at the home varied in age and abilities and some had complex needs. Whilst there was a lack of individual care plans, the home had established a programme of activities and occupation to help meet the social and recreational needs of this diverse group of people. There was a range of group and one to one activities facilitated by the activity organisers, care staff, outside entertainers and volunteers. The residents had mixed views about the activities. One told us that there was not much on offer that they liked so they preferred to pursue their own interests. Others told us there was enough for them to do. The annual quality assurance assessment (AQAA) indicated that Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 Page 14 the service planned to offer more varied activities and more availability. We discussed with the manager how information that is already collected about the residents’ interests, could be used more effectively to help residents to feel more stimulated. Several residents went out regularly with family and friends. One resident told us they went home every week, another went to church every Sunday and others went out for specific events. The activity organisers also arranged to take people out. Venues for outings were discussed at residents’ meetings. Over the past few weeks there had been small group visits to the theatre and there were fortnightly shopping trips. Residents were also supported to visit family members. There was open visiting at the home, which helped people to maintain contact. A visitor said they were always made to feel welcome and one said, “There is never a bad atmosphere.” We were told that all the residents currently accommodated would be able to tell staff if they had any wishes with regard to forming new relationships. There was a policy to guide staff on supporting people to form relationships. The residents we spoke with said they were satisfied with their lifestyles at the home. One told us, “Being here is much better than I thought it was going to be.” Another commented, “The only place better than here is home.” There was a four week rotating menu, which offered residents a varied diet. There were two choices at every meal and residents were asked for their choice the day before. A resident told us, “The kitchen staff are very good, if you don’t like what’s on the menu they will do their best to get it or cook it for you.” All other comments we received about the meals were positive. One resident told us, “The food is lovely and they do things that suit me.” Another said, “The fish and chips on a Friday are great.” The home catered for people who needed special diets. There were two sittings at each meal to ensure that residents who needed assistance did not have to wait too long. There was a range of equipment to assist residents to eat and drink independently. We observed staff providing support to residents in a sensitive manner. Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents’ received the support they needed to meet their personal and physical health care needs. EVIDENCE: Although, as previously noted, there were some shortfalls in the care plans, they generally included good information about residents’ personal care needs and their preferences for support. Residents said they received flexible personal care. One told us, “I try to be independent and they help me with the things I can’t do.” Each resident had a moving and handling assessment and plan, which was reviewed regularly. Those we saw had been drawn up by the physiotherapist, who did daily exercise routines with a number of residents. The physiotherapist told us that, at Meadow House physio was viewed as an holistic treatment, and that residents’ benefited psychologically as well as physically from participating in exercises. There were aids to assist residents who were Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 Page 16 independently mobile and a range of equipment to assist staff to move people who were not. One member of staff told us, “Moving and handling here is very important, we always have 2 staff and use the hoist.” Staff told us that routines in the home revolved around the residents. One member of staff said, “We fit in with what times residents like to get up and go to bed.” A resident also told us, “It is all quite relaxed and if you want to spend the day in bed you can do.” Staff received training in core values during their induction and in their NVQ training. There was a policy on privacy, dignity and safety, which gave staff some good reminders on how to ensure these principles were incorporated into everyday practice. The AQAA told us that the home had appointed a dignity champion but their role had not yet been clearly defined. Throughout the course of the visit staff were seen to speak to people politely and with respect. A member of staff explained that they treated residents the way she hoped she would be treated. One resident told us, “Staff are polite and friendly and we respect each other.” A relative commented, “She always looks nice, they don’t forget the niceties just because she is disabled.” Residents told us they received good medical and nursing care. A relative said, “The staff are competent and skilled in providing care for people with multiple sclerosis.” The AQAA indicated that the home was a preferred provider for the multiple sclerosis society. From looking at records and talking to people it was apparent that additional support was available to provide total care for the residents, whatever their diagnosis and needs. For example, there was a physiotherapist on site and residents had regular appointments with GPs, opticians and chiropody. Records showed that residents were also referred to specialist nurses, speech and language therapy, and dieticians when needed. Plans showed that any advice or treatment was followed. The care plans did not show that psychological healthcare needs were given the same emphasis as physical healthcare. One member of staff we spoke to was very aware of residents’ mental health needs and understood the support individual people needed. However, the care plans were not detailed enough to ensure that all staff provided a consistent approach. There was a complete set of policies for medicines management and various good practice guidelines were available for reference. Each resident had an assessment on file as to their wishes and ability to administer their own medication. For example, some residents administered their own creams but most medicines were managed by the registered nurses. We observed staff doing part of the medicine round and found her practice to be safe and hygienic. Medication was stored securely. The majority of tablets were administered from a monitored dose system. There were safe systems for ordering Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 Page 17 medication on a monthly cycle and for disposing of medication no longer needed. There were full records of medicines received, administered and disposed of. This provided a complete audit trail to show that residents received their medication as it was prescribed and reduced the risk of mishandling. There were records of stocks of medicines carried forward from the previous month and the balance was recorded each time a dose was given so any errors could be identified immediately. A small random audit showed that the stocks of medicines matched the records. There were some handwritten entries on medication administration record (MAR) charts. Not all of these were double signed to show that the entries had been checked by a second member of staff. One of the entries did not include the strength of the tablet to be given, which could cause confusion. When pointed out these were immediately rectified. There were very clear guidelines for administering medication to be given ‘when required.’ This helped to ensure that residents received their medicines correctly. Staff had helped one resident to identify the best times for him to receive his pain relief and his medicine was administered to suit his needs. With one exception variable doses of medicines were recorded, which helped staff to evaluate how effective the dose was. Controlled drugs were stored, recorded and administered in accordance with the policy. Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents knew that their concerns would be listened to and taken seriously. Training and procedures helped to safeguard people from abuse. EVIDENCE: The complaints procedure was on display in various areas of the home to make it widely available to residents and visitors. Residents did not receive an individual copy in their resident’s guide. The procedure provided details of the process and timescales for responding to complaints and included contact details for the commission. It was available in different formats. There were records of two complaints and a concern since the last inspection. All had been investigated and responded to as laid out in the procedure. Some aspects of the complaints were upheld and action had been taken to resolve the issues. Part of the concern was about the lack of adjustable heating in some parts of the home. The manager told us that the company were investigating the feasibility of a new heating system. Residents and relatives we spoke with said they had not had to make any complaints but would know who to speak to if they were unhappy about the home or the care. One said, if I had a complaint I would talk to the person concerned or if it was serious I would go to the manager.” Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 Page 19 Staff received training in safeguarding during their induction and NVQ training. The manager told us there was refresher training every three years. Staff we spoke to were clear about their role in reporting poor or abusive practice. One said, “I would report it even if it was my mate, if not you are as bad as them.” There was a company policy on safeguarding. This provided good information about recognition of abuse but the process for reporting suspected, or actual, abuse was not completely clear. However, the staff also had the Norfolk County Council procedure for guidance. The manager was very clear about his role and responsibilities, should anyone report a safeguarding issue to him. Senior staff had also dealt with an incident appropriately in the absence of the manager. We were told that the company procedure was under review, with a plan to dovetail the process with the local authority procedure. Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People using the 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 provides a comfortable and clean environment for the residents. EVIDENCE: At the time of the inspection a new extension was being built. When completed this would provide seven extra places. Disruption to residents was being kept to a minimum. One resident told us, “The noise is a bit irritating but on the whole I am not really bothered by it.” There was an ongoing maintenance programme. A tour of the building showed that the home was in a good state of repair. There was an ongoing programme of redecoration and renewal. The AQAA told us that there had been major improvements to the décor and improved accessibility for the residents. One visitor confirmed this and told us, “They have done a fair Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 Page 21 number of improvements; it is brighter and airier than it used to be.” Communal rooms were comfortable and adequately furnished. There was a lack of storage space and some areas were cluttered with equipment and other items. Some of this problem would be solved when the extension was completed but in the meantime there were some issues that needed to be addressed. For example one of the bathrooms was being used to store commodes and some food was being stored in the same area as cleaning trolleys. Residents could personalise their bedrooms with items of furniture, pictures and other possessions. At least one resident had chosen the colour of their room. Most of the residents and relatives we spoke with mentioned that the bedrooms were small but adequate. One told us, “A little bigger would be better but on the whole it is all right.” Residents had sufficient equipment to assist them to be comfortable, mobile and independent. There was a range of physiotherapy equipment in the activity room, and residents had specific chairs and wheelchairs for their own use. On the day of the visit the home was clean and free from unpleasant odours. Some of the residents and staff commented about the lack of odour and one resident said, “I really appreciate the cleaning ladies, it never smells of urine.” Staff received infection control training during their induction and some had done refresher courses. Staff told us that infection control was taken seriously in the home. There were sufficient hand washing facilities. The laundry was adequately equipped for the size of the home. It was clean and well organised. There were no complaints about the laundry and one visitor said their relatives clothing was well looked after. Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34 and 35 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were supported by a staff team who understood their needs. Recruitment practices provided safeguards. EVIDENCE: The staffing rosters showed that there were always a consistent number of staff on duty. The manager told us that there had been a successful recruitment drive and other staff were returning from long term leave so recent agency use should decrease. One resident told us, “Staff have just about enough time that people are not left waiting for attention but they don’t have a lot of spare time.” This was the general consensus of other residents and staff. The manager told us he had some flexibility to increase staff on a temporary basis, if, for example, they had a resident who needed a lot more support than usual. Throughout the visit staff were seen interacting positively with the residents, and the residents we spoke with said that staff were very good and treated them well. Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 Page 23 We looked at the files of two newly appointed staff. Both had the required preemployment checks, which helped to provide safeguards for residents. Their files contained all the required information and documents. The manager carried out six monthly checks to make sure that nurses had a current registration with the Nursing and Midwifery Council. New staff went through a thorough induction training programme. This was a company wide programme, which included six days of taught sessions followed by mentorship and self study. The training covered all the topics in the common induction standards and counted towards the NVQ training. Staff told us that there were good opportunities for training. All staff had completed at least some mandatory training but the central training record only started last year, therefore, it was not possible to show whether all mandatory training was up to date. Registered nurses told us that they were provided with enough, relevant training to satisfy the requirements of their registration. The AQAA told us that over half of the care staff held an NVQ at level 2 or above. Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People using the 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 was run by a competent manager who ensured that peoples views were listened to and acted upon. EVIDENCE: Meadow House is owned by Healthcare Homes Limited, who also own a number of other services in the locality. The company has a clear management structure, providing support and supervision to the registered manager. The manager is a registered nurse with many years experience of managing this service. He holds a relevant management qualification. Since the last inspection, two staff have been appointed into the new roles of lead nurse and administrator. The manager said this had been an important factor Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 Page 25 in the improvement of the management and administration systems in the home. The company had recently appointed a quality director, who was in the process of implementing a range of new initiatives to monitor and improve the quality of services and outcomes for residents. The last satisfaction survey had been carried out in December 2008. The manager completed an action plan to address issues which had scored low, such as attendance at resident and relative meetings. The responsible individual carried out monthly unannounced visits to the home to monitor all aspects of the service and the running of the home. Information provided in the AQAA stated that all installations, appliances and equipment had been serviced and maintained appropriately. As required after the last inspection, the recommendation from the last fire inspection had been carried out and fire doors had been replaced. Staff had received fire safety training and drills were carried out regularly. During the inspection it was noted that the hot water taps were not fitted with valves to maintain the water temperature to a safe level. The manager said these had been tried in the past but had not been successful. There were thermometers in the bathrooms to remind staff to check the water temperatures but we did not see any risk assessments for residents who were able to run a sink or bath of water without staff assistance. Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 2 X Version 5.2 Page 27 Meadow House Nursing Home DS0000071004.V375593.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement To ensure that residents receive the support they need, care plans must address their psychological needs. In order to protect residents, the temperature of hot water must be restricted unless there are risk assessments to evidence that this is not necessary. Timescale for action 31/08/09 2. YA42 13 31/08/09 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 YA1 Good Practice Recommendations The service user’s guide should be revised to ensure it provides sufficient information about the service provided at Meadow House. It should also include a copy of the complaints procedure. The bank account used to temporarily hold residents’ money should not be part of the company’s assets. DS0000071004.V375593.R01.S.doc Version 5.2 Page 28 2. YA7 Meadow House Nursing Home 3. 4. 5. 6. YA9 YA20 YA24 YA35 The assessments to assist people to take responsible risks as part of independent living should be further developed. Handwritten entries on MAR charts should be double signed to reduce the risk of transcribing errors. Equipment should be stored to ensure that it does not pose a risk to residents’ safety and comfort. There should be a training plan to show when mandatory training is due. Meadow House Nursing Home DS0000071004.V375593.R01.S.doc Version 5.2 Page 29 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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