Care Home: Meadow View

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What the care home does well The service aims to inform people considering moving into the home and to understand how they will need to be supported. The service offers individualised support to residents and encourages independence and the development of personal life skills in comfortable, homely surroundings. They complete care plans that set out instructions for staff in meeting people`s needs. There is a greater emphasis on the person as a whole in both the care plans and the staffs recording of their daily lives. The premises are generally clean and homely. They provide a comfortable environment for the people living there. People are able to personalise their rooms.Meadow ViewDS0000073242.V376125.R01.S.docVersion 5.2The service maintains and reviews all policies and procedures in a clear, tidy format that are easily accessed and readily available. Other required documents are also well stored and maintained. What has improved since the last inspection? This was a pre existing service that had been inspected before but re registered with a change of provider in February 2009. A programme of redecoration has taken place since the new provider took over and residents` bedrooms have been redecorated with the help of service users and new furniture purchased. Staff spoken with and the training records seen show that training takes place and staff are encouraged to undertake further qualifications. As a result of listening to people the manger and staff plan to increase trips out, and example of which would be to include all service users swimming weekly. Shopping trips are available with staff if the service user wishes. Freeview TV has been installed in service users` rooms that did not have it installed. The menus have been updated with varied cultural meals. A regular exercise activity has been introduced involves the use of a family dog for the service users to take for exercise, twice a week and provision for a third service user to attend a club in Holland on Sea every Tuesday. Additionally a holiday to Spain for all service users is planned for October 2009. What the care home could do better: Issues identified in care plans should be more person centred and indicate the assistance required to aid the person`s predominant needs such as physical and healthcare needs, and these should correlate with the daily evaluations to ensure all service users individual care needs are met and that staff are aware of these needs. Transcribed medications should evidence two signatures to ensure service users receive their correct medication. The manager should ensure that sufficient staff are on duty to meet the needs of service users and ensure staff are not working more that their contracted hours affording sufficient breaks so that residents can be cared for competently and safely. Staff recruitment procedures must include discussions where required about issues such as CRB checks for staff to ensure residents are protected. The quality of information provided to the Commission in the Annual Quality Assurance Assessment should support the understanding of how the service is complying with their responsibilities under the Care Standards Act 2000 andMeadow ViewDS0000073242.V376125.R01.S.docVersion 5.2include specific details on the steps they are taking in order to improve the outcomes for people living at the service. Key inspection report CARE HOME ADULTS 18-65 Meadow View 178 Meadow Way Jaywick Essex CO15 2SF Lead Inspector Helen Laker Key Unannounced Inspection 24th June 2009 10:30 Meadow View DS0000073242.V376125.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 View DS0000073242.V376125.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 View DS0000073242.V376125.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadow View Address 178 Meadow Way Jaywick Essex CO15 2SF 01255 431301 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) Shamrock Villas Nikki Faber Care Home 4 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (4) of places Meadow View DS0000073242.V376125.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories 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: Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is 4 2. Date of last inspection Not Applicable Brief Description of the Service: Meadowview is a newly registered care home providing support for up to four people with a diagnosis of mental disorder. The house is in a residential area of Jaywick Sands and in close proximity to local shops, a public house and the beach and back onto wide, open areas of meadowland. A local bus service provides access to the nearest town of Clacton on Sea, approximately 2 miles away, for local amenities such as day centres, local hospital, sports centre, swimming pool, library, colleges and the town centre for shopping. Information about the service is provided to prospective service users in the home’s Statement of Purpose. The current fees are £532.00 to £700.00 per week, all-inclusive. Inspection reports are available from the home and from the CQC website www.cqc.org.uk Meadow View DS0000073242.V376125.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 home is two star. This means that people who use this service experience good quality outcomes. This key unannounced inspection looking at the core standards for care of adults took place on a weekday between 10:00 and 16:00. The registered proprietor/manager was present throughout and assisted with the inspection process by supplying records and information. This report has been compiled using information available prior to the visit such as the annual quality assurance assessment (AQAA), which is required by law and is a selfassessment completed by the service, surveys sent out, as well as evidence found on the day of inspection. During the day the care plans and files for two of the residents were seen as well as two staff files, the policy folders, the medication administration records (MAR sheets), some maintenance records and the fire log. The manager also supplied a copy of the duty rotas, the menus, finance records of residents’ personal monies and minutes of meetings held between residents and staff. A tour of Meadowview was undertaken and three residents, one member of staff as well as the manager were spoken with. The home was clean and tidy offering homely accommodation to the residents. The residents seen were relaxed and clearly felt at home in the environment using all areas of the building. All the records and files were well maintained and easily accessible. Interactions between staff and residents were friendly and appropriate. What the service does well: The service aims to inform people considering moving into the home and to understand how they will need to be supported. The service offers individualised support to residents and encourages independence and the development of personal life skills in comfortable, homely surroundings. They complete care plans that set out instructions for staff in meeting people’s needs. There is a greater emphasis on the person as a whole in both the care plans and the staffs recording of their daily lives. The premises are generally clean and homely. They provide a comfortable environment for the people living there. People are able to personalise their rooms. Meadow View DS0000073242.V376125.R01.S.doc Version 5.2 Page 6 The service maintains and reviews all policies and procedures in a clear, tidy format that are easily accessed and readily available. Other required documents are also well stored and maintained. What has improved since the last inspection? What they could do better: Issues identified in care plans should be more person centred and indicate the assistance required to aid the person’s predominant needs such as physical and healthcare needs, and these should correlate with the daily evaluations to ensure all service users individual care needs are met and that staff are aware of these needs. Transcribed medications should evidence two signatures to ensure service users receive their correct medication. The manager should ensure that sufficient staff are on duty to meet the needs of service users and ensure staff are not working more that their contracted hours affording sufficient breaks so that residents can be cared for competently and safely. Staff recruitment procedures must include discussions where required about issues such as CRB checks for staff to ensure residents are protected. The quality of information provided to the Commission in the Annual Quality Assurance Assessment should support the understanding of how the service is complying with their responsibilities under the Care Standards Act 2000 and Meadow View DS0000073242.V376125.R01.S.doc Version 5.2 Page 7 include specific details on the steps they are taking in order to improve the outcomes for people living at the service. 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 View DS0000073242.V376125.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 View DS0000073242.V376125.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service will have an assessment of need undertaken prior to being offered a place to ensure the home can meet their needs and have a contract of terms and conditions drawn up for living there. EVIDENCE: The home’s statement of purpose and service users’ guide have been updated and both contained a lot of information about the service offered and the environment of the home and staff qualifications. This is readily available for review within the home or upon request. The admission policy was seen and offers prospective residents the opportunity to visit the home prior to moving in. There is the possibility of day care visits or a trial period. This was evidenced for a recent admission who was still visiting the home on graduated visits prior to permanent residency. Residents are encouraged to bring personal items of furniture, ornaments and pictures with them when they move in to use in their own rooms. Meadow View DS0000073242.V376125.R01.S.doc Version 5.2 Page 10 Two files were reviewed and each contained a comprehensive pre-admission assessment document that looked at areas of daily life the resident may need support with. The manager stated these have all been re formulated so they are much more detailed. Areas covered included mobility, personal hygiene, diet, continence and any health problems. They also assessed the resident’s comprehension, looked at social needs, their likes and dislikes, whether there was any substance dependency or if the resident was a smoker and any known allergies were recorded. The AQAA confirms “We get the necessary information needed for a new client from families, advocates , and others involved in their life ,enabling them to settle in well previously, to them moving in.” One service user spoken with confirmed they were welcomed at all visits and the process was a comfortable one and they would be happy to become a permanent resident. Meadow View DS0000073242.V376125.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, 9. Quality in this outcome area is good. People who use this service will have an individual plan of care devised so their needs can be met as they would choose, and they will be encouraged to make choices about their chosen lifestyle. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two care files seen contained a care plan assessment for daily activities and a care plan developed from the assessment. There was a heading for daily routine and night time routine as well as daily occupations and personal hygiene preferences. Other headings included orientation and social activities. The level of skills for managing daily tasks and occupations were recorded such as ‘can tidy room with help from staff’, ‘washes dishes and puts away’. Each file also had a section to record the final wishes of the resident. Meadow View DS0000073242.V376125.R01.S.doc Version 5.2 Page 12 The care plans reflected the individual’s ability and personal interests although there were some interventions that were common to both the files seen such as management of medication and specific medication protocols. Each intervention had a space to complete the ‘service user’s understanding’ (of the intervention), ‘the carer’s understanding’ and the ‘resource support’ needed to achieve the desired outcome. Although informative these were noted to become mixed up in some sections with the carers understanding of the situation being more of a description of the service users’ understanding. Also it was noted that identified needs included things such as ‘allotments’ and ‘clozaril clinics’, this was discussed with the staff and manager and the need to clearly identify needs rather than list an activity which would aid that need. Separate smaller ‘grab files have also been developed containing a condensed amount of relevant information which also fully details support needs and how these are to be met. It also contains a description of the person, night routines and personal choices. For example one detailed “Post is given to mother to avoid service user becoming stressed” and another “Walking is limited due to medical condition, needs encouragement to get involved but when they do they have a good time”. There was evidence of three monthly reviews taking place of the individual plans and signatures present for relatives and or service users. The AQAA states “Our care plans are reviewed regularly and are updated to reflect changing needs, with the guidance of the service users, their families and friends.” One resident has a keen interest in gardening and has an allotment and potting shed that the home had acquired for them. This service user was at their allotment on the day of inspection. Another resident has an interest in going to visit their family or socialising for example at a pub. There were risk assessments in place for some activities and areas of potential concern such as alcohol use, substance abuse and smoking. One resident spoken with, had been out to the doctors on the day of inspection and said they could go out metal detecting on the beach if they wished and they enjoyed sitting in the conservatory looking at the meadowland behind the house where there were a number of horses grazing and a lot of birds to watch. Meadow View DS0000073242.V376125.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, 17. Quality in this outcome area is good. People who use this service will have opportunities to be part of the local community and be able to maintain contact with their family and friends following a lifestyle they would individually choose. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The files seen all had recorded any particular interests of the residents. They noted that the residents enjoyed regular contact with different members of their family and went on outings and overnight stays with them. One resident was on holiday with their family at the time of this inspection. One resident has a keen interest in gardening and brings home produce they have grown on their allotment. It was recorded that they also enjoy books about plants and birds. Meadow View DS0000073242.V376125.R01.S.doc Version 5.2 Page 14 Two residents attend an evening club, called ‘The Buzby club’, for a disco every week. One resident spoken with who was sitting outside enjoying the sun and a cigarette said “I come and go as I please it is very relaxed and they are very good”. They also spoke of being excited that a holiday to Spain is being planned by the home for all of the residents to go on in October 2009. The AQAA states they have made the following changes as a result of listening to people “We have increased trips out. Staff are available to attend appointments with service users if necessary. We have updated the menus with varied cultural meals. Introduced regular exercise activity and the lone of a family dog for the service users to take for exercise, twice a week. Provision for a third service user to attend a club in Holland on Sea every Tuesday.” Residents are encouraged to help with the light daily domestic tasks and will help with washing up and preparing drinks and one helps with preparing vegetables. A risk assessment for them to use the main kitchen was not in place and this was discussed with the manager on the day of inspection who agreed to ensure one was put in place. The parent of one resident is involved with the staff to help develop daily living skills and encourage independence with tasks such as managing their own laundry. Another resident manages the tea rota and can prepare light snacks. A small kitchenette area is in the conservatory so residents can just help themselves. The AQAA states “Each of our service users has a personal activity plan to suit their own needs and abilities, which they design and create themselves.” And they plan to “continually be researching for newer activities to stimulate the service users” The menus were seen and showed that the main meal of the day is taken in the evening with a hot light snack at lunchtime. Residents are involved in menu planning, food preparation and shopping. The menus always offer a vegetarian option such as cauliflower cheese or Quorn and the main meal could be steak and mushroom pie, vegetable pie, a roast or spaghetti bolognaise. At lunchtime the snack could be sausages, quiche, cheese and onion slice, sandwiches or jacket potatoes. On the day of inspection the carer was preparing sandwiches followed by an individual choice of desert for the midday meal. Questionnaires have recently been sent out to residents as part of the homes audit procedures and some previously sent out by the service to residents and relatives in February 2008 had ticked ‘excellent’ for the food provided by the home. Records in the kitchen showed a cleaning regime that was followed during each shift so the cleanliness of the kitchen was maintained. There were stock control records completed for the rotation of dry stores to ensure they did not go over their ‘use by’ dates. The temperatures of refrigerators and the freezer were recorded to make sure they were functioning within safe limits for food storage. Meadow View DS0000073242.V376125.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, 20. Quality in this outcome area is good. People who use this service will have their health needs met and are protected by the home’s management of medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents’ files seen contained contact details of all the health professionals involved in their support such as the GP, dentist, optician, chiropodist, community psychiatric nurse (CPN) and the consultant psychiatrist. There were records of appointments with health professionals and out patient appointments. Two residents have a medication that requires close monitoring and there were records of regular blood tests that were taken and clinic appointments. There was evidence of health screening checks being made for gender specific conditions. Note was made of past health issues that could resurface such as alcohol and substance misuse and risk assessments were in place. As some medications can have an effect on weight residents were weighed regularly and there was a weight record in each file. Meadow View DS0000073242.V376125.R01.S.doc Version 5.2 Page 16 One new service user visited the doctor to obtain registration forms on the day of inspection. The medication policy was seen and contained full guidance on the management of medicines including ‘homely’ remedies and covert administration of medication. The home has also compiled a folder containing the information leaflet from the medicine boxes and other information from the Internet about all the medicines presently used in the home. This is a resource folder for use by staff or residents who wish to know more about the effects or side effects of a specific drug. The home has no controlled drugs (CDs) in stock at the present time. The medication administration records (MAR sheets) were inspected. The folder had an identification photograph of each resident attached to it and contained a specimen list of signatures of staff authorised to give out medication. No signature gaps were noted on the MAR sheets and there were ‘carry forward’ figures recorded allowing for an audit trail of medicines. It was however noted that MARS charts were handwritten and all transcribed medications did not have two signatures to evidence checking procedures. This was discussed as not being best practice and to ensure printed MARS charts are obtained ideally, with the manager on the day of inspection. The manager said all the staff had had training in the management and administration of medicines and this was confirmed in discussion with one staff member. It was noted that on a list of future training dates posted up on the notice board that a distance learning medication management course was one of the subjects that all staff were currently undertaking. Meadow View DS0000073242.V376125.R01.S.doc Version 5.2 Page 17 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, 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service will have their complaints taken seriously and be protected from abuse. EVIDENCE: There is a robust complaints policy that forms part of the service users guide. The complaints log has the appropriate documents required for making a record of a complaint and corresponds with the homes AQAA which details that the home has received three since the previous inspection. One resident spoken with said they had not made a complaint but were clear about how to go about it if they needed to. They said that staff are approachable and responsive. Complaints recorded were noted to have been dealt with sensitively and appropriately There is a policy giving staff guidance on the protection of vulnerable adults (POVA) based on the guidelines issued by the Essex POVA committee. The most recent guidance has been issued by the joint scheme between Social Care Services, the Police and CQC previously the CSCI and is called Safeguarding Adults. The manager is aware of the initiative and has undertaken training and all staff have completed appropriate POVA training courses. Staff spoken with showed they had a good awareness of safeguarding and protection procedures and whistle blowing. Meadow View DS0000073242.V376125.R01.S.doc Version 5.2 Page 18 Evidence was seen that all the present residents have their money paid directly into their bank accounts and no member of staff manages any of their financial affairs. If residents require help they have family members to guide them. Meadow View DS0000073242.V376125.R01.S.doc Version 5.2 Page 19 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, 30. Quality in this outcome area is good. People who use this service will benefit from living in a clean homely house that is well maintained. They can be assured that it is comfortable and suitable environment and will suit their need and lifestyle. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home was undertaken with the manager and everywhere looked clean and tidy. The furnishings and decoration were suitable for the client group and created a homely feel. The conservatory, which is also the designated smoking area for residents, has a lovely outlook over meadows and is bright. Following the change of legislation staff now smoke outside the building. Residents spoken with confirmed they had been involved in the choice of decoration for their rooms some of which had recently been redecorated and the AQAA states “All our service users have just been involved in the Meadow View DS0000073242.V376125.R01.S.doc Version 5.2 Page 20 redecoration of the hallway and lounge at Meadowview. Our home offers several different areas which offer different ambiences, for the comfort of our service users.” Meadowview is a detached, two storey house with a loft conversion that is situated in a quiet residential area of Jaywick and set back from the road. It benefits from local amenities and the proximity of Clacton on Sea, which is a larger town and has more attractions and facilities. The ground floor consists of an entrance hall, kitchen, laundry, lounge/diner, toilet and a large conservatory. The first floor has the three residents’ bedrooms, a bathroom and a separate shower room. The loft conversion, accessed by a set of very steep stairs, has an office and the sleep-in room with a toilet and shower for staff. The infection control policy was seen and gave full guidance on the prevention of cross infection. It included details of good hand-washing techniques, the use of protective clothing and the safe management of soiled linen. The toilets and bathrooms seen had liquid soap and paper towels available for hand washing. Staff spoken with were able to explain the procedure for the management of soiled linen and the use of the high temperature programmes on the washing machines. Meadow View DS0000073242.V376125.R01.S.doc Version 5.2 Page 21 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): 32, 33, 34, 35. Quality in this outcome area is good. People who use this service will be supported by suitably trained staff and can generally be sure that there is evidence that all recruitment checks are carried out before employment commences to protect them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rotas were seen and showed that for the four present residents there was always one member of staff on duty with the manager either on site or on call during waking hours and one member of staff sleeping-in over night. On occasions a second staff member did additional hours which overlapped shifts between 8.00am and 12.00pm. The early shift was from 8.45am to 14.00pm and overlapped the late shift that commenced at 12.00 until 21.00. It was noted that shifts were not uniform but set to suit staff and service users so variables of an hour difference were noted. For instance a sleep in member of staff may do an hour in the morning from 08.00am to 09.00am and recommence at 16:45pm to 22.00pm followed directly by a sleep in. Meadow View DS0000073242.V376125.R01.S.doc Version 5.2 Page 22 Another example showed one member of staff commencing an early on Thursday from 08.45 to 22.00 hours followed by a sleep in and another full shift on the Friday from 08.45am to 19.00 pm and a total of 50.75 hours weekly. This was discussed with the manager and the implications of staff working consecutive long hours for instance increases in tiredness, and plans in the event of sickness and annual leave. As some staff were working in excess of their contracted hours for example 57.5 hours a week, she agreed to review the rota and ensure all staff were aware of the working time directive. The AQAA states “We work well as a team, having regular staff meetings to discuss the concerns of the home.” One staff member spoken with stated “ Because of the client group am able to do the hours as it is not like working it is enjoyable being here”. Staff are responsible for the running of the home and all the domestic duties that that entails such as cooking, cleaning, shopping and laundry. They support residents to help with tasks as they chose to develop their life skills. All members of staff have either achieved or are enrolled to study an NVQ level 2 qualification or equivalent. Two staff are doing NVQ level three and two have already attained this. One person has NVQ level four and is working towards it and the manager is currently undertaking NVQ level five. Staff spoken with confirmed this. The home has recently recruited two new members of staff and the manager showed a good awareness of the home’s recruitment procedures. The staff files seen evidenced that checks on identity had been carried out as well as a criminal records bureau (CRB), photographic identification and references being taken up. One CRB check had warranted a discussion prior to employment, however there was no documentary evidence to confirm this had been done. A discussion was held with the manager regarding the importance of doing this to protect the residents ensuring staff were suitable for employment. There was documentary evidence of a skills for care induction programme being undertaken covering domestic tasks, daily care and health and safety issues including fire awareness. Other training records showed first aid, care planning, management of challenging behaviour, POVA and moving and handling were all areas that had been covered by courses. A training programme showing planned courses was on the notice board and showed the future sessions included health and safety, infection control, management of medication, record keeping, moving and handling, safeguarding adults and nutrition. A good training plan within the home will ensure that staff have the appropriate knowledge and skills required to meet service users needs Meadow View DS0000073242.V376125.R01.S.doc Version 5.2 Page 23 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, 42. Quality in this outcome area is good. People who use this service will live in a well managed home and have their opinions sought and their welfare protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The management structure of the home has changed since the last inspection. It is now under new ownership with Ms Nikki Faber as proprietor/manager since February 2009. She has nine years experience in care environments both as a carer and manager, and has worked for MENCAP previously. There was evidence during the day of the good working relationship that has been established between the staff members and the manager and also between the Meadow View DS0000073242.V376125.R01.S.doc Version 5.2 Page 24 manager, staff and the residents. Staff spoken with enjoyed working in the home and a resident said that they thought the staff were ‘kind and thoughtful’ and ‘always there if you need them it is very relaxed’. The home has a quality assurance system in place and surveys and questionnaires have just been given to residents and relatives in June 2009 The minutes of a meeting that took place in June 2009 between residents and staff were seen. They showed that a number of issues that concerned all people in the home were discussed including meal provision, smoking, activities, holidays, rewriting of menus and introduction of new service user. The home’s AQAA was submitted on time and was informative but would benefit from more detail in some areas to clarify the future development plans for the home. For example the AQAA identifies the home wishes to have a “better self monitoring system” but does not detail why or how. A book that recorded weekly health and safety checks that are carried out in the home showed that defects that were recorded such as two new windows which were cracked and had been replaced. External tradesmen are also employed to complete larger jobs. Maintenance certificates for the home were up to date and regular fire drills and fire equipment checks were recorded. Meadow View DS0000073242.V376125.R01.S.doc Version 5.2 Page 25 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 3 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 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 2 x x 3 x Version 5.2 Page 26 Meadow View DS0000073242.V376125.R01.S.doc Are there any outstanding requirements from the last inspection? Not Applicable 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 YA6 Good Practice Recommendations Issues identified in care plans should be more person centred and indicate the assistance required to aid the person’s predominant needs such as physical and healthcare needs, and these should correlate with the daily evaluations to ensure all service users individual care needs are met and that staff are aware of these needs. Transcribed medications should evidence two signatures to ensure service users receive their correct medication. Staff should be working within their own contracted hours affording sufficient breaks. The implications of staff working consecutive long hours for instance may impact on their performance and cause increases in tiredness, and sickness and this may mean that decreases in staff could affect residents being cared for competently and safely. Staff recruitment procedures should include and document discussion regarding issues such as CRB checks for staff to ensure residents are protected if a concern is apparent. The quality of information provided to the Commission in DS0000073242.V376125.R01.S.doc Version 5.2 Page 27 2 3 YA20 YA33 4 5 YA34 YA39 Meadow View the Annual Quality Assurance Assessment should support the understanding of how the service is complying with their responsibilities under the Care Standards Act 2000 and include specific details on the steps they are taking in order to improve the outcomes for people living at the service. Meadow View DS0000073242.V376125.R01.S.doc Version 5.2 Page 28 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.east@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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