Care Home: Meadowbank Care

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What the care home does well There is a relaxed and homely atmosphere. People say that the care workers are kind and attentive. They also say that they receive the support and assistance they need. People are helped to stay in good health. This includes keeping an eye on how everyone is and then calling doctors as soon as they are needed.People`s medicines are handled safely so that they take them in the right way at the right time Sensible things are done to help prevent people having accidents. People are served with good quality meals. What has improved since the last inspection? Some bedrooms have been redecorated. Some new items of bedroom furniture have been bought. More housekeeping hours have been provided in order to relieve care workers from some of their cleaning duties. Members of staff have done various training courses. What the care home could do better: The care plans have lots of useful information. However, this might make it difficult for some of the people who live in the Service to know what`s being written about them. One aspect of the health care support provided for one person needs to be more organised. This is so that we can be sure that this care will be provided in a consistent and reliable manner. CARE HOMES FOR OLDER PEOPLE Meadowbank Care 44 Braywick Road Maidenhead Berkshire SL6 1DA Lead Inspector Mark Hemmings Key Inspection 23rd December 2008 08:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadowbank Care Address 44 Braywick Road Maidenhead Berkshire SL6 1DA 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) 01628 781186 meadowbank.uk@btinternet.com Meadowbank Care Home Limited Mrs Caroline Li Mr James Li Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th January 2007 Brief Description of the Service: Up to 16 older can make their home in Meadowbank Care (the Service). The property is an older detached house. Its been extended over the years. At the moment another ground floor extension is being built and some alterations are being done in the main building. When the Service is full, one bedroom can be shared by two people. However, its only ever used as a single. In practice then, everyone has their own bedroom. All of the bedrooms have a private wash hand basin. Five of them also have their own shower and toilet. There is a passenger lift between the floors. There is also a call bell system. This has call points in each of the bathrooms and toilets as well as in all of the bedrooms. This means that people can ring for assistance. The Registered Provider is a private company. The Directors of the company also run the Service on a day to day basis. In this Report we refer to them as being the Managers. People who want to find out more about the Service and about the fees charged, can phone the Service and speak with the Managers. Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this Service is 2 Star. This means that the people who use this Service experience good quality outcomes. Since 1 April 2006, we have developed the way we do our inspection of care services. This inspection of the Service was Key Inspection. We arrived at the Service at about 9 oclock and we were there for about six hours. It was a thorough look at how well things are going. We took into account information provided by the Registered Provider in its self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). Further, we considered any information that we have received about the Service since the last inspection. During the inspection, we spoke with five of the people who live in the Service. We also spoke with the Managers and with the Team Leader. This latter person is a senior care worker who is in charge whenever the Managers arent around. We spoke with two of the care workers and with the cook. We walked around parts of the accommodation and we looked at a selection of key records and documents. Before we called to the Service, we asked ten of the people who live there and 10 members of staff to fill out a questionnaire for us. We wanted them to tell us what they think of Meadowbank Care. We got six questionnaires back from each group. What the service does well: There is a relaxed and homely atmosphere. People say that the care workers are kind and attentive. They also say that they receive the support and assistance they need. People are helped to stay in good health. This includes keeping an eye on how everyone is and then calling doctors as soon as they are needed. Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 6 Peoples medicines are handled safely so that they take them in the right way at the right time Sensible things are done to help prevent people having accidents. People are served with good quality meals. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this Service. We look at Standards 3 and 6. People who are thinking of moving in are asked about what support they need and how they want this to be done. People who want to stay for shorter periods will be helped to go back home. EVIDENCE: The Managers ask people who are thinking of moving in about what support they need and want. This is done so that everyone can be confident that moving into Meadowbank Care is the right thing for them. They also talk with family members and with people like care managers (social workers). All of Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 9 this is done so that they can build up a really good picture of how the person can best be supported. After they have got all of this information, they can then decide if Meadowbank Care can meet the persons needs for help. We looked at the information that has been collected for one person who has recently moved into the Service. We wanted to see what sorts of things were considered. There is lots of useful information. There is stuff about practical things such as the help needed in the bathroom. But there is also other information about quality of life things. Such as how the person needs to be supported to handle a recent bereavement. The Managers say that when they get the information they share it with care workers. This is done so that care workers know in advance about what support they will need to provide. We asked two care workers about how all of this works out in practice. They say that they are indeed told about people who are about to move in. They say that as a team they discuss how best to help the person in the first few days, while they get to know them better. The Managers recognise that moving into a residential care setting is a big step for anyone to take. They say that they want to do everything possible to put the persons mind at rest. We agree that this is really important. They say that as part of the assessment process people are invited whenever possible to visit Meadowbank Care. This is so that they can see what the place is like first hand. During these visits, people can ask any questions they want. There are also some written documents that say about the Service in quite a lot of detail. These are called the Service Users Guide and the Statement of Purpose. People can ask to see these if they want. The Managers are quite happy for them to take away a copy if they want to have a look at them at their leisure. We asked one person about their experience of moving in. They say that the care workers did know about the support they need from the start. They also say that they were made welcome and that this made a big difference for them. Nearly all of the people who move into the Service do so with the intention of making it their longer term home. However, there is the chance that someone will only want to stay for a shorter period. This might be so that someone who cares for them at home can have some time to themselves. Or, someone might move in because theyve been in hospital and arent quite ready to go home yet. When someone moves into a residential care setting theres always the risk that their stay might become longer than is necessary. The Managers are aware of this. They say that they will help people make any arrangements that are necessary for them to go home as planned. Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this Service. We looked at Standards 7, 8, 9 and 10. People are provided with the personal and health care they need. One particular arrangement needs to be strengthened. Some of the paperwork is complicated and not user friendly. Medicines are handled safely, but one improvement is needed. People are treated with kindness and respect. EVIDENCE: The people who live in the Service say that the care workers offer them all the assistance they need. There is a written individual plan of care for each person. These are important because they are one of the ways that people can say what assistance they want to have and how they want it to be done. Also, the plans give information to staff so that they know what to do. We looked at Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 11 three of these plans. They give a clear account of who needs to do what and why. For example, there is useful information about things such as helping people in the bathroom, about health care and about keeping people safe. In more detail, one person finds it difficult to organise words into sentences. This means that they need to be given plenty of time to say things and then their words need to be understood using other clues such as pointing. Another person needs to have things clearly explained to them. This is so that they know in advance how care workers are going to support them. We asked two care workers about some of these things. We wanted to know what all of this written information means in practice. Whether its used or not. They know all about it and we saw them using it in practice. For example, they are patient with the person who finds it hard to make sentences. They wait for them to finish what theyve got to say. Then they check out that they have understood them right. The plans are kept up to date so that they are accurate. This involves care workers making daily notes about how things are going. There are then monthly reviews. This is when the Team Leader checks out with the care workers how things are going and what might need to be changed. As weve already said the care plans are very detailed. While this is useful for members of staff it can make it difficult for the people who live in the Service to fully appreciate whats being said about them. The Managers recognise this to be an issue. Theyre going to continue to look into what can be done to make the parts of the plans more user friendly without loosing the detail that leads to good quality individualised care. Sensible steps are taken to ensure that people do not have any avoidable accidents. For example, some people are a bit unsteady on their feet. They are accompanied by a care worker so that they dont lose their balance. People are helped to keep healthy. Care workers keep a tactful eye open so that a doctor can be called if someone is becoming unwell. Since our last inspection, a number of people have seen their doctors, some on more than one occasion. There have also been visits by other professionals such as district nurses. We looked at some of the records about how quickly doctors are being called after the need for medical attention is first noted. Its being done straightaway. The Managers are active about this and they make sure that people get the medical attention they need. One person needs special support to manage a medical condition that requires them to take regular medication. They also need extra help if they become unwell. We looked in detail about how well all of this is organised. We think that things can be a bit clearer. For example, there needs to be more information about how to recognise when the person is becoming unwell. Also, there needs to be a more definite plan for when outside medical advice is to be Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 12 asked for. This information needs to be shared with the care workers so that they know all about it. The Managers are going to do this by 1 January 2009. Although people can do their own medication if they want to, none are doing it at the moment. Members of staff handle it for them. There is a system to check that the correct medicines are received from the chemist. Once in the Service, they are stored securely. There is a procedure for administering medicines and the Assessment says that all care workers know about it. Part of the procedure says about the need to double check that the right medicines are given to the right people at the right time. We saw a care worker following this bit of the procedure in the right way. There is a record that is completed on each occasion that a medicine is given. We examined three sets of these records. They are correctly completed. We looked at two medicines in more detail. This was done to see if the remaining stock matches what should be there. Again, we found things to be in order. Some people can have medicines as and when they are needed. We looked at one of these in particular. This is because its something that can be used to help someone to relax a bit when they are becoming anxious. Its very important that everyone is clear about when this sort of medicine is to be offered. Some care workers arent too clear about when to offer this medicine. We think that having a more organised approach to planning this will help them in this. The Managers are going to sort this out by 1 February 2009. We asked a number of people what they think of the care workers. They praise them saying that they are courteous and attentive. In our questionnaire we ask, do you receive the care and support you need? All of the people who replied say that they always do. We also ask, do the staff listen and act on what you say? Everyone says yes. When we were in the Service we talked with people a lot about this. They are very positive about the care workers. Two people summarised the general mood in their comments to us. They say, the staff are wonderful and helpful. I never feel a nuisance at all and theyre always so kind and I get on well with the staff who are always around whenever you need them. They never mind helping you even if theyre very busy, which they usually are. Care workers are relaxed and informal in how they are. Things are orderly without being too much so. When people want to use the bathroom, they are helped to leave the lounge without drawing attention to themselves. Then they are helped in the bathroom with the door closed so that they can have privacy. People are helped to wear neat and clean clothes so that they can present themselves how they want. They are given their post promptly. Also, they are helped to deal with it if something is difficult for them. People can use the phone if they want. Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this Service. We looked at Standards 12, 13, 14 and 15. There are some interesting things for people to do. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. EVIDENCE: The plan is that each weekday there is a social thing that people can do. There is also an outside entertainer who comes in every other week. We looked at the calendar that is used to plan the routine events. It says that they include things like bingo, soft ball and sing-alongs. There isnt an activities person. This means that the care workers have to fit in organising activities after Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 14 theyve finished everything else. We saw care workers being busy doing other things. Such as helping people to get dressed, supporting them in the bathroom and then serving lunch. We made a point of noting what people were doing when we were there. Most people for most of the time werent doing that much really. There was quite a lot of sitting around and not being engaged in things. There is a record that shows roughly what each person has chosen to do. We looked at the records for two people for several weeks. One person had taken part in seven social activities. However, the other person hadnt done that much. For a period of five days the records say that all they did was to sleep in their chair. We asked three people about what activities they do and we got different accounts. One person says, Im quite happy doing my puzzles and watching things in the lounge. However, the others say, theres not that much to do here really. You have to keep yourself occupied or your mind will go and I like talking to people. Theres not that much to do, we sit quite a lot. We asked these last two people when they when they last did a social thing that sticks in their mind. Neither can really recall one. The Assessment says that the Service, ensures that (peoples) expectations and preferences are satisfied (so that people) … have a choice of how they wish to spend their day. In line with this, we asked the Managers to take a fresh look at this subject. Since our inspection they have done this by speaking with each person to see what if any additional activities they would like to do. They say that at the moment no one has asked to do anything new. The Managers say that they will continue asking people about this so that they keep up to date with peoples changing wishes. People are helped to keep in touch with members of their families, if this is necessary and if this is what they want. Family members and friends are welcome to call to the Service at any reasonable time. The Managers keep in touch with family members so that they know how things are going. For example, if someone is not well or if they are admitted to hospital. The Managers dont get involved in handling peoples financial affairs. For example, running bank accounts or signing for things in someones name. Its a good idea not to get involved in this way. This is because it avoids conflicts of interests. These can sometimes lead to complicated misunderstandings about who has the right to do what. Instead, most people get help from members of their family. People say that they receive good quality meals and that they have enough to eat. They consider meal times to be a relaxed and pleasant affair. We were in the lounge while lunch was being served so we could see what was going on. The meal time was relaxed. People dined at their pace while chatting about the events of the day. One of the questions we ask in our questionnaire is, do you like the meals? Everyone says that they always do. One person summarises the general view when they say, the meals are really good and we always have more than plenty to. The meals are very good. There is a choice of dish Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 15 at each meal time. We looked at the records of the meals provided over a two day period. We wanted to see if different people are actually having different things. They are. We also looked at the variety of meals provided over a period of two or three days. There is a reasonable balance. The main lunchtime dishes include things like turkey casserole, macaroni cheese, shepherds pie and tuna salad. Care workers say that people can have drinks and snacks throughout the night. This is important. Otherwise, it can be a long time for some people between the late evening milky drink and breakfast the next day. Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this Service. Standards 16 and 18. There is a complaints procedure. Complaints are dealt with properly. People are safeguarded from being bullied or taken advantage of. EVIDENCE: We asked several people about making complaints. They say and show by their relaxed manner they would feel quite okay about raising a complaint should they need to. There is a written complaints procedure. This explains how to go about making a complaint or raising a concern about something. We looked at what complaints have been received by the Registered Provider since we were last in the Service. We wanted to see what sorts of issues have been raised and what has been done to sort them out. There hasnt been that much really. One person complained about a bedroom being too cool. But it then turned out that the window had been open to air the room. Another person wasnt happy about the early time they were being helped up in the morning in order to use the toilet and to take some medicine. The Managers say that this was the Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 17 result of a misunderstanding in that the person concerned had previously agreed to the arrangement. They say that since then the person in question has said that they are happy with the arrangement. We spoke with this person and they dont say that there is anything concerning them at the moment. Another complaint was from someone who wanted help first thing in the morning to use the toilet. They had to wait because the care workers were busy supporting someone else. In the end they couldnt hold on and understandably they were upset about this. The Managers say that they apologised to the person concerned and that it hasnt happened since. The person isnt living in the Service any longer and so we couldnt check this out with them. However, we do talk about early mornings later on in this Report. Its very important that people are confident that they are safe from being taken advantage of. For example, that theyre not going to be bullied or pushed around. The Assessment commits the Registered Provider to guarding against this. We asked some care workers about this matter. They know what to look out for. None of them have any concerns about how things are going. The people who live in the Service say and show us that they feel safe in Meadowbank Care. Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this Service. We looked at Standards 19, 22, 25 and 26. The accommodation is comfortable and pleasant. There is a modern fire safety system. The kitchen is well equipped. There is a suitable laundry. EVIDENCE: The accommodation is generally well decorated and furnished. There are a few areas where paintwork is chipped or where wall-coverings are scuffed. Nothing too much though and overall the place has a homely, lived-in feeling to it. On the outside, things are a bit upside down at the moment. This is because of the Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 19 building work. At the front, there is a large skip. The back garden has been badly churned up by machinery and there are piles of building materials here and there. The work is nearing completion and the Managers hope to start sorting the garden out in time for spring. The building is fitted with an automatic fire detection system. This provides a high level of fire safety protection. We understand that the fire brigade people say that the system meets the national standard. The Managers have a system of doing regular fire safety risk assessments. This is where someone goes around the place to check out that everything is still working in the right way. We looked at the records of the most recent one. It says that things are still okay. Its a good idea for the assessment to be sent to the local fire and rescue service. This is so that they can have a look at it to check that its detailed enough. The Managers are going to do this by 1 February 2009. The local Department of Environmental Health has called to look at the kitchen in the past few months. We looked at its report. It says that at the time of the inspection all areas of the kitchen and stores were found to be in a very satisfactory condition. There were some limited recommended developments. We checked out one of these. This was to do with the need to test the temperature of some hot foods to make sure that they are cooked through enough. This is now being done. We looked in the kitchen. Its well equipped, clean and well organised. The cook does sensible things to ensure good food hygiene. For example, once food is opened it is covered. Then a date is written on it to make sure that things are not allowed to hang around too long. He regularly checks the fridges and the freezers to make sure that they are cold enough. He knows about good food hygiene. For example, he knows about the importance of washing your hands before touching food. People who need it are helped to get about. In one of the bathrooms, there is a bath with a hoist. This means that there is a seat that goes up and down. You can sit on it outside the bath, then it can be raised to go over the side of the bath before its lowered once youre over the bath. There is also a walk-in shower and there is a bath with a seat that goes up and down. There is a mobile hoist that can be used in the bedrooms. This might be needed if someone cant manage at all to get out of bed. At key places there are assistance poles. These are fitted to the wall and they are there for people to hold onto for extra support. There are frames near to the toilets. People find these very helpful when they are getting down and getting back up again. There are other less obvious things to help people get about. For example, there are special belts that can be used to give people that extra bit of help they might need when getting up from a chair. Also, there are special sheets that can be used to help people change position in bed. Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 20 When someone moves into the Service, the Managers make a note of what assistance they need to get about. They look at things such as the help someone needs in the bedroom and in the bathroom. We asked care workers about this. They know what theyre doing. We saw one person being helped to sit in their armchair in the lounge. They were helped in a way that is right for them. The care workers used one of the special belts we mentioned above, to help them get seated. Then they arranged the persons cushions so that they were comfortable. We asked people how warm the accommodation is kept. They say that they are always comfortable even during the coldest weather. When we arrived in the Service the central heating was on and it was on when we left. The radiators are fitted with guards. This has been done to reduce the chance that someone will be burnt if they fall against them. The hot water taps that are used by the people who live in the Service are temperature controlled. This means that they wont get hot enough to scald someone. We tested a few taps and the temperature seems alright to us. The laundry has a commercial grade washing machine. This has an extra cycle for items that need an especially hot wash. There is a large dryer. The local water supply company says that the plumbing complies with new water purity regulations. This means that used water cant leak back from the washing machine into the main cold water supply. The Team Leader says that everyones clothes are marked so that theres less chance of them getting lost or mixed up with other peoples things. This is very important because its a really basic thing to wear only your own clothes. We asked people about this. They say that they do nearly always get their own clothes back from the laundry. Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this Service. Standards 27, 28, 29 and 30. There are enough care workers around. Care workers know what theyre doing. Security checks are completed on new members of staff. EVIDENCE: There are at least two care workers on duty from early in the morning until later in the evening when the night care workers start. During the day, there is also the Team Leader on duty and/or the Managers. They do some care work, but inevitably they will get called away to do other things as well. In our questionnaires we ask members of staff, are there enough staff to meet the individual needs of all the people who use the Service? Five of the six replies say yes and one says usually. In more detail, one person says, its very busy early on you know and we have to run around. Another says, its too much in the morning really because we cant get around to everyone when they need us. So sometimes people do have to wait a bit. Ideally, we need another Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 22 person on duty in the morning. We asked four of the people who live in the Service about the early mornings. Two didnt say much. One of the others says, the girls are too busy first thing in the morning because theres so much for them to do. I dont ring at all because its not fair on them. Some days are busier than others but in general theyre rushing around in the morning up to about breakfast time. Another says, the staff are excellent but theyve only got one pair of hands and things are a bit hectic first thing. If you have to wait, then its in the early morning. Its not everyday but some days. It depends. We asked the Managers to look into this in more detail. They have now done this. As a result, they have increased the number of staff who are on duty first thing. During the day there are other members of staff around. For example, there is the cook and there is a housekeeper. Its very important that only honest and trustworthy people are employed as care workers. With this in mind, the Managers complete a number of security checks on new care workers. These include things such as confirming their identity and doing a police check. We looked at the records for one care worker who has been appointed since our last inspection. The required checks have been completed. New care workers have introductory training before they work on their own. We asked two care workers about their introductory training. They say that it was very useful. They say that they were introduced to the people who live in the Service and that they were told about each person’s needs for support. Also, they were told about important things. For example, the individual plans of support and how to go about things such as helping people get about safely. This initial training is just to get them started. Theres a lot to learn after that. The Managers say that all care workers are expected to do regular training in important subjects. For example, in how to safely support people move about, in food hygiene and in basic first aid. Some of this training is done in-house and some involves care workers going away to more formal courses. We looked at the records of the courses that two people have done. One of them has done a lot of courses. However, there were no records at all for the other person. The Managers werent sure what had happened to the records in question. The Managers say that since our inspection they have reviewed the training that each care worker has done. They have told us that there are no gaps in that everyone has done the training courses that are intended for them. The Managers say that nearly all of the care workers have completed a National Vocational Qualification (NVQ) at Level 2 or 3 in health and personal care. This qualification is a very good idea. This is because it helps care workers to deliver high quality residential care services. Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 23 We spoke with two care workers to find out what they know about particular bits of the support they will need to give people. They know a lot about how each of the people who live in the Service like to be supported. For example, they know about helping older people to take care of their skin. They also know about how to respectfully help people who need assistance to manage their continence. Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this Service. Standards 31, 33, 35 and 38. In general things are well managed. People are asked what they think. People are helped to buy what they want. There are sensible health and safety things. EVIDENCE: The Managers are in the Service on most days. Between them, they have a detailed knowledge of how things are going. When they are not around the Team Leader is in charge. Both of the Managers have the equivalent of the Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 25 formal qualifications that are required for people managing residential care settings. These are important. This is because they are designed to help managers ensure that high quality support is reliably provided. The care workers say that there is good team work between them. There are handover meetings at the beginning and end of each shift. These are held so that care workers can be kept up to date with developments. There are team meetings every month or so. We looked at the records of the sorts of things that are being discussed. Theyre practical and relevant. For example, how to correctly complete the medication administration records that we spoke about earlier. The Managers say that once a year, peoples relatives are asked to complete a questionnaire to say how they think things are going in the Service. They say that in the most recent ones relatives are saying positive things about the Service. The results of this exercise are not yet available for us to see. Therefore, we cant confirm this for you. Its really important that the people who live in the Service have their say on how things are going. After all, theyre the experts because they live there. There are house meetings every couple of months or so. Everyone who lives in the Service can go along to them, but not everyone wants to. The people who do go, can talk about anything they want to do with their home. We looked at the records of the last two meetings. These show that in general people are quite happy with Meadowbank Care. The Assessment says that people who live in the Service are regularly asked what they think about their home as part of everyday life. This sort of informal thing is very important. The Managers and the Team Leader help some of the people to buy what they want. For example, they pay for them if they want to see the hairdresser. They then add up what has been spent and send a bill once a month to the relatives. Each person and their relatives have agreed to this in advance. The arrangement seems to be working okay. We looked at the records for one person. We wanted to see if the amounts claimed to have been spent are reasonable. They are. We also wanted to see if the purchases are supported by a receipt to prove that the money in question has been spent. Again, we found things to be in order. Regular checks are completed to ensure that the Service’s fire safety equipment remains in good working order. This includes a weekly test of the fire alarm bells. More detailed checks are completed every now and then by an engineer. There are regular fire drills. In addition to this, there should be a system to double check that each member of staff knows how to follow the Services fire safety procedure. This training is more detailed than the things that are done in a fire drill. Also, not everyone will attend a fire drill because Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 26 theyre unannounced and so you cant rely on the drills to include all members of staff. At the time of our inspection there was some uncertainty about when the last fire safety training was done. Since then, the Managers say that they have looked in to the matter. They have told us that all members of staff will receive updated fire training by early March this year. There are up to date reports from engineers about the gas appliances, the mobile hoist and the lift. They say that everything is in good working order. When we were in the Service we couldnt find a current engineers report for the electrical wiring installation. This is important because we need to know that its safe to use. The Managers have now assured us that the necessary report has been found and that it shows the electrical wiring to be in good order. We looked at the record of accidents that have occurred in the Service since the last inspection. There hasnt been that many. Most have been minor bumps and bruises. The Managers keep an eye on who has had an accident and what has happened. This is done so that they can do something if there is a particular problem that is causing the accidents. We dont think that theres anything obvious that needs to be sorted out at the moment. Each month or so the Managers do a review of the building. This is done to see if there are any hazards that might cause someone to have an accident. We looked at the records of the most recent of these reviews. They show that the Managers are looking at sensible things such as are all areas well lit and are fire escape routes clear? The Managers say that they havent found any obvious hazards around the place. We kept our eyes open when we were walking around. We didnt notice any particular hazards. Things such as bleach are stored safely when they are not being used. This is done because some people might mistake this for something you can drink or something you dont need to be careful with. Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 3 X 3 X X 2 Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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. Refer to Standard Good Practice Recommendations Meadowbank Care DS0000011310.V373604.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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