Care Home: Meadowbank Nursing Home

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What the care home does well The home had thoroughly assessed people`s needs before they were admitted to Sabrina House so that the staff team were confident that they could deliver the care and support required by each individual wanting to move in to this unit. The plans of care varied in quality. Two were very detailed, giving staff clear guidance about how the assessed needs of individuals could be best met and how challenging behaviour could be minimised within a risk management framework. Care plans were being followed in day to day practice to ensure that people`s needs were being met, supported by a variety of external professionals so that health care needs were also addressed. Sabrina House was quiet, calm and relaxed with some residents receiving one to one activities, therefore enjoying some quality time with staff who were sitting with people and chatting with them about daily events and things that interested them. Records showed and staff spoken to confirmed that they had received appropriatetraining in relation to challenging behaviour and how to deal with volatile situations. Staff were able to talk about the needs of people whose care we tracked and were very knowledgeable about the care and support required by each individual. Relatives spoken with remarked about the excellent communication by staff and how they had been involved in care planning process and reviews. It was pleasing to see that staff had evidently developed a good rapport with the people in their care and their relatives. At the time of our visit Beech House was clean, hygienic and pleasant smelling, providing a comfortable and homely environment for people to live in. The people living on this unit looked well cared for, being appropriately dressed with clean clothing and smart hair styles. We spoke to several staff whose first language was not English. However, these people were able to converse clearly in the English language and could respond fluently to any questions asked. All staff on duty at the time of our visit to Beech House were presentable in clean uniforms and footwear. There was no evidence of staff looking unkempt. The health and safety of people living on Beech House was protected by not allowing them access to the satellite kitchen where a hot water geezer is installed. This area was only accessible by a coded key pad and the door was closed at all times during our visit. What the care home could do better: The plans of care did not consistently reflect some changes in people`s assessed needs in accordance with the care plan reviews, therefore staff were not always given up to date information about people`s current needs. The care records for some people whose care we tracked on occasions provided conflicting information, which could be confusing for staff and which could potentially result in the wrong care being delivered or care not being provided at all. The plans of care could have included all the information about people`s care needs as described by staff spoken with to ensure that staff were provided with clear and detailed information about how they could exactly meet everyone`s assessed needs. The care plan for one person who was prescribed as and when required medication for his aggressive behaviour could have provided guidance for staff as to what point on the pathway of escalation of aggression this should be administered. It was concerning to note that despite the number of incidents reported in relation to this person there was no risk management plan in place in relation to his aggressive outbursts to ensure consistency and the use of appropriate techniques. Care staff could be given the opportunity to be involved in planning the care of the people they support, so that they have more responsibility, which would aid in developing even stronger links with the people living at the home and their relatives. The records for one person living on Sabrina House showed that he lacked capacity to make decisions and so staff needed to act on his behalf, but it was not clear who had made this judgement or how the decision had been made. We considered that this resident should be assessed by a Deprivation Of Liberty Safeguards representative toensure that he was not being deprived of his liberty to make decisions for himself. The recently appointed manager of Meadowbank confirmed that she would seek further advice and address this issue appropriately. Random inspection report Care homes for older people Name: Address: Meadowbank Nursing Home Meadow Lane Clayton Green Bamber Bridge Lancashire PR5 8LN three star excellent service 11/06/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Vivienne Morris Date: 2 7 0 1 2 0 1 0 Information about the care home Name of care home: Address: Meadowbank Nursing Home Meadow Lane Clayton Green Bamber Bridge Lancashire PR5 8LN 01772626363 01772698044 askinsh@bupa.com www.bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : BUPA Care Homes (CFHCare) Ltd care home 120 Number of places (if applicable): Under 65 Over 65 0 0 dementia old age, not falling within any other category Conditions of registration: 0 0 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is: 120 Date of last inspection Brief description of the care home Meadowbank Nursing Home is situated in Bamber Bridge close to the motorway network, easily accessible by road and public transport. The home provides care for up to 120 persons within four 30-bedded single storey houses, set amongst wellestablished, landscaped gardens. Enclosed sensory gardens are also available. Care is Care Homes for Older People Page 2 of 12 Brief description of the care home provided for older people and persons requiring care associated with a diagnosis of dementia. All private accommodation is in single, fully furnished bedrooms. Although there are no en-suite facilities provided, toilets and bathing facilities are conveniently located throughout each unit. Each house has pleasantly decorated spacious lounges and dining areas, although service users are able to dine within their private accommodation, if they so wish. The laundry services and kitchen facilities are centrally located within the administration block and main reception area. The scale of charges as at 27th January 2010 ranged from £335.50 to £770.00 per week. Additional charges were incurred for hairdressing, chiropody, holistic therapies, magazines and newspapers. The service users guide contains detailed information about life at Meadowbank and is provided to prospective residents to assist them in making an informed choice about where to live. The quality rating for this service is three star, which means that people who us this service experience excellent quality outcomes. Care Homes for Older People Page 3 of 12 What we found: We tracked the care of four people living on Sabrina House who we had identified from information received from the home as being involved in numerous altercations with other residents. The needs of all four people had been thoroughly assessed before they were admitted to Sabrina House to ensure that the staff team could deliver the care and support required. Plans of care examined told staff how aggressive episodes of individuals should be managed and what they needed to do in the event of challenging behaviour to ensure that any risks to people were minimised. Staff spoken to were able to tell us the techniques used for calming volatile situations so that people were protected from harm. We spoke with three staff members who were all very knowledgeable about the support required by the people whose care we tracked. They explained to us in plain English exactly how they supported people to meet their individual needs, but this was not always as clear or as detailed within the plans of care. The care records for one person who had difficulty with communication did not incorporate a care plan specific for preferred methods of communicating, such as the use of monosyllables and what these mean to him, pointing or using gestures. The care records did not give a clear picture about how this individual could be supported to make decisions and what kind of decisions he makes when he has the capacity to choose. There were no details in his care records of his preferences and neither was the information told to us by care staff about what he was able to do, what he liked or disliked. We were told that this resident was receiving one to one supervision at certain times of the day, but again this was not incorporated in to the care planning process and records did not clarify if the plan of care was effective or not. One care worker told us that she had a good relationship with one of the people whose care we tracked and his wife and had lots of information about him but never had the opportunity to write this down. We understood that care staff do not routinely have the opportunity to be involved in the care planning process by making entries within the plans of care themselves. This was discussed with some care staff during our visit who said that they would welcome the opportunity to be more involved, which would give them added responsibility and maintain their interest and motivation. However, if this is considered then training would be needed and the process would need to be overseen by qualified nurses to ensure consistency. Records showed that staff had received training in relation to aggressive and challenging behaviour, including de-escalation techniques and safe holds to ensure they knew what to do in the event of any volatile situation. A variety of assessments were in place within a risk management framework to ensure that any potential harm had been identified and minimised as far as possible so that people living on Sabrina House were kept safe. At the time of our visit Sabrina House was quiet, calm and relaxed and it was evident that those living there had a good rapport with staff. We noted some one to one activities taking place and we were able to talk to two relatives who were visiting individuals living Care Homes for Older People Page 4 of 12 on Sabrina House. They told us that they were very happy with the care and support provided for their relatives and that there was extremely good communication with the staff. They both confirmed that they were involved in the care planning process and that they met with staff regularly to review the contents of the plan of care. We noted that there was a good ratio of residents to staff to ensure enough support was being offered and it was pleasing to see staff spending quality time with residents in the communal areas of the unit, sitting with them and chatting about every day events and things that interested the individual. The plans of care varied in quality, although in general they were sufficiently detailed. However, they did not consistently co-incide with the monthly reviews and on occasions provided some conflicting information for staff. One example of this was that the care plan for one person stated, unable to communicate effectively due to CVA. However, the care plan review of the 10th December 2009 stated, Resident continues to communicate well. Although the monthly reviews showed that any changes in needs were reflected well, the plans of care should also reflect the changes as these are a working document for staff to follow. Two plans of care seen were very detailed showing how staff needed to manage aggressive behaviour, including what triggers they needed to be aware of that indicated escalating aggressive behaviour. The guidance advised staff how to diffuse incidents, so that people living on Sabrina House were protected. The care records of one person living on Sabrina House stated, Due to lack of capacity staff have to act in the residents best interests, even if he refuses or becomes resistive and Resident cannot make decisions for his own best interests. We were unable to determine who had made these decisions on behalf of this individual, but later established that an external assessment had not been requested to ensure that this person was not being deprived of his liberty. We discussed this with the new manager of the home, who took our comments on board and told us that she will take appropriate legal advise and will act accordingly. Records throughout showed that one resident responded better to male staff and preferred male staff to attend to his needs. We established that his key worker was a male carer, which was good practice and showed that this persons preferences were being followed in day to day practice. We visited Beech House during our random inspection to this service. This was because we had recently received some information about this unit, in which the contact raised a variety of concerns about Beech House. The information was passed back to the provider to investigate using the homes complaints procedure and a detailed report had subsequently been forwarded to us. The concerns raised and our findings were as follows: 1. The unit stunk, the carpets were sticky and there was a lump of faeces on a chair. We toured Beech house viewing a random selection of private accommodation and all communal areas. At the time of our visit there were no unpleasant smells evident, no sticky areas of flooring noted and no evidence of excrement in any of the areas we saw. We spoke with one of the domestic staff who was thoroughly cleaning the unit. We established that there were 80 hours of domestic input on Beech House alone per week, which we considered sufficient to maintain good hygiene standards within this unit. 2. Residents were inappropriately dressed. At the time of our visit there were 24 people Care Homes for Older People Page 5 of 12 living at Beech House whose care needs were associated with a dementia related illness. We were told that one person living at Beech House required one to one supervision. The staff rota showed that there were seven staff on duty during the morning period and six in the afternoon and evening, which provided a good ratio of residents to staff. We spent some time in the lounge area of Beech House observing how people were presented and found that residents looked well cared for and were wearing appropriate clothing, with neat hair styles and clean clothes. 3. One staff members English was poor. During our visit we spoke with two overseas staff who were both able to converse well in the English language. They were both easily understood and responded fluently to any questions asked. 4.Residents were walking in and out of the satellite kitchen on Beech House where there was a hot water geezer installed. We viewed this kitchen and found that the door was operated by a coded key pad. The door did not remain in the open position at any time during our visit and it was constantly inaccessible by people who did not have the code to access this area. The satellite kitchen was adjacent to the lounge and we noted that a number of staff were available in this area at all times to ensure the safety of people living at Beech House. Staff we spoke to told us that there were enough staff on duty to maintain close observation and to sit and spend time with the people in their care. 5. Staff looked unkempt with dirty uniforms. We observed staff going about their daily duties on Beech House and spoke with a number of them. At the time of our visit staff on duty were well presented with clean uniforms. 6. Poor care planning. At the time of our visit to Beech House we did not assess the care planning process because the provider informed us in the homes response to the information received that the contact did not at any time view any plans of care or request to see them, but gained information required from staff working on Beech House at the time. Therefore on this occasion we found that regulations had been met. What the care home does well: The home had thoroughly assessed peoples needs before they were admitted to Sabrina House so that the staff team were confident that they could deliver the care and support required by each individual wanting to move in to this unit. The plans of care varied in quality. Two were very detailed, giving staff clear guidance about how the assessed needs of individuals could be best met and how challenging behaviour could be minimised within a risk management framework. Care plans were being followed in day to day practice to ensure that peoples needs were being met, supported by a variety of external professionals so that health care needs were also addressed. Sabrina House was quiet, calm and relaxed with some residents receiving one to one activities, therefore enjoying some quality time with staff who were sitting with people and chatting with them about daily events and things that interested them. Records showed and staff spoken to confirmed that they had received appropriate Care Homes for Older People Page 6 of 12 training in relation to challenging behaviour and how to deal with volatile situations. Staff were able to talk about the needs of people whose care we tracked and were very knowledgeable about the care and support required by each individual. Relatives spoken with remarked about the excellent communication by staff and how they had been involved in care planning process and reviews. It was pleasing to see that staff had evidently developed a good rapport with the people in their care and their relatives. At the time of our visit Beech House was clean, hygienic and pleasant smelling, providing a comfortable and homely environment for people to live in. The people living on this unit looked well cared for, being appropriately dressed with clean clothing and smart hair styles. We spoke to several staff whose first language was not English. However, these people were able to converse clearly in the English language and could respond fluently to any questions asked. All staff on duty at the time of our visit to Beech House were presentable in clean uniforms and footwear. There was no evidence of staff looking unkempt. The health and safety of people living on Beech House was protected by not allowing them access to the satellite kitchen where a hot water geezer is installed. This area was only accessible by a coded key pad and the door was closed at all times during our visit. What they could do better: The plans of care did not consistently reflect some changes in peoples assessed needs in accordance with the care plan reviews, therefore staff were not always given up to date information about peoples current needs. The care records for some people whose care we tracked on occasions provided conflicting information, which could be confusing for staff and which could potentially result in the wrong care being delivered or care not being provided at all. The plans of care could have included all the information about peoples care needs as described by staff spoken with to ensure that staff were provided with clear and detailed information about how they could exactly meet everyones assessed needs. The care plan for one person who was prescribed as and when required medication for his aggressive behaviour could have provided guidance for staff as to what point on the pathway of escalation of aggression this should be administered. It was concerning to note that despite the number of incidents reported in relation to this person there was no risk management plan in place in relation to his aggressive outbursts to ensure consistency and the use of appropriate techniques. Care staff could be given the opportunity to be involved in planning the care of the people they support, so that they have more responsibility, which would aid in developing even stronger links with the people living at the home and their relatives. The records for one person living on Sabrina House showed that he lacked capacity to make decisions and so staff needed to act on his behalf, but it was not clear who had made this judgement or how the decision had been made. We considered that this resident should be assessed by a Deprivation Of Liberty Safeguards representative to Care Homes for Older People Page 7 of 12 ensure that he was not being deprived of his liberty to make decisions for himself. The recently appointed manager of Meadowbank confirmed that she would seek further advice and address this issue appropriately. 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 set out on page 2. Care Homes for Older People Page 8 of 12 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 12 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Plans of care must include all 08/03/2010 assessed needs and must provide details of how these needs in respect of health and welfare are to be met. This must be done so that people living at the home receive the care and support they need. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The plans of care should not provide any conflicting information and should always reflect changes in peoples assessed needs in accordance with the care plan reviews. This would ensure that staff are given clear and up to date information about the care and support required by each person living on Sabrina House. The plans of care could have included all the information about peoples care needs, as described by staff spoken to, so that clear and detailed guidance about how everyones assessed needs could be accurately met was provided. The plans of care should provide staff with guidelines about Page 10 of 12 2 7 3 9 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations the point at which as and when required medications should be administered. 4 18 When a person living at the home is thought to lack the capacity to make their own decisions and informed choices then a Deprivation Of Liberty Safeguard referral should be made so that an independent person can assess if the person is being deprived of their liberty. Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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