Care Home: Meadowcroft

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What the care home does well The home provides care in a well maintained, pleasant, spacious and welcoming environment by a well managed, supported, motivated, well-trained and qualified staff team who work as a closely coordinated team in a manner that recognises resident`s need for personal privacy, dignity and independence. Additional support is also available through good reliable external health care staff from a variety of services and resources. What has improved since the last inspection? Following the drawing up of a detailed action plan, all previous requirements relating to, risk assessments, the deployment of staff, care plans, guidance to staff and the provision of a quality monitoring system that seeks the views of residents have been complied with. A further action plan has been developed to ensure progress continues. What the care home could do better: To ensure that residents can exercise choice in what they eat the menus should be displayed in a format that all residents can understand, and any choices made should not be compromised by the absence of a cook. The current quality monitoring system should be expanded to include all residents` relatives, representatives and visiting health and social care professionals. CARE HOME ADULTS 18-65 Meadowcroft Whitchurch Close Aldershot Hampshire GU11 3RU Lead Inspector Peter J McNeillie Unannounced Inspection 12th November 2007 09:00 Meadowcroft DS0000040579.V349422.R01.S.doc Version 5.2 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 Meadowcroft DS0000040579.V349422.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 Adults 18-65. 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. Meadowcroft DS0000040579.V349422.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadowcroft Address Whitchurch Close Aldershot Hampshire GU11 3RU 01252 313470 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) Hampshire County Council Mr Peter Bedser Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Meadowcroft DS0000040579.V349422.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1. The home can accommodate one service user in the bungalow with the date of birth 07/02/1973. 7th December 2006 Date of last inspection Brief Description of the Service: Meadowcroft is a care home owned and managed by Hampshire County Council registered to providing care and support for up to eleven adults with a learning disability. Seven of the places available have been designated to provide a six to eight week assessment prior to a permanent place being found and the remaining three places for short term respite care. Accommodation is provided in single rooms in a large purpose built building close to local amenities and public transport to Aldershot town centre approximately a mile distance. Current residents contributions to fees are from £4.98 to £7.48 per night. Meadowcroft DS0000040579.V349422.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report was written after taking into consideration a number of sources of information and evidence including a site visit to the premises, previous reports, examining residents and staff training records, talking with residents, staff and management, responses by the manager to a pre inspection Annual Quality Assurance Assessment. (AQAA) and the results of in house satisfaction questionnaires completed by residents and residents representatives. During this inspection which took place on 14/11/07 between the hours of 9.00 am and 1.45pm and was the first inspection for the year 2007/08. All of the designated key standards for younger adults and all previous requirements were inspected. As a result of this visit no requirements or recommendations have been made. The results and findings contained in this report will determine the frequency and type of future inspections. What the service does well: What has improved since the last inspection? What they could do better: To ensure that residents can exercise choice in what they eat the menus should be displayed in a format that all residents can understand, and any choices made should not be compromised by the absence of a cook. The current quality monitoring system should be expanded to include all residents’ relatives, representatives and visiting health and social care professionals. Meadowcroft DS0000040579.V349422.R01.S.doc Version 5.2 Page 6 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. Meadowcroft DS0000040579.V349422.R01.S.doc Version 5.2 Page 7 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 Meadowcroft DS0000040579.V349422.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a system of assessing and identifying residents needs which ensures residents safety and that their assessed needs can be met in compliance with a previous requirement. EVIDENCE: Following the last inspection a requirement was made that “The registered manager must ensure that when admissions are made to the home sufficient numbers of staff are on duty. A sample of three residents records and pre admission assessments of need and risk were viewed. All of the records viewed confirmed that potential residents are only admitted in accordance with their admissions policy and procedure; following an initial referral and receipt of a care management assessment a second in house assessment of any potential residents needs and any risks is carried out by the manager or another member of the homes management team. All of the assessments viewed included an acknowledgement that the resident or their representative and contributed to the assessment procedure. Meadowcroft DS0000040579.V349422.R01.S.doc Version 5.2 Page 9 In addition to the above assessments of needs and risk we viewed a further assessment, which employs a pre, determined formula to establish a “support score”. This score indicates if additional staff are required to enhance the core staff levels to meet the assessed persons needs. Should additional staff be required we were informed no admission would take place until additional funding had been agreed to pay for the enhanced staffing levels. To allow any potential residents to settle in to their new surroundings, the home also has introduced a procedure that ensures there is a minimum of seven days between admissions. We were satisfied the previous requirement has been complied with. Meadowcroft DS0000040579.V349422.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a system of assessing and identifying residents needs which ensures residents safety and that their assessed needs can be met. EVIDENCE: Following the last inspection the following requirements were made 1) ” The registered manager must ensure that up to date, person centred and fully completed care plans are devised with service users and implemented. And 2)” The registered manager must ensure that risk assessments are completed where necessary such as for challenging behaviour and guidance in place for staff to minimise risks”. A selection of three residents care plans were viewed all had been produced in a written and alternative format such as pictures and symbols to assist residents understanding. All plans are reviewed at least monthly and were based on an initial assessment of needs and risk and took into consideration, resident’s wishes, choices and aspirations. Meadowcroft DS0000040579.V349422.R01.S.doc Version 5.2 Page 11 The home believes the right of residents to take risks is seen as fundamental, however it was clear from records, observations and talking to some residents they would have difficulty in totally understanding the concept of risk and risk taking. Consequently should restrictions be indicated to keep the resident safe by a risk assessment these are reflected in the care plan. Staff spoken with had a good understanding of the contents of the care plans and risk assessments and was able to explain how the care plan was put into day-to-day practice. Staff understanding was also helped by the availability of a single sheet summary of the key parts of the plan. From the evidence viewed and comments by management, care staff and residents, we were satisfied the previous requirements had been complied with. In discussion with residents, they indicated verbally that they were very happy living in the home and liked the staff who treated them with respect and observed their right to privacy e.g. by always knocking on bedroom doors and waiting to be invited in, a practice we observed. Meadowcroft DS0000040579.V349422.R01.S.doc Version 5.2 Page 12 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): 12,13,15,16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The social activities family contacts and the provision of varied and nutritious meals were well managed and reflected residents interests and choices. EVIDENCE: Following the last inspection a requirement was made that: The registered manager must ensure that all individual service users social recreational needs are assessed and staff are provided to meet those needs. To ensure that this requirement was complied with, as part of an action plan the home carried out the following. 1) Initial assessment forms were amended to include recreational needs; this information was fed into the care planning process. 2) A questionnaire was sent to all service users to ascertain what their wishes were. Meadowcroft DS0000040579.V349422.R01.S.doc Version 5.2 Page 13 3) Money has been set-aside in the budget for the purchase of a vehicle. Residents said they were happy with the social and recreational opportunities available, which currently include, shopping, bowling, swimming, and visits to pubs, restaurants, garden centres and cinemas. In house pool, table tennis, basketball (including those in a wheelchair), craft, television and, music, are also available in house. When residents are admitted from the local area, any existing programmes involving day centres are maintained. Where distance precludes the continuation of a programme for persons outside of the area as part of the initial assessment, the home would in consultation with the service user replicate as near as possible the previously agreed programme. Residents confirmed they were fully consulted and were able to exercise choice in all aspects of their lives for example; when to get up and go to bed, mealtimes and where meals are taken, visiting times, the right to receive and converse with visitors and to make and receive telephone calls in private. From the evidence viewed and comments received we are satisfied the previous requirement has been complied with. A written daily menu based on resident’s likes and dislikes was displayed. The manager informed us that he was aware that the menu was displayed in format that all residents may not fully understand and as part of work currently in progress will be converting the written text into a pictorial format. The homes staff and management recognised that alternatives to a written menu is of importance for some residents with a learning disability who may find the addition of pictures would be beneficial to their understanding and assist in them making meaningful choices. Staff and residents confirmed mealtimes are flexible to fit in with resident’s programmes, appointments and activities. We joined the residents and staff for their lunchtime meal and witnessed residents making a choice and in some instances preparing their own food. Residents indicated they liked the food and always had a choice. Tea, coffee, soft drinks and water were available at all times. Meadowcroft DS0000040579.V349422.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This judgement has been made using available evidence including a visit to this service. Satisfactory arrangements are in place, ensuring the personal emotional, health care and medication needs of residents are met. EVIDENCE: Details of all residents support needs are recorded in individual care plans, which indicated that a number of external health care professionals are consulted, these included doctors, district nurses, physiotherapists, occupational therapists, psychiatrists and the local community learning disability team. As residents are admitted for a short period of time, those who are admitted from the local area retain their own G.P; those from other areas are temporally registered with a local practice. Whilst choice is limited, residents are able to register with a doctor of the same gender as himself or herself if they wish. Meadowcroft DS0000040579.V349422.R01.S.doc Version 5.2 Page 15 Records were kept of appointments with GPs, dentist, optician, chiropodist and any other external health/social care professional and included details of an advice/treatment given by them. Medication records seen confirmed that all prescribed drugs and medicines, which are securely stored including those of residents who are self-medicating, are dispensed by a pharmacist and administered by trained staff. The record of drugs and medicines administered to residents and unwanted drugs disposed of were complete and accurate. The homes medication policy and procedure ensures that following a risk assessment any resident can assume responsibility for their own medication. During this visit we witnessed a resident administering and recording their own medication with encouragement and monitoring by staff. Meadowcroft DS0000040579.V349422.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has clear policies and procedures in place which ensures residents are able to complain and are protected from abuse . EVIDENCE: A Hampshire County Council whistle blowing and Adult Protection Policy and Procedure had been implemented. Records viewed management and staff spoken with confirmed they had received training in reporting and recognising various types of abuse. All were able to demonstrate they knew the procedure to follow should they witness or suspect the abuse of any resident. The complaints procedure, which is also included in the service users guide and was displayed in a written and pictorial format within the home included information on how to contact The Commission for Social Care Inspection (CSCI), was seen, as was the record of complaints, which indicated no complaints, had been received since the last inspection. Residents confirmed they knew who to speak to should they have a complaint; this was either the manager or a member of staff. All members of staff spoken with of stated they felt confident in discussing any concerns, complaints with management either in house or external on behalf of any resident. Meadowcroft DS0000040579.V349422.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24and 30. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. A safe, spacious, well maintained, clean and suitably furnished home and accessible garden is provided for residents which meets their needs. EVIDENCE: All areas of the home were clean and free from unpleasant odours and obvious hazards. Furniture was comfortable, homely and met residents needs. Residents spoken with confirmed the home is always clean, smells fresh. Professional assessment to ensure that any equipment and personal aids required by residents was available has been carried out. Aids currently in use within the home include hoists, special beds, special baths, walk in shower, bedsides, grab rails, ramps, special beds, handrails and Meadowcroft DS0000040579.V349422.R01.S.doc Version 5.2 Page 18 wide doors and corridors .The initial assessments of prospective residents would consider what aids they required. A regular maintenance programme is in place overseen by the property services department of Hampshire County Council who undertakes all of the routine maintenance for the Home. Since the last inspection apart of the routine maintenance a central quadrangle equipped with a garden table and chairs has been paved and refurbished providing a safe, secure and private area for residents. One of the outstanding features of the home is the availability of space allowing residents to live in an environment that provides ample room for them to live without encroaching on each other. In addition to the main building, a bungalow used for resident training and assessment of independent living skills was available. At the time of the visit this resource was unoccupied. Meadowcroft DS0000040579.V349422.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s needs are met by sufficient numbers of well trained and supported staff who are recruited and selected using a procedure designed to protect all residents. EVIDENCE: Due to the nature of the service, the resident group needs vary considerably as some attend day centres and others remain in the home. To ensure that staffing levels meet residents needs at all times a in addition to the initial pre admission assessments of needs and risk being carried out an additional assessment, which employs a pre, determined formula to establish a “support score” is undertaken. (Section covering standards 1-5 of this report also refers). This score indicates if additional staff are required to enhance the core staff levels, which are currently 5/6 cares per daytime shift and a minimum of one waking and one sleeping in person at night. Meadowcroft DS0000040579.V349422.R01.S.doc Version 5.2 Page 20 Care staff are were supported by a number of other personnel including, the registered manager, a cleaner, a laundry assistant and an administrator. The home does not employ a cook, the responsibility for cooking falling on the care staff. The current arrangements give rise to concerns regarding the consistent quality of the food available and the potential to compromise resident’s choice. Staff were observed to carry out their duties in a calm unhurried manner taking time to talk with and assist individual residents. We viewed three staff recruitment and training files, which included evidence that all staff are employed in accordance with a Hampshire County Council robust recruitment and selection procedure designed to protect residents . This involves the completion of an application form, the signing of a rehabilitation of offender’s declaration, an interview, and satisfactory Criminal Record Bureau (CRB), Protection of Vulnerable Adults (POVA) and reference checks. Following their appointment all staff are subject to an in house and Hampshire County Council induction training, which involves courses in first aid, moving and handling, POVA, Food Hygiene, Fire Safety (including evacuation) and handling medication as part of a Learning Disability Qualification (LDQ) foundation course. On completion of a probationary period of employment, all staff are then expected to undertake a National Vocational Qualification (N V Q) course. Currently 46.7 of staff has been trained to NVQ level 2 of these 13.3 are in the process of upgrading their qualification to NVQ level 3. Comprehensive up to date user friendly and fully signed recruitment and training records and copies of certificates gained were available for all staff. Meadowcroft DS0000040579.V349422.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home seeks the views and opinions of residents/ residents representatives and safeguards the health and safety of staff and residents through the implementation of safe working practices in compliance with previous requirements. EVIDENCE: Following the previous inspection requirements were made that: 1) The registered manager must provide guidance to staff to ensure that they are clear about their roles and responsibilities. 2) The registered manager must ensure a system is developed to review the quality of the service provided including the views of service users and their representatives. Meadowcroft DS0000040579.V349422.R01.S.doc Version 5.2 Page 22 As a result of these an action plan was developed to overcome these deficiencies. The registered manager is qualified to N.V.Q. level 4, has been in post for a number of years, is very experienced in managing staff and a residential home for persons with a learning disability. The manager indicated that he receives regular support and supervision from external senior management who are described as available and approachable In talking with staff we confirmed that the manager has established a well defined management structure and following an “away day training session” had agreed new aims and objectives for the home in consultation with the staff who demonstrated to us a clear understanding of what needs to be done and how to do it. Staff said that they felt well supported by the manager, who organised regular team meetings and ensured they had regular supervision. A quality monitoring system that seeks the views of residents was viewed. Two types of survey have been developed in both a written and pictorial format, one seeks the views of respite residents, and their relatives and representatives, the second seeks the views of only residents admitted for assessment. As part of their action plan the homes management have recognised the need to expand the existing procedure to include, in all case relatives, residents representatives, and visiting social and health care professionals such as district nurses doctors and care managers irrespective of the reason for which they were admitted. A verbal undertaking was given by the manager the existing system will be expanded as a matter of urgency. As a result of the evidence viewed and undertakings given we are satisfied that both of the previous requirements have been complied with. Meadowcroft DS0000040579.V349422.R01.S.doc Version 5.2 Page 23 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 X 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 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 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 3 x 3 X 3 X X 3 x Meadowcroft DS0000040579.V349422.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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 Meadowcroft DS0000040579.V349422.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Office 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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