Care Home: Meadowfield House

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What the care home does well What has improved since the last inspection? There is a new care planning system. The new recording system will gradually replace the original assessment format. The documentation now includes new approaches to obtaining the background and social history of new residents. A booklet has been designed for recording the information including photographs; this approach has not so far commenced. Lancashire County Care Services has its own web site to provide information about their residential services. Staff have been provided with medication training that ensures their competence and staff spoken with appeared more confident over this aspect of their role. A new activities programme is in operation and new large board games have been purchased. There have been trips out to Barton Grange and Lytham and there is a planned trip to the Illuminations at Blackpool. A new activities record is being maintained of when residents participate in activities. One of the lounges has sensory lights to encourage relaxation and music CD`s are available. Meetings take place between residents and relatives with a member of the management team once a month. This approach is to encourage good communication and examine any issues about care practices. A Suggestion Box is in place and there is a leaflet encouraging new ideas within each resident`s bedroom. What the care home could do better: Staff need to ensure that all parts of the documentation for care planning is completed and that they show a complete picture of the individual resident. Staffing levels should not be reduced from their current levels. The manager has designed staffing rotas to maximise the staffing hours available and ensure there are adequate staff on duty at the busiest times during the day. The number of staff on duty overnight is low with 2 staff responsible for 45 residents with the majority having high dependency needs. There should be evidence that the resident has been involved in the compilation of their care plan with a signature obtained where possible. A seat in a shower located within the mainstream residential unit should be resited to ensure the safety of residents as currently the seat is situated too close to the controls which get very hot. Grab rails should be in place around toilets and showers including raised toilet seats to encourage independence and ensure the safety of residents. One of the toilets seen had been placed in a very difficult space for any resident with poor mobility. There were no shelving or hooks for towels, clothing and toiletries within certain bathrooms/showers. Toiletries had been left out and there is a danger that they could be ingested. Staffing levels should not be reduced from their current levels. Consideration should be given to employing a dedicated activities co-ordinator and more hours provided for kitchen assistance in order to allow the current staff more time to provide care and services. The number of staff on duty overnight is low with 2 staff responsible for 45 residents overnight with the majority having high dependency needs. CARE HOMES FOR OLDER PEOPLE Meadowfield House Meadowfield Close Fulwood Preston Lancashire PR2 9NX Lead Inspector Ms Susan Dale Unannounced Inspection 22nd September 2008 09:45 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 Meadowfield House DS0000032674.V367177.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. Meadowfield House DS0000032674.V367177.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadowfield House Address Meadowfield Close Fulwood Preston Lancashire PR2 9NX 01772 563002 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) alison.walker@careservices.lancscc.gov.uk Lancashire County Care Services Alison Walker Care Home 45 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (14), Physical disability (21) of places Meadowfield House DS0000032674.V367177.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - Code PC To people 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 (Maximum number 14) Dementia- Code DE (Maximum number 10) Physical disability- Code PD (Maximum number 21) The maximum number of people who can be accommodated is: 45 Date of last inspection 15th August 2006 Brief Description of the Service: Meadowfield House is a Direct Service Organisation managed by Lancashire County Care Services. The accommodation is situated in Fulwood, a residential suburb to the north of Preston; a good range of shops is located close by and a bus route into the centre of town. Meadowfield House provides personal care to older people of both sexes, and specialist care to persons with dementia. Rehabilitative care is provided to people with a physical disability. The home has recently had a complete refurbishment to a comfortable standard taking in to account the needs of individual service users. All the bedrooms are single and contain a hand basin. Since refurbishment there are now 8 bedrooms with en-suite toilets and basins; 7 bath/shower rooms and 13 toilets separate to those in the en-suite bedrooms. Lounges are in the individual units and there are quiet areas for sitting both inside and outside the home. The fees are currently set per week at £366.00 lower rate, £412.00 higher rate and £433.00 for Dementia Care. Meadowfield House DS0000032674.V367177.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 stars. This means the people who use this service experience good quality outcomes. The visit was unannounced and the focused mainly on key standards. Information was also gained from the Annual Quality Assurance Assessment completed by the manager. The inspector was able to speak to service users and staff and examine various records. Surveys were provided to service users prior to the site visit and 6 were returned. There were only a few comments and no negative aspects within the surveys. A tour of the home took place. A Random Inspection visit was carried out on the 14th March 2008 because of some concerns raised at the Annual Service Review by both staff and relatives about staffing levels at the home. We do an Annual Service Review when there has been no major inspection of the service in the last twelve months. A Random Inspection visit can be carried out at any time if there are any concerns about a service. The inspector was joined by an ‘expert by experience’ for part of this visit. (An ‘expert by experience’ is a person who because of a shared experience of using or needing a service, and/or ways of communicating, visits a service to help get a picture of what it is like to live in the home.) The ‘expert by experience’ spent time in the communal areas of the home, talking to those living there and then provided feedback; their findings have been incorporated into this report. What the service does well: The majority of staff have worked at the home for a long time and are committed to providing a high standard of care under the leadership of the registered manager. The home has been completely refurbished and provides a pleasant place to live; carpets fixtures and fittings were of a high standard of quality. There were many positive comments about the care provided and the manager and staff working within the home. There was a comment from a resident: ‘Staff are very good and helpful.’ A Relative made the following comment when visiting her sister –in-law: Meadowfield House DS0000032674.V367177.R01.S.doc Version 5.2 Page 6 ‘She is very well cared for here.’ The ‘expert by experience’ noted that the residents looked well cared for with clean fresh clothing, clean hair, hands and fingernails. Staff receive comprehensive training and when spoken with appeared very knowledgeable in all aspects of care and therefore confident in the care they deliver. Over 50 of staff have completed their National Vocational Qualification (NVQ) in Care at level 2 or above. There are currently 35 staff and 26 have an NVQ qualification. The number of trained staff enhances the service provided to residents. What has improved since the last inspection? There is a new care planning system. The new recording system will gradually replace the original assessment format. The documentation now includes new approaches to obtaining the background and social history of new residents. A booklet has been designed for recording the information including photographs; this approach has not so far commenced. Lancashire County Care Services has its own web site to provide information about their residential services. Staff have been provided with medication training that ensures their competence and staff spoken with appeared more confident over this aspect of their role. A new activities programme is in operation and new large board games have been purchased. There have been trips out to Barton Grange and Lytham and there is a planned trip to the Illuminations at Blackpool. A new activities record is being maintained of when residents participate in activities. One of the lounges has sensory lights to encourage relaxation and music CD’s are available. Meetings take place between residents and relatives with a member of the management team once a month. This approach is to encourage good communication and examine any issues about care practices. A Suggestion Box is in place and there is a leaflet encouraging new ideas within each resident’s bedroom. Meadowfield House DS0000032674.V367177.R01.S.doc Version 5.2 Page 7 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. Meadowfield House DS0000032674.V367177.R01.S.doc Version 5.2 Page 8 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 Meadowfield House DS0000032674.V367177.R01.S.doc Version 5.2 Page 9 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): 3&6 Quality in this outcome area is good. Prospective service users are assessed in order to ensure that the services provided meet their needs. The Rehabilitation Unit provides care in a way that assists service users to maximise their independence and move on where appropriate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Any prospective resident is provided with up to date information on the service they can expect to receive should they decide to take up residence. The AQAA states that an arrangement can be made to visit the home prior to admission in order that an individual can feel the ambiance of the home. Prospective users are shown around the home to give them as much detail as they require. When they leave they are given their own copy of The Service Users Guide. The following day a member of the team gives them a courtesy call to see if they are happy with the information provided. Meadowfield House DS0000032674.V367177.R01.S.doc Version 5.2 Page 10 Records belonging to service users were examined and the details showed that a comprehensive assessment had been undertaken prior to admission. All areas of physical and emotional requirements are assessed and any risks are examined and recorded. Prospective residents are visited at home or in hospital by the manager and the key worker (currently for rehabilitation care only) to undertake a pre-admission assessment and devise a preliminary care plan. Each resident is treated as an individual. Any requirements arising because of race, gender, disability, sexual orientation, age, religion, belief system, language, cultures or heritage is promoted through an individuals care plan. Aids and equipment are available in most areas to minimise physical disabilities; i.e. disabled parking, ramps, hoists. Information is available for residents with sensory difficulties; i.e. talking books, large print. There is access to information in different languages or to an interpreter if required. There are policies and procedures in place with regard to for example Sexuality and Personal Relationships. Privacy is positively promoted throughout the home. Resident’s bedrooms are seen as their own personal and private space. Wherever possible a choice of room is offered and residents are encouraged to make their rooms as home like as possible. The home is divided into three units. Two units cater for mainstream and high dependency residents. The third unit provides dementia care. A lot of attention has been paid to the admission of new residents following the introduction of a new care planning system. The new recording system will gradually replace the original assessment format. Intermediate Care is provided by the Rehabilitation Unit which caters for persons requiring temporary care and eventually returning to their own homes where possible. Lancashire County Care Services now has its own web site to provide information about their residential services. Meadowfield House DS0000032674.V367177.R01.S.doc Version 5.2 Page 11 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): 7, 8, 9 & 10 Quality in this outcome area is good. A comprehensive care plan is produced that meets all physical/health and emotional requirements of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans seen provided a clear picture about the needs of each individual service user and risks had been identified. Reviews of the care plan are taking place every month. The care plans seen, had not been signed by the resident or a representative. There was evidence of signatures on the review sheet. There was some information missing on some of the documentation seen. Far more commitment is placed now on finding out the social history and background of individual residents to help in the compilation of an effective care plan. A new booklet has been devised for the purpose of recording the previous history but has not yet been used. The manager explained that it could take some time before all the information on the care plan can be recorded as the resident is observed and monitored. Meadowfield House DS0000032674.V367177.R01.S.doc Version 5.2 Page 12 The care plans within the rehabilitation unit have different formats with goal setting and achievements recorded by care staff and physiotherapists. Some of the paperwork seen was a little disjointed. There is a need to ensure that the recordings are clear and include all necessary information about the individual residents with a signature on the care plan obtained from the resident or representative. The records showed that prompt action had been taken with regard to the resident’s health and that specialist medical, nursing, dental and chiropody services had been sought appropriately. Residents are allowed to see the G.P. of their choice and have access to hearing and sight tests according to need. Nutritional requirements are recorded at the initial assessment and a record kept of any weight gain or loss and fluid charts are maintained for certain residents who are at risk. The medication records seen were complete and signed for at the time of administration. Handwritten records are checked and pharmacy labels are not being used, the details on them are handwritten on the medication record. Staff now have more responsibility for the administration of medication and all staff have been provided with medication training apart from a few staff that were reluctant to include this within their duties. At a random inspection that took place on the 14th March 2008, concerns were raised by staff about administering medication. Some staff were worried about having to complete other tasks at the times when medication was given out such as breakfast time. Staff were spoken with during the site visit did not appear to have the same concerns as previously although, there is still concern that if staffing levels were any lower, medication would be difficult to manage safely. Staff were observed to treat residents with respect and dignity and surveys returned from residents confirmed that staff treated them well and their privacy was respected. All the residents looked well cared for with clean fresh clothing, clean hair, hands and fingernails. The following comment was recorded on a survey: ‘Staff are very good and helpful.’ A Relative made the following comment when she visiting her sister –in-law: ‘She is very well cared for here.’ Staff are taught the importance of privacy, dignity and confidentiality at Induction Training. At the initial assessment a recording is made of individual requirements including the residents preferred form of address. Residents open their own mail and have access to a telephone. Meadowfield House DS0000032674.V367177.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): 12, 13, 14 & 15 Quality in this outcome area is good. Appropriate activities are in place according to the needs and capabilities of the residents. Contact is maintained with family, friends and the local community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The routines of daily living are flexible according to need and activities are arranged around the capabilities of individual residents. At the initial assessment a recording is made of hobbies and interests and residents are encouraged to continue any interests as much as possible. Residents can choose to participate in a variety of activities and any celebrations are ‘themed’ and include, Easter, Chinese New Year, Ramadan and Passover. Up to date information about activities is circulated verbally and displayed on a notice board. The majority of permanent residents are very frail an unable to participate in outings or certain activities. Meadowfield House DS0000032674.V367177.R01.S.doc Version 5.2 Page 14 There is no dedicated Activities Co-ordinator and this would be beneficial for a large home with such diverse requirements for individual residents. An Activities Co-ordinator would also free up staff and allow them more time for the physical needs of the residents. A new activities record is being maintained to show evidence of individual activities enjoyed. There has been a recent purchase of large board games including, Ludo and Snakes and Ladders. Seeds have been purchased to encourage planting in the garden. Baking has been introduced and a member of staff has brought in a quiz game to be played through the TV. The notice board in the rehabilitation unit included the following: Activity programme each day - Quiz, Brain Gym, Forget me not box, Word Game. Friday Bingo in the main lounge. Sunday – Communion, Tuesday pm – Baking, Exercises in the afternoons. There have been two days out within the last 12 months, a trip to Barton Grange and a trip to Lytham. A trip to the illuminations is being planned. There is to be an additional mini bus driver and the plan is to take out smaller groups of residents. Within the dementia unit is an area for sitting in which there were sensory lights with changing colours to promote relaxation along with C.D’s and a T.V. Visitors are able to visit the home at any time. Representatives from various Churches visit the home on a regular basis. At the initial assessment a recording is made about any dietary requirements, likes and dislikes. Meals are taken in the individual units that ensure a homely setting for smaller numbers of residents. New menus have been introduced and residents are able to choose their food the day before. On the whole residents were pleased with the food on offer although there were some comments about there being too many sandwiches. One resident said that she did not like the ‘buffet’ arrangement of food that was provided on Sundays. This was checked and residents appeared to have been provided with a cooked lunch on the Sunday before the site visit took place. Meadowfield House DS0000032674.V367177.R01.S.doc Version 5.2 Page 15 One of the cooks was spoken with and she has particular concerns about her ability to complete tasks in the time allocated. Concerns have been raised previously about the lack of kitchen help. There are currently 2 cooks who are contracted for 28 hours a week. Domestics are employed to also provide kitchen assistance for a few hours each day; they have to change their clothes before entering the kitchen, which also takes up some of the time. The manager is aware of the issues raised by the cook and is monitoring the situation. A resident spoken with stated that her daughter took her washing home as clothing was going astray. Meadowfield House DS0000032674.V367177.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): 16 & 18 Quality in this outcome area is good. People know how to complain and can be confident that staff will take action to address any concerns that they may have. Polices and procedures are in place for protecting service users from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an appropriate policy and procedure for complaints and the details are publicised within the Statement of Purpose and Service Users’ Guide. The Commission has received some complaints and these have been passed on to be dealt with under Meadowfield’s Complaints procedure. Although the complaints were not substantiated there were a number of issues raised about the recording of information and the manager has implemented changes to ensure good communication is maintained for individual residents. The surveys received indicated that residents were aware of the complaints procedure and knew who to raise any concerns with. Procedures are in place for safeguarding service users from any harm. Training has been provided to staff with regard to Adult Abuse and in the handling of any physical or verbal aggression. Policies and procedures are in place to ensure the safety of any financial records or money belonging to service users. The home has a safe for the storage of any valuables or money. Staff are not allowed to assist service users with regard to any legal documents. Meadowfield House DS0000032674.V367177.R01.S.doc Version 5.2 Page 17 Lancashire County Care services is also corporately developing Safeguarding Adults and Mental Capacity Act training for all staff in Residential Care Services. Meadowfield House DS0000032674.V367177.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): 19, 21, & 26 Quality in this outcome area is good. The home is clean and well maintained. All areas of the home seen including service users’ personal accommodation were bright, clean and comfortable creating a positive environment for residents to live in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has been newly refurbished and provides a high standard of furnishings and equipment. A rolling programme of scheduled maintenance is in operation. The grounds have been landscaped and there are plans for secure dementia garden through Dignity In Care grant monies. New Legionella procedures have been introduced and ‘sit on scales’ and additional hoists obtained. New Occupational Health and Safety Policies & Procedures have been implemented. Meadowfield House DS0000032674.V367177.R01.S.doc Version 5.2 Page 19 The home has a dedicated dementia care unit, rehabilitation unit and ‘mainstream ‘ older person unit. Each unit has its own lounge and dining area with a small kitchen for making drinks and a dishwasher. Meals are prepared and cooked in the main kitchen. During a tour of the home it was noted that some of the new bathrooms/showers and toilets do not encourage independence by the residents and are causing the staff some difficulties. There was no facility for clothing to be hung when a resident was undressing. Toilets did not have a rail or raised toilet seat to assist getting on and off the toilet. The only exception was a raised toilet fixture with rails that had been brought in by a relative. One of the toilets has been positioned so close to the wall at the far end that it makes it extremely inaccessible for a person in a wheelchair or any mobility problems. The bathroom /shower in the older persons unit has a seat which has been secured close to the shower controls and the metal plate with the controls on gets very hot and could cause a burn. Staff have had to place a towel on the plate and as there are also no grab rails, residents are unable to shower by themselves. The bathroom in the dementia care unit is not used as staff cannot get to both sides and there was no hoist. Residents are being taken from this unit to the mainstream unit for a bath, which has the effect of removing staff from the Dementia Care Unit. One of the residents spoken with in the rehabilitation unit although very happy with the care provided by the staff had not managed to have a shower by herself as she had been having in hospital, because there were no grab rails. There is no linen cupboard as there was previously before the home was refurbished and this has caused difficulties for staff. Baskets have been purchased to help alleviate the problem. Individual toiletries and shower gel were in evidence; staff are aware that they should not be within reach of residents but there was no place for toiletries to be kept safely. The manager is aware of the situation and raised the issues with higher management. The cost implications apparently have to be taken into consideration and there are issues over which budget; no action has yet been taken by Lancashire County Care Services. Meadowfield House DS0000032674.V367177.R01.S.doc Version 5.2 Page 20 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): 27, 28, 29 & 30 Quality in this outcome area is adequate. Staffing rotas have been readjusted to cover busy times. There is some concern over the low number of night staff and the risks this may cause to the care of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All staff have been placed on standard contracts working 8.00 am till 3.30 pm and 3.30 pm till 10.00 pm. Currently there is a staffing review taking place across all the homes belonging to Lancashire County Care Services. There are to be no more permanent residents admitted to the Dementia Care Unit as a new home specifically designed for persons with dementia/nursing care has recently been opened. Currently there are 5 staff on duty in the mornings covering the dementia care unit and mainstream. There are 5 staff are on duty in the rehabilitation unit am and pm. Only 2 staff are on duty during the night. Meadowfield House DS0000032674.V367177.R01.S.doc Version 5.2 Page 21 There were considerable concerns about staffing levels raised by the staff and relatives at the Annual Service Review, which took place on the 6th February 2008. Since then some of those concerns have been alleviated by careful management of the staffing rotas, flexibility of certain staff hours and new risk assessments on some residents who previously required 3 staff during any personal care. Staff confirmed that they were managing to cover the needs of the current residents but any reduction on 5 staff in the main busy time between 8:00 am and 3:30 pm would be detrimental. Two staff on duty overnight appears very low for the number and needs of the current residents. Even with a reduction in dementia care residents, the needs of these people is high with only 2 residents within the dementia and mainstream residential units requiring minimal assistance. As previously mentioned, domestic assistance is low in the kitchen and the cook spoken with was unhappy with the amount of work within her contracted hours. Care staff also have to instigate and carry out activities within their role as a carer looking after the physical needs of the residents. The employment of a full time kitchen assistant and dedicated activities co-ordinator would be beneficial and contribute towards allowing staff more quality time with the residents. A suitable recruitment procedure is in operation and training is provided to staff that ensures they are competent and able to meet the needs of the service users. Over 50 of staff have completed their National Vocational Qualification (NVQ) in Care at level 2 or above There are currently 35 staff and 26 have an NVQ qualification. Staff spoken with confirmed that they had received training suitable for their job that included Health and Safety, Moving and Handling, Adult Abuse and Medication. Meadowfield House DS0000032674.V367177.R01.S.doc Version 5.2 Page 22 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. The home is well run and service users are consulted about the way the home is run. Service users are also protected by the policies and procedures operating within the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home has an appropriate qualification; many years experience in care and the management of staff within a residential setting. The home has benefited from the leadership skills of the manager however the manager explained that she has given her notice and will be leaving shortly to take up a new position. Meadowfield House DS0000032674.V367177.R01.S.doc Version 5.2 Page 23 There have been various new initiatives to meet with relatives and residents with monthly meetings taking place. The next meeting is planned for the 21st October 2008. The meetings are designed to encourage any issues to be raised. A Suggestion Box is now in place and leaflets have been left in individual residents bedrooms for any ideas for improvements. Questionnaires are sent out twice a year from Headquarters; the results are analysed and then returned to the home for any action required. Staff meetings take place on a regular basis and one to one supervisions of staff. The home has Investors in People Status. Records are kept of financial transactions and personal allowances on behalf of service users. The home has a safe to secure articles of value belonging to service users and an inventory is taken of the contents. The health and safety of people living and working at the home is promoted through regular maintenance checks, the provision of mandatory training and health and safety audits. Risk assessments are completed for safe working practices and any equipment that is used in the home. Accidents are recorded and reported in line with legal requirements. As previously mentioned there is a need to look at the safety aspects within the bathrooms/showers and look at the need for grab rails, raised toilet seats, and measures that will help residents be more independent and free up staff time. Staff need to ensure that toiletries and shower gel are kept out of reach of the residents within the mainstream and dementia units to ensure they are not ingested. Meadowfield House DS0000032674.V367177.R01.S.doc Version 5.2 Page 24 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 X X X X 3 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Meadowfield House DS0000032674.V367177.R01.S.doc Version 5.2 Page 25 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. 1. 2 3. Refer to Standard OP7 OP7 OP12 Good Practice Recommendations Vigilance should be maintained over some missing gaps in care plan documentation in order to show a full picture of the individual resident’s needs. A signature should be obtained where possible from the resident or their representative to show approval of the care plan. Consideration should be given to employing a dedicated activities co-ordinator to free up staff hours and provide a more stimulating environment for people living within the home. A seat in a shower located within the mainstream residential unit should be re-sited to ensure the safety of residents. Grab rails should be in place around toilets and showers including raised toilet seats to encourage independence and ensure the safety of residents. 4. 5. OP21 OP21 Meadowfield House DS0000032674.V367177.R01.S.doc Version 5.2 Page 26 6. 7. 8. OP21 OP27 OP38 Consideration should be given to providing storage facilities for towels, clothing and toiletries within bathrooms/showers. Any staffing review should take into account the low number of staff (2) overnight in order to ensure the health and safety of residents with very high dependency needs. Staff should ensure that any shower gel and toiletries are kept out of reach of residents to ensure they are not accidentally ingested. Meadowfield House DS0000032674.V367177.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection North West Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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. Extracts may not be used or reproduced without the express permission of CSCI Meadowfield House DS0000032674.V367177.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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