Care Home: Meadowfield Lodge

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What the care home does well People are cared for by staff that understand this client group and know how to meet individual needs. One person said "the staff sort everything out for me" another person stated, "I have no complaints, but I know if I had the manager would help me". People are offered appetising and appealing food, which is served in a pleasant environment. People are asked about their views and opinions about the service and what their likes and dislikes are. This is then acted upon to improve the quality of life for people. What has improved since the last inspection? Staff have undertaken abuse awareness training, this means that they are more alert to signs of abuse and know what action to take to protect people from further harm. What the care home could do better: Staff could record the water temperatures more effectively and use pre-set valves on individual taps. This would reduce the risk of burns/scalds through water being too hot for people to use. Staff could have a greater understanding of infection control procedures. This would prevent cross contamination or accidents happening through equipment being left in the corridor area. People would benefit by having greater access to the call bell system in the toilet area. CARE HOMES FOR OLDER PEOPLE Meadowfield Lodge 22 Meadowfield Road Bridlington East Yorkshire YO15 3LD Lead Inspector Jo Bell Key Unannounced Inspection 30th September 2008 10:30a 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 Lodge DS0000039795.V372553.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 Lodge DS0000039795.V372553.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadowfield Lodge Address 22 Meadowfield Road Bridlington East Yorkshire YO15 3LD 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) 01262 675214 F/P 01262 675214 Hexon Limited Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (24) of places Meadowfield Lodge DS0000039795.V372553.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th October 2007 Brief Description of the Service: Meadowfield Lodge is a care home offering personal care and accommodation for up to 24 elderly people. It is a three-storey building with passenger lift access to all floors. The home is situated near the centre of the seaside town of Bridlington and has good access to the shops, transport and social and recreational activities of the local community. The award winning south beach is a 5-minute walk from the home. Accommodation is available in a choice of single or twin rooms, the majority having en-suite facilities. The statement of purpose, that tells people about the services the home offers, is made available for all service users and their families. The range of weekly fees charged at the date of this site visit was between £297.00 and £375.00. Additional charges are made for hairdressing, chiropody, newspapers and personal toiletries. Meadowfield Lodge DS0000039795.V372553.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. “We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken.” The key inspection took place on Tuesday 30th September 2008 Prior to the visit the information from the following sources was obtained and considered: The annual quality assurance assessment. This is information, which details what has happened during the past 12 months. Notifications (Regulation 37) relating to incidents in the home affecting people using the service. Details of complaints and allegations raised by people connected to the service. Progress of the previous requirements and recommendations made at the last site visit. At the site visit one inspector spent 4.5 hours at the home. During this time observations of care practices took place. People using the service were spoken with along with some relatives. Discussions with the manager regarding meeting needs, mealtimes, protecting people and the environment took place. The lunchtime meal was observed and time was spent inspecting care plans, looking at individual rooms and reviewing a selection of health and safety information. Staffing and management issues were discussed and feedback was given to the manager and the general manager at the end of the inspection. Meadowfield Lodge DS0000039795.V372553.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Meadowfield Lodge DS0000039795.V372553.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Meadowfield Lodge DS0000039795.V372553.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 is not applicable) People who use this service experience good outcomes in this area. People are effectively assessed prior to admission, which helps to ensure individual needs can be met. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The three pre-admission assessments looked at confirmed that a senior person completes an assessment before an individual moves to the home. This is to check what type of care and support the person needs and whether the staff have the skills and knowledge to provide that care if the individual chooses to move there. The process also reassures the individual and their family that they will receive the right support. The manager discussed the client group and how she assesses the individual’s needs. Assessments are completed if the person has a care manager or is privately funded. These detail health, personal, nursing, social and mental health needs. Meadowfield Lodge DS0000039795.V372553.R01.S.doc Version 5.2 Page 9 All the surveys completed by people living there report that people are given enough information about the service and what it provides. This means they can make an informed choice about whether to move there or not. Meadowfield Lodge DS0000039795.V372553.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use this service experience good quality outcomes in this area. People have their health and personal care needs met in a dignified manner. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Three care plans were looked at during this visit. These describe the care and support people need to stay in charge of their own lives as much as possible. The plans looked at contained a lot of information, so that an unfamiliar carer could look at them and would be able to work out how much support they needed. There were written assessments as to whether people were at risk of developing pressure sores, of losing weight because of poor appetite or a health problem or needing help with moving and handling. Those identified as ‘at risk’ had a care plan in place describing how that risk was to be managed. Meadowfield Lodge DS0000039795.V372553.R01.S.doc Version 5.2 Page 11 The care plans are reviewed and evaluated on a monthly basis. An audit of each care plan is kept at the back of the records. This helps staff identify any improvements in record keeping and means that individual needs are continually looked at and acted upon. People in the home looked clean and very well cared for. One person said, “Staff know all my likes and dislikes”. Another comment was “I have my hair done when I want and my key worker looks after my clothes”. People had clean nails, teeth and hair and this was consistently confirmed when observing and speaking with people. The home deals with accidents and incidents appropriately and keeps The Commission informed of any serious issues, which affect people. An audit of the number of accidents takes place. This helps staff to identify what improvements can be made to reduce the number of falls occurring. Throughout the visit privacy and dignity was maintained, staff were observed knocking on people’s doors prior to entering and speaking to people in a pleasant and dignified manner. The medication system was inspected and discussed. Staff have training in this area and only those who are deemed competent administer medication. Currently there is no medication room to store the drugs trolley or medication cupboard, this would be beneficial. However, the trolley used is securely fastened to the wall in the dining room, and the medication cupboard is secure with a separate cupboard used for storing controlled drugs. Again this is located in the dining room. The medication charts were detailed with photographs of people, correct codes were used and stock balances are in place. Staff store medication in the fridge when required. Each care plan has a medication audit in place, which identifies any errors or areas for improvement. Meadowfield Lodge DS0000039795.V372553.R01.S.doc Version 5.2 Page 12 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 and 15 People who use this service experience good quality outcomes in this area. People participate in a range of activities and visitors are welcomed. Staff encourage autonomy and choice, and people enjoy dining in pleasant surrounding with appealing food. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People have access to a range of activities. There is a dedicated activities person who works part time. People spoken with said they enjoyed bingo, dominoes, and trips out for ice creams or fish and chips or one to one sessions with staff. Some people felt there should be more activities, though this was discussed at the resident’s meeting and only a few people came up with suggestions. Christmas shopping was requested which the manager confirmed would take place. Relatives are able to take people out and links with the community are encouraged. People were observed watching television, reading and listening to music. Entertainers come into the home on a regular basis and key workers are encouraged to spend time with people. Meadowfield Lodge DS0000039795.V372553.R01.S.doc Version 5.2 Page 13 People have their religious needs documented in their care plan, and staff are aware of the equality and diversity policy. This is viewed as meeting people’s needs. The client group tends to be from similar backgrounds with many people having lived in the Bridlington area many years. People discussed their daily routine and how the home is run for the benefit of the clients and not the staff. People confirmed they could get up and go to bed when they want, staff are very accommodating and will arrange a bath when it suits the individual. Visitors are welcomed into the home at anytime and they sign a book to confirm who they are and when they have arrived and left. The lunchtime meal was observed. The cook offers home-cooking, freshly baked food and a choice of main courses and puddings. People were observed having either fishcakes or stew and dumplings. The portions sizes were suitable and assistance was given where necessary. The dining area was light and airy and people clearly enjoyed the dining experience. Staff were wearing protective clothing and observed interacting positively with people. People are offered a choice of food and drink at breakfast time and during the evening. The cook is aware of how to puree food and talks to people about their likes and dislikes. Meadowfield Lodge DS0000039795.V372553.R01.S.doc Version 5.2 Page 14 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 and 18 People who use this service experience good quality outcomes in this area. People have their concerns listened to and acted upon, and people are safe and protected from harm. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home have a complaints procedure in place which details who to contact and the timescales in which a response will be given. People spoken with said they were aware of how to complain and felt the manager would deal with any issues effectively. No formal complaints have been made to the Home or The Commission in the past 12 months. Staff in the home are alert to signs of abuse. They have received training in the different types of abuse a person may be subjected to and the action needed to protect people. The manager had a good understanding of how to make a safeguarding referral to Social Services and how to use the Protection of Vulnerable Adults list. A safeguarding procedure is in place and staff are aware of the term ‘Whistle Blowing’. All staff have a check prior to being employed to ensure they have no convictions against vulnerable adults. This means that the risk of harm is minimised because staff have had the correct training and have a good understanding of the issues involved with safeguarding. Meadowfield Lodge DS0000039795.V372553.R01.S.doc Version 5.2 Page 15 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, 22, 25 and 26 People who use this service experience adequate quality outcomes in this area. People live in a comfortable and clean environment, though everyone needs access to a call bell and improvements to the risks regarding hot water need to be made. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home is warm and comfortable and people said how much they like the environment. There is a dedicated maintenance person and areas of the home are refurbished when needed. Three rooms were inspected and these were well lit, clean and personalised with a mix of furniture from the service and people’s own furniture, which they had brought into the home. One person had a large screen television and had a phone in their room, the room was spacious and had a sink and toilet attached to the bedroom. One person said, “my room is always clean and I have all my things around me”. There are communal areas Meadowfield Lodge DS0000039795.V372553.R01.S.doc Version 5.2 Page 16 to socialise and eat and drink in and the home is close to the sea front in Bridlington. The home has a call bell system in place, which works well. It was evident that in one person’s toilet there was no access to a call bell, this may prevent someone from getting help when needed. This was discussed with the manager who confirmed this would be addressed. All areas of the home inspected smelt pleasant, and looked clean. Staff undertake infection control training though this needs updating. In one corridor area upstairs there was a mop and bucket full of dirty water, two vacuum cleaners and a red plastic bag open with clothes/bedding in. This could pose a hazard to people walking in this area, and could cause cross contamination. Staff need to be clear about how to store cleaning equipment and how to use the different laundry bags appropriately. Water temperatures were checked in three rooms and these were within the expected range. However, the monthly checks that have previously taken place had a range of temperatures recorded from 39-55 degrees centigrade. This may put people at risk. The taps in people’s bedrooms currently do not have pre-set valves which would help prevent the temperature from being too hot. The manager and general manager confirmed they would look into this and take appropriate action (see also Standard 37-record keeping). Meadowfield Lodge DS0000039795.V372553.R01.S.doc Version 5.2 Page 17 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 and 30 People who use this service experience good quality outcomes in this area. People are cared for by staff who are competent, well trained and recruited and in sufficient numbers to meet individual needs. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home currently has 16 people using the service. There is enough staff to meet people’s needs. Staff have received some training in caring for people with dementia and they have a good understanding of how to care for older people. Throughout the visit staff were seen answering buzzers promptly and offering people assistance when needed. In a morning there are usually three care staff, one of which is a senior carer. Overnight there are two staff on duty. Many staff have completed NVQ Level 2 or 3 in Care and training is regularly offered. Staff are expected to complete induction training (equivalent to Skills for Care). This covers health and safety, care practices and responsibilities specific to the home. Eventually all staff will have completed this as more staff are employed. Staff undertaker supervision, which is where individual development and performance is discussed. One person said, “the staff are really nice” another person said, “staff are great they really look after me”. Meadowfield Lodge DS0000039795.V372553.R01.S.doc Version 5.2 Page 18 Recruitment files were inspected for new and previously employed staff. The recruitment policy is being updated, though the manager is aware that two written references are needed along with a police check and vulnerable adults check. These files were well maintained and staff spoken with confirmed what checks they had to undergo prior to being offered a job in the home. Meadowfield Lodge DS0000039795.V372553.R01.S.doc Version 5.2 Page 19 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): 31, 33, 35, 37 and 38 People who use this service experience good quality outcomes in this area. The home is run in the best interests of the people using the service. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home is run in the best interests of people using the service. The manager is competent, effective approachable and professional. She has completed an NVQ Level 4 in Care and is well supported by the general manager and a dedicated group of staff. People are able to express their views and opinions openly and without fear of repercussions. This was evident when speaking with people and observing a Meadowfield Lodge DS0000039795.V372553.R01.S.doc Version 5.2 Page 20 resident’s meeting. A range of issues were discussed and those people that did not wish to contribute so publicly could talk to any member of staff privately. A quality assurance system is in place. This consists of different audits being undertaken on a monthly basis. These include health and safety; care plans, medication and visits from the general manager where a monthly record is made of any changes, improvements or deteriorations to the service. People are sent questionnaires and bar charts and graphs confirmed the response received and the action taken. A procedure is in place, which details the quality assurance process. The manager fully understands the process and was keen to make sure people enjoyed living in the home. Personal finances were discussed. The procedure in place for dealing with money is robust and throughout the Hexon Homes the same system is used. People pay extra for hairdressing, chiropody, newspapers and toiletries. Receipts are kept and records are in place for all money coming in and going out. Three people spoken with confirmed what happens to their money in the home. Health and safety was discussed. People said they felt safe in the home and the electrical wiring and gas certificates were inspected to confirm these systems were safe. A fire risk assessment has been completed and individual rooms have been risk assessed. Staff undertake a range of mandatory training. This includes moving and handling, fire safety, first aid, and food hygiene and infection control. Staff discussed the training they have received and felt this prepared them to do their job effectively and keep people safe. Record keeping was discussed and it was evident from the water temperature records that more detailed information needs to be kept. For example the actual date of water temperature testing and the action taken when temperatures are too high. This was discussed with the manager and general manager. Meadowfield Lodge DS0000039795.V372553.R01.S.doc Version 5.2 Page 21 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x 2 x x 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x 2 3 Meadowfield Lodge DS0000039795.V372553.R01.S.doc Version 5.2 Page 22 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. 1. Standard OP26 Regulation 13(3) Requirement Staff must be familiar with infection control procedures. This will help prevent crosscontamination or accidents occurring. Timescale for action 30/11/08 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. Refer to Standard OP22 OP25 Good Practice Recommendations People should have access to a call bell system in the toilet area of their rooms. Taps should be fitted with pre-set valves, which have failsafe devices to provide water close to 43 degrees centigrade. This will minimise the risk of burns/scalds to people. Records relating to health and safety (water temperatures) need to be accurately maintained, this helps to identify any concerns and when they occurred. 3. OP37 Meadowfield Lodge DS0000039795.V372553.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Lodge DS0000039795.V372553.R01.S.doc Version 5.2 Page 24 - 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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