Care Home: Meadowvale

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What the care home does well The home provides a very welcoming, warm and comfortable living environment, conducive to the needs of the service user group. As mentioned in a previous report there is a strong feeling of `community`. The environment is well maintained and the variety and quality of food is rated highly by service users. The home has successfully achieved a balance of friendliness and humour with a professional approach. What has improved since the last inspection? The home has acquired a minimum/maximum thermometer with reset facility for the medicine storage fridge. There is now a separate wash-hand basin in the laundry with clear instruction as to its` purpose, therefore the three requirements made at the last key inspection have been fully met. What the care home could do better: The standard of care is very good and would benefit further from having the induction programme brought up to date and made consistent with the Skills for Care common induction standards. The home may wish to consider how it can provide clearer evidence of individual, formal supervision of care staff. The files stored in the dining area should either be moved or hidden from view in a suitable cupboard. CARE HOMES FOR OLDER PEOPLE Meadowvale Monkhopton Bridgnorth Shropshire WV16 6SA Lead Inspector Martin George Key Unannounced Inspection 17th January 2008 09:20 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 Meadowvale DS0000020722.V358171.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. Meadowvale DS0000020722.V358171.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadowvale Address Monkhopton Bridgnorth Shropshire WV16 6SA 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) 01746 714061 Mr George Henry Riley Mrs Denise Riley Mrs Claire Diane Price Care Home 16 Category(ies) of Dementia (1), Old age, not falling within any registration, with number other category (15) of places Meadowvale DS0000020722.V358171.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th January 2007 Brief Description of the Service: Meadowvale is registered to care for up to 16 older people. It is situated five and a half miles from Bridgnorth, on the outskirts of the village of Monkhopton, The home benefits from its rural setting with beautiful vistas of Shropshire. Accommodation comprises a spacious combined lounge and dining area and 16 single bedrooms, five of which have en-suite facilities. There are attractive, well-maintained gardens, which surround the property and are easily accessible to those of all abilities. The Proprietors are Mr and Mrs Riley and the Registered Manager is Mrs. Claire Price. The fees range from £300 - £360. Meadowvale DS0000020722.V358171.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 3 star. This means the people who use this service experience excellent quality outcomes. This unannounced key inspection was carried out by a single inspector between 09:45 and 16:00. As part of the inspection all National Minimum Standards defined by the Commission for Social Care Inspection (CSCI) as ‘key’ were inspected. Information about the performance of the home was sought and collated in a number of ways. We were not provided with an annual quality assurance assessment (AQAA) on this occasion as the home requested the inspection. The views of a number of people living and working at the home were acquired through discussions during the inspection and through surveys. Information held by us was analysed prior to inspection and helped to formulate a plan for the visit and helped in determining a judgement about the quality of care the home provides. On the day of the inspection we spoke to the owner, deputy manager, staff and service users and observed practice and this provided evidence in support of the records that were also checked on the day. What the service does well: What has improved since the last inspection? What they could do better: Meadowvale DS0000020722.V358171.R01.S.doc Version 5.2 Page 6 The standard of care is very good and would benefit further from having the induction programme brought up to date and made consistent with the Skills for Care common induction standards. The home may wish to consider how it can provide clearer evidence of individual, formal supervision of care staff. The files stored in the dining area should either be moved or hidden from view in a suitable cupboard. 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. Meadowvale DS0000020722.V358171.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 Meadowvale DS0000020722.V358171.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): 1 and 3 Quality in this outcome area is excellent. Pre-placement assessments ensure that service user needs are met and they are reviewed to keep them up to date and to ensure the changing needs of service users continue to be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service user records we looked at provided evidence of pre-placement assessments of need. These included areas detailed in National Minimum Standard (NMS) 3.3. For those service users who are self-funding the preplacement assessments are carried out by the manager. For service users funded by the local authority the necessary assessment was completed prior to admission. Pre-placement assessments we looked at had not been signed by the service user and where this is possible the home should ensure they are given the opportunity to do so. Meadowvale DS0000020722.V358171.R01.S.doc Version 5.2 Page 9 The home provides useful information to those living at the home and works hard to help new admissions feel welcome. They are keen to assure themselves that service users and their relatives are happy that they have made the right choice. The contracts given to service users fully explain what is provided by the home, and all those we checked were signed and dated. The home does not provide intermediate care. Meadowvale DS0000020722.V358171.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, 10 and 11 Quality in this outcome area is excellent. Care plans comprehensively identify and review a range of service user needs and the medication practices in the home safeguard service users from potential harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides a comprehensive care plan for each service user, based on the initial assessment. Care plans include information on areas such as blood pressure, weight monitoring, urine sample records, pressure sores, risk assessments (including falls), and health professional visits. Consent forms for those wishing to self medicate were seen and the home also requests that service users wishing to use the lift unattended sign a disclaimer form. We are satisfied that information acquired is sufficient to ensure that service user needs are met. Meadowvale DS0000020722.V358171.R01.S.doc Version 5.2 Page 11 The medication ordering, storage, administration, recording and disposal practices are well established and effective. Medication Administration Records (MAR) were up to date. The management of controlled drugs was also consistent with safe practice guidance. Staff are trained in the safe handling of medicines before administering medication. We observed part of a medication round and saw a very sensitive approach with a service user who presented a degree of confusion when asked to take her medication. The deputy manager provided a very clear explanation of how the medication process is managed, satisfying us that service users are properly safeguarded. A requirement from the last inspection regarding the need for the home to acquire a minimum/maximum thermometer with a reset facility has been met. Observations on the day of the visit, discussion with the deputy, owner and staff, comments made by service users and surveys all evidenced that respect, sensitivity and dignity are part of everyday life at the home. The home adopts a very sensitive and respectful approach to terminal illness and dying and recognises the importance of knowing and responding to individual preferences about these issues. Meadowvale DS0000020722.V358171.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 Quality in this outcome area is excellent. The home listens and responds well to service user preferences with regard to meals and activities and encourages the involvement of relatives and the community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home offers an interesting and varied programme of activities, planned jointly with service users. Information about activities was posted on a notice board in the main dining/sitting area of the home. Views expressed by service users indicated satisfaction with activities offered and organised by the home. Service users were very complimentary about the quality and choice of food provided and the menus we saw gave evidence of good nutritional balance. The kitchen hygiene records were in order and the standard of hygiene was very good, ensuring the well being of service users is consistently protected. Meadowvale DS0000020722.V358171.R01.S.doc Version 5.2 Page 13 The cook told us that she could not think of anything that needed addressing to make the kitchen a better working environment. The dining area is a pleasing environment in which to eat but was slightly spoiled by having some of the homes’ files stacked against one of the walls. Discussion with the deputy and owner confirmed that there is a storage space issue at the home and that they had already considered how best to resolve this. If it remains necessary to continue storing some files in the dining area we would like to see them in an unobtrusive and secure cupboard, conducive to the décor of the room. Links with families and the local community are seen as important and encouraged and supported by the home. The home listens to, and tries hard to meet, the expressed needs and preferences of service users wherever possible. Meadowvale DS0000020722.V358171.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 Quality in this outcome area is good. The home has a good complaints procedure, which is readily available to service users and their relatives. Safeguarding is given the necessary priority in terms of training and service users say they feel well cared for. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is understandable and is available to all service users and their families. There have been no complaints since the last inspection. Discussion and observation suggest this is due to service user satisfaction rather than a reluctance to make a complaint. As there have been no complaints it is difficult to judge how effectively the home would use the procedure and how satisfactory any resolution would be, but we are satisfied the home would be responsive and professional. Knowledge of safeguarding of vulnerable adults is good amongst the staff team and training in this area is provided. Service users consistently reinforced, through discussion and surveys, how well they were cared for and how safe they felt. The level of awareness and competence in this area of practice is sufficient to satisfactorily safeguard service users from the risk of abuse Meadowvale DS0000020722.V358171.R01.S.doc Version 5.2 Page 15 The home has procedures that clearly explain how to deal with a suspicion or incidence of abuse. Meadowvale DS0000020722.V358171.R01.S.doc Version 5.2 Page 16 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, 23, 24 and 26 Quality in this outcome area is excellent. Service users benefit from the commitment of the home to keep them safe and to maintain and improve their living environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is in good order throughout and benefits from regular maintenance and refurbishment, providing service users with a pleasing and safe living environment. The garden is designed and maintained in a way that keeps it suitable for the physical abilities of those who live at the home. The garden also provides service users with very pleasant views of the surrounding countryside. Meadowvale DS0000020722.V358171.R01.S.doc Version 5.2 Page 17 Bedrooms are comfortably furnished and equipped to a high standard. Observation and comments from service users evidenced that they are encouraged to personalise their bedrooms. One of the bedrooms had an alarm call cord in the en-suite that was not long enough should the service user fall to the floor. The laundry has good quality washing and drying machines suitable for the number of service users. The laundry area is quite small and we were informed that there is an intention to enlarge this area, which will make it easier to manage the amount of laundry that needs to be dealt with and allow service users to deal with their own laundry should they so wish. The lift had a torch, which could be used in the event of lift failure and the process for dealing with this occurrence had been included within induction of staff, showing how the home thinks about keeping service users safe in a range of circumstances. The standard of hygiene in the kitchen is commendable and records relating to hygiene practices are in good order. Training and practice in the area of infection control is very good. We checked the quality audit file which evidences how and when the necessary checks are carried out. The most recent Environmental Health Officer report was dated 07/08/07 and contained no requirements. Meadowvale DS0000020722.V358171.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is good. Recruitment practices and the commitment to training and qualifications shows how the home wants to provide high quality care to service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff files we examined were well organised and provided evidence of compliance with schedule 2, Care Homes Regulations. The recruitment process used by the home is thorough and ensures, as far as is realistically possible, that staff who are employed are safe to work with vulnerable adults. The induction programme used by the home is comprehensive but would benefit from being brought up to date and made compliant with the Skills for Care common induction standards, to ensure service users continue to be cared for in accordance with current best practice guidance. Training for staff is consistent with mandatory requirements and ensures staff are given the necessary knowledge and skills to safeguard service users from potential harm. The homes continues to ensure the percentage of staff holding or working toward NVQ 2 meets the National Minimum Standard. Evidence found on the day indicates the home gives the required priority to continuous Meadowvale DS0000020722.V358171.R01.S.doc Version 5.2 Page 19 professional development, recognising the positive impact this has for service users. The care staffing compliment is sufficient to meet the needs of the service user group throughout the 24 hour period. There is also a good mix of age and experience and an understanding of diversity issues, giving service users a good balance of care provision. Meadowvale DS0000020722.V358171.R01.S.doc Version 5.2 Page 20 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, 32, 33, 35, 36 and 38 Quality in this outcome area is good. Good leadership and clear levels of accountability support a competent and confident staff team well able to provide quality care to service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The deputy on duty on the day of the visit was very skilled and knowledgeable and we observed several interactions with service users and staff, evidencing respect, sensitivity and good use of humour, while still retaining the necessary authority. Our observations also evidenced that staff were clear about their job Meadowvale DS0000020722.V358171.R01.S.doc Version 5.2 Page 21 responsibilities. The home has a staff communication book, which helps keep everyone informed of what is happening. There was a very cheerful feel to the home, balanced with a professional approach, giving service users a very relaxed and friendly service with their safety as a consistent focus. The rapport between the proprietor and the deputy was good and our observation suggests that there is no conflict of role. We were informed that the home does not manage personal monies for any of the service users. Although there is a culture of “on floor” supervision and good quality annual appraisals, ensuring staff are competent and confident in the care they provide to service users, it would be good to see clearer evidence that individual care staff have received at least 6 formal supervisions per year. The deputy manager, owner and staff we spoke to are fully aware of the need for good health and safety practices and ensure they provide a service consistent with requirements from regulatory authorities, such as environmental health and the fire service. Training and day to day practice around care of substances hazardous to health (COSHH), infection control and the management of falls are good. Maintenance checks and actions are also well recorded. Meadowvale DS0000020722.V358171.R01.S.doc Version 5.2 Page 22 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 3 x 4 x x x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 4 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 x 18 3 4 x x x 4 4 x 4 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 4 x 3 3 x 3 Meadowvale DS0000020722.V358171.R01.S.doc Version 5.2 Page 23 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. 1 Refer to Standard OP22 Good Practice Recommendations The alarm call cord in one of the en-suite bathrooms was not of sufficient length to allow a service user to reach it if they fell to the floor and this should be rectified without undue delay Although the home has a comprehensive induction programme it would benefit from being brought up to date, consistent with Skills for Care common induction standards Although the home provides good levels of support, guidance and ongoing staff development it should provide clearer evidence that staff receive formal supervision at least six times per year 2 OP30 3 OP36 Meadowvale DS0000020722.V358171.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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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