Care Home: Meadowyrthe

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What the care home does well Staff treat all people as individuals, promoting privacy and dignity at all times. People were cared for in a sensitive and caring manner. The atmosphere at Meadowyrthe was warm, relaxed and friendly. Relative confirmed that they are encouraged to visit the home and are made welcome by staff. Long standing nucleus of staff who have worked here for many years, and provide consistency for people using the service. What has improved since the last inspection? The homes heating system has been repaired and updated. Risk assessment audits are now in place. An audit of accident records is now carried out. Peoples care plans have been reviewed and updated and this is ongoing. The homes Statement of Purpose has been updated. What the care home could do better: Socialisation and Activities for people with dementia be further developed. Two signatures be obtained by staff when dealing with peoples monies. When booking money out of peoples accounts it should be idenfied what the money is for. Attention be given to pruning and tidying the enclosed courtyard garden. Key inspection report Care homes for older people Name: Address: Meadowyrthe Comberford Road Tamworth Staffordshire B79 8PD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kathryn Marks     Date: 2 5 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Meadowyrthe Comberford Road Tamworth Staffordshire B79 8PD 0182766606 0182756923 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Staffordshire County Council Social Care And Health Directorate Name of registered manager (if applicable) Mr Leon Smith Type of registration: Number of places registered: care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: Age: Dementia (DE) age 50 and above. The maximum number of service users who can be accommodated is: 44 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (MD) 44 Dementia (DE) 44 Physical disability (PD) 44 Old age, not falling within any other category (OP) 44 Date of last inspection Care Homes for Older People 2 6 0 3 2 0 0 9 44 44 0 44 Over 65 0 0 44 0 Page 4 of 26 Brief description of the care home Meadowyrthe is a Local Authority home that can accommodate a total of 44 older people. The home is located on the outskirts of Tamworth, close to amenities, and is served by public transport. Accommodation is provided on two floors served with a shaft lift and comprises a total of 44 single bedrooms, twelve of which have an ensuite facility. Adequate communal spaces are provided, with separate lounge areas. The home is pleasantly situated with extensive grounds and a car parking area that would benefit from being extended. There are three different services on the same site all using the car parking area. Current fees are £658.00 weekly for long stay, Respite stay £717.00 per week. These charges are subject to annual review. Charges are made for hairdressing, newspapers and personal items. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced Key Inspection was carried out on Wednesday 25th November 2009 by one inspector, who used he National Minimum Standards for Older People as the basis for the inspection. On arrival for this inspection the staff on duty were as follows: Registered Unit Manager, Care Team Leader Two senior support workers, nine support workers, all people on the rota were on duty. One catering manager, one cook, one catering assistant, one handyperson, one domestic, one laundryperson. The Care Manager provided written information regarding staffing, staff training, menu and dietary provision, that were observed to be in place at the home. We discussed with the care manager the arrangements for the day, to avoid disruption to people using the service, staff, and routines in the home. Care Homes for Older People Page 6 of 26 We talked to people using the service, staff and a relative who was visiting the home. The care records of three people were reviewed, and the records of the last three members of staff employed, including recruitment and training records. We discussed food with people using the service, and observed lunch being served. Choices were available at lunchtime and identified on the menu. We also looked at the Annual Quality Assurance Assessment (AQAA) this is a self assessment tool, and had been well completed, and sent to us prior to the key Inspection. Completion of the AQAA is a legal requirement and it enables the service to undertake a self assessment, which focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who wish to use the service and their relatives, have the information they need to make an informed choice about living at the home. Evidence: The AQAA we received prior to the inspection told us that The service have just re introduced an updated version of the statement of purpose and service users guides. Now included is a front page which picturally informs the reader who their keyworker is, and which Care Shift Leader is over seeing their care. The service are currently working on a Polish version for our Polish resident as well as a audio version later in the year. All new admissions to the home are assessed via the social worker teams. The home will produce its own care plan and risk assessments, based on the information from the social worker and staff team. We continue to assess our residents needs every week during their first six weeks, to ensure we are meeting their needs and that they are happy with the service on offer within the home. Care Homes for Older People Page 10 of 26 Evidence: We looked at the records of the last three people admitted to Meadowyrthe, that told us they or their relatives had previously visited the home. In some cases respite stays had been experienced and influenced decisions to move into the home. We talked to the relative of a recently admitted person who was very happy that their relative was at the home, and that they had settled in so well. This person confirmed that they had received information about the service offered at Meadowyrthe prior to making a decision. We saw the homes Statement of Purpose and Service Users Guide that have been updated and provide detailed information for people wishing to use the service. The Service User Guide contains the fees charged, as does the contract. We looked at the care records of the last three people admitted to the home, records contained detailed information that was used as part of the assessment process. We saw that an interpreter had been accessed to assist the staff and a Polish lady with communication on a daily basis, this person is still working with the lady and staff at the home. We saw that risk assessments were in place on peoples care records. This means that peoples needs had been assessed, and the home was satisfied it could meet those needs. Meadowyrthe does not provide intermediate care. We had received no surveys at the time of this inspection. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people using the service are met: personal care is delivered in the way the individual wishes. Evidence: The AQAA we received prior to the inspection told us that The service had recently updated individual care plans, they are more person centred and the format is now easier to follow. There are clear sections for monitoring and recording information, the care plan and risk assessment can be found in the front of each file, to ensure they are read and being followed by the staff team. Each file is being audited by the Keyworker and Care Shift Leader each month, this is followed by a six monthly review by the social worker. Medical care is undertaken by visiting professionals such as district nurses, CPNs, G.Ps Chiropodists. All people will be offered the opportunity to receive the flu vaccine and Staffordshire County Council has a contingency plan for pandemic flu. All medication is administered by a Care Shift Leader or Manager, all long stay residents medication is administered using the MDS blister system and supplied by our local Pharmacist. All medication is stored in a cabinet that meets the legal requirements. On the whole the staff team offer a good level of care and support Care Homes for Older People Page 12 of 26 Evidence: and often receive positive feedback from people, families and other professionals. We looked at the care records of the last three people admitted to the service. Care plans have been updated and are continually reviewed to identify where they can be further improved. Information was detailed and up to date, clearly identifying areas of need. We saw that the care plan of a Polish lady was in Polish and translated into English. We saw health care records that told us regular health checks take place, and identify that medical professionals visit the home. The rapid response nurse visited during this inspection. We saw that people have received the flu vaccine, and that the service has a pandemic flu contingency plan in place. We saw that risk assessments were in place for areas of daily living activity. All risk assessments are reviewed on a regular basis. We saw that all medication is administered by two senior staff, that have been trained in the management of medication. We looked at medication administration sheets, these were being signed as medication was administered, and were up to date. We observed throughout this inspection staff promoting the privacy and dignity of the people using the service. We have received no surveys at the time of this inspection. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service make choices about their daily lifestyle, with their visitors being made welcome. The food provided is of a good standard with a varied and nutritional diet being offered. Evidence: The AQAA we received prior to the inspection told us that The service actively encourage family contact and involvement within the home. There are no retrictions to family visiting unless this become disruptive to other people. The kitchen actively encourages feedback from people, staff and family about food choices and the quality of the meals. There is always more than one choice of meal on offer throughout the day and special dietary needs are catered for. We have made some improvements to the activities on offer within the home. We saw that a daily activities programme is displayed in various areas of the home. The planned activities were not taking place in some areas, and had been substituted with activities that people in those areas wanted to do. We saw that all activities and socialisation are recorded on a daily basis in the daily activities book, along with pictures and photographs. Care Homes for Older People Page 14 of 26 Evidence: We talked to the manager, and staff, who told us that they want to further develop the activities for people with dementia. We saw that an interpreter was visiting the home daily to assist with communication between a Polish person and the staff. A list of key words are being developed to assist staff with communication. The person understands english but does not speak it well, body language and gestures are used with key words to communicate. We saw that pertinent signs around the home are in English and Polish to further assist with communication. We looked at the care records of the last three people admitted to the service, these were detailed and identified peoples likes, dislikes, hobbies and interests, past social and health history. We observed flexible routines to be in place at Meadowyrthe with people moving freely around the home and the managers office. We talked to people using the service who indicated they were happy at the home. People looked cared for and staff were interacting with individuals. We talked to a relative who told us that he was very satisfied with the care being delivered to his relative, and spoke of the staff as being caring and genuine. We saw the menu displayed and talked to the cook. The menu offered alternative main choice and desserts, the cook was able to identify choices available for people with Diabetes. Two soft food diets were also provided. We saw food being served, this was nicely presented and portions were generous. We observed one person being assisted with their meal, this was done with sensitivity and in an understanding way. The staff member took their time, talked to the person, and ensured that they had enough time to eat their food. Staff that we observed serving lunch all gave people enough time to enjoy their meal. We have received no surveys at the time of this inspection. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make complaints and are safeguarded by the homes procedures. Evidence: The AQAA we received prior to the inspection told us that The service respond very quickly to all complaints and ensure the appropriate professionals are informed and documentation is completed. We saw that the service have the Local Authority complaints procedure in place, this is displayed in the home for people using the service and visitors. The procedure is also in the Service Users Guide that is given to people new to the home. The previous report told us the homes complaints procedure is written in a leaflet about complaints, which is readily accessible in the hallway of the home. We saw the home has a complaints book in place that identifies complaints and action taken to deal with them. The service has received nine complaints since the last key inspection. All complaints related to care issues, have been dealt with and are fully recorded. Four safeguarding referrals have also been made and dealt with, all are recorded at the home. We talked to people in the home who told us that they talk to staff if unhappy. Care Homes for Older People Page 16 of 26 Evidence: We looked at the finances of three people using the service, cash balanced with records maintained. One staff signature only on financial records, staff were advised to have two people dealing with monies spent on behalf of people using the service. Some entries were not clear about what money was spent on, but receipts were there and balanced. We saw staff training records that identified that the staff have received Safeguarding and Protection of Vulnerable Adults training. We saw on staff files that Criminal Records Bureau checks are carried out, and two written references are taken up prior to employment. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables people to live in a safe, clean, and comfortable environment. Evidence: The AQAA we received prior to the inspection told us that The home still requires a level of refurbishment but remains a safe and suitable environment for the Ladies and Gentlemen of Meadowyrthe to live. We saw the physical design and layout of Meadowyrthe meets the needs of the people using the service. The communal areas are comfortable with many homely touches, people were relaxed in their surroundings and moving freely around the home. We talked to the unit manager, who told us that, a planned refurbishment is to take place to further improve and enhance the physical enviroment for people living at the home. We visited various areas of the home to talk to people using the service, the home was warm in all areas we visited. Peoples bedrooms we looked at were personalised with favourite items, warm and clean. We saw that there is an enclosed courtyard area with seating for people to use in Care Homes for Older People Page 18 of 26 Evidence: clement weather. This area is becoming overgrown and will benifit from some attention in the spring before people start to sit here. We saw that health and safety checks are carried out, fire risk assessments are in place, and regular servicing of equipment is carried out. We saw training records that identify staff have received infection control training. We saw infection control practices in place with hand gels available around the home. Areas of the home we visited were clean, pleasant and hygienic. We had received no surveys at the time of this inspection. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A well trained and consistent staff team support the people using the service. Evidence: The AQAA we received prior to the inspection told us that The staff team offer a very good level of care for all people using the service, and general support to the peoples families. Many of the staff team have worked at the home for many years, and have a good understanding of the principles of care. The staff team have had to cope with a lot of changes over the last 12 months but are willing to accept and respond to change. We talked to the unit manager, and looked at the staff rota. Records told us that there are seven senior staff and twenty five care staff working at the home. The staff identified on the rota for today were in the home on duty. We saw that six senior staff have National Vocational Qualification level 3, one staff has National Vocational Qualification level 2. Fifteen care staff have National Vocational Qualification level 2, and two staff are currently working towards this. We saw local authority policies and procedures in place for the recruitment of staff. There is a planned staff induction and on going training plan, staff have individual training records. Care Homes for Older People Page 20 of 26 Evidence: We saw staff records of the last three people employed by the home. Records told us that staff have received appropriate pre-employment checks prior to commencing employment with the service. We saw that regular staff meetings take place with records being maintained. Staff receive planned supervision and appraisal on a regular basis. We talked to staff who confirmed to us that they receive regular training opportunities, and that they are well supported by the management of the home. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are protected by competent management systems. Evidence: The AQAA we received prior to the inspection told us that All levels of management within the home now have a shared and identified case load, to assist managers to priorities their workload. We have continued to make improvements during this period of change and to undertake regular audits of all aspects of the care provision within the home. The registered Unit Manager has worked at the home for fourteen months, and has previously worked as a Unit Manager at other homes since 1997. The manager has National Vocational Qualification Level 4 in care, the Registered Managers Award, and seventeen years experience in care. The manager is only responsible for Meadowyrthe, and attends training with staff to keep up to date with current procedures and guidelines. Care Homes for Older People Page 22 of 26 Evidence: We saw a quality assurance system in place at the home. This is co-ordinated and managed by the provider. People using the service, and their relatives are invited to express their views at least twice yearly in a written format. An internal audit of standards is carried out and was seen by us. We looked at the records of three peoples personal allowance managed by the home. Cash balanced with records maintained. However, only one signature was obtained and monies paid out in one case, did not identify what it had been paid out for. It is a recommendation of this report, that two signatures are obtained when money is spent on behalf of people using the service. It is also a recommendation that records identify what the money is paid out for, and receipt attached. We observed safe working practices to be in place, staff training records show that health and safety training has been completed, along with other mandatory training. We saw that risk assessments are carried out for areas of the home, and peoples safety and well being. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 4 12 18 18 19 To further develop the activities and social opportunities for people with dementia. Two signatures be obtained when spending money on behalf of people using the service When booking money out of peoples personal allowance accounts it should be identified what the money is for. Attention be given to pruning and tidying the enclosed courtyard garden area before people start to sit here in clement weather. Two signatures be obtained when signing for money on behalf of person using the service, where the person is unable to sign. Records identify what money is being paid out for. 5 35 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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