Care Home: Meesons Lodge

What the care home does well Meesons Lodge was tidy and bright and provides the service users with spacious and comfortable surroundings. Staff spoken with demonstrated good awareness and understanding of service users needs. What the care home could do better: All care staff need to be trained in infection control, manual handling and safeguarding adult protection awareness. New staff must be provided documented induction training as soon as they commence working at the home. There needs to be sufficient numbers of staff trained in first aid to ensure that a first aider is on duty at all times, and all staff must receive regular recorded 1 to 1 supervision. The system in place for reviewing and improving the level of services provided by the home must include evidence that actions are taken on any shortfalls identified. Inspecting for better lives Random inspection report Care homes for adults (18-65 years) Name: Address: Meesons Lodge 1 Henry de Grey Close Meesons Lane Grays Essex RM17 5HR two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Alan Thompson Date: 1 2 0 1 2 0 0 9 Information about the care home Name of care home: Address: Meesons Lodge 1 Henry de Grey Close Meesons Lane Grays Essex RM17 5HR 01375383267 01375383238 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Care Management Group Ltd care home 10 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Conditions of registration: Date of last inspection Brief description of the care home 10 6 Meesons Lodge is a care home for nine residents with severe learning disabilities. It is situated in Grays close to local shops and transport. Accommodation is on two levels and there is a passenger lift to allow easy access between floors. Public transport by both rail and bus is available approximately 1 mile away. The home has its own minibus. All bedrooms are single occupancy and the home provides care for 10 adults with severe learning disabilities and physical disabilities. Services provided include personal, psychological, social, emotional and educational care by a multidisciplinary team and enabling the service user to remain as independent as possible. Service users within the home can access a range of formal day care placements and are encouraged to participate in leisure pursuits within the local community. There is a large garden to the rear which is available to all the residents. Care Homes for Adults (18-65 years) Page 2 of 10 Brief description of the care home The Service User Guide and Statement of Purpose are available and are updated as required. The residents and their representatives are provided with this information. Fees for service users are assessed according to individual needs as agreed with the commissioning agency. Inspection reports can be obtained from the home or from the CSCI internet website on: www.csci.org.uk . Care Homes for Adults (18-65 years) Page 3 of 10 What we found: The reason for this visit was because of concerns made know to us in December 2008 by Thurrock Borough Council about the day to day management of the service, and of issues relating to gaps in staff training and supervision support records. On this visit we focused on the management of the home, medication training for staff, whether new staff receive appropriate induction training, staff recruitment, staff supervision records and the frequency of 1 to 1 supervision meetings. We also spoke with staff and met with service users. We looked at medication records and found these to be in order at the time. The current manager told us that following a medication administration error in 2008 the medication procedures followed by staff had been updated and that medication is now stored in a quiet room on the first floor. The room change was to minimise the risk of staff being distracted whilst dealing with medication. The procedure change includes medication now being signed for immediately it is administered and for only one service user at a time, instead of the previous practice of administering to all service users and returning to the medication room to sign records. Staff spoken with said they been trained on medication issues before performing this role and update medication training had been provided to several staff in December 2008, two certificates were seen to evidence this. Unfortunately there was insufficient evidence to confirm that all staff responsible for administering medication had received update training nor that all had an observed and recorded competency assessment before taking on this role. A staff rota was available for inspection. On the day of the inspection seven service users were living at Meesons Lodge. The manager said that normal daytime staffing was a minimum of five staff on duty, but as one service user was out of the home staffing on 12th January was four. At night there are two waking staff. Agency staff are employed at the home. Records seen included confirmation from the agency used that their staff had been police checked and had been trained before being sent to work at Meesons Lodge. The manager said that changes to staffing include one person now focusing on activities and someone being employed soon to carry out domestic tasks. Progress on these changes will be looked at on our next inspection. Staff records seen for new employees taken on since the last inspection showed that proper recruitment checks had been carried out. These included an application form, proof of ID, photo, evidence that a CRB check had been carried out and two references. However records looked at did not confirm that induction training had commenced as soon as all new staff started work at the home. Also other records seen for staff did not evidence that induction had been provided to those employed in the past. Some staff training records had been kept in files, and a training matrix record was supplied to us. These showed that courses attended by some staff had included fire Care Homes for Adults (18-65 years) Page 4 of 10 safety, conflict management, medication, gastro feeding, epilepsy, health and safety, safeguarding, first aid, manual handling, food hygiene, pressure care, wound care, mental health, continence management, infection control, PCAS and NVQ 2 and 3. The manager also showed us evidence that further training was booked for safeguarding, care practice and medication. However the records seen of training so far provided did not fully evidence that all staff had received initial and update training on, first aid, manual handling, infection control and safeguarding awareness. The new manager had recently commenced regular 1 to 1 supervision support meetings but there were no records to show that this had been provided regularly by previous managers. Staff spoken with said that 1 to 1 meetings were now taking place and we saw a supervision matrix that showed dates booked for this in January and February. During discussion with staff they added that they felt much better supported since the current manager started working at the home. Since our last inspection there have been four changes of manager at Meesons Lodge. The current manager is a senior manager for the registered provider and had only been working at the home since December 2008 when the previous manager left suddenly. The current manager is experienced and displayed as very competent in the management of care services. The manager normally works for the provider in a quality monitoring capacaity, assessing the services run by the Care Management Group. Meesons currently has no deputy manager or administrative support at the home, which we feel places extra pressure on the manager role. However the manager displayed commitment to improving the record keeping in the home, ensuring that staff are properly trained with good records of this, and in providing regular 1 to 1 support meetings for staff. Although the manager had only been at Meesons for a few weeks she had commenced working at ensuring improvements in all these areas, until a suitable new permanent manager could be appointed. Quality assurance was looked at. The registered providers procedures for this include regular internal audits of services which should result in an action plan for managers to make improvements. We saw the report from a visit to Meesons carried out on 24.7.08 but there was no action plan or evidence that the shortfall identified had been addressed. Quality assurance was seen to also include asking service users their views and regular monthly visits by the provider regulation 26 visits. We looked at some service records and these showed that the homes fire alarms, passenger lift, fire equipment, emergency lights, gas systems, the electrical installation supply and portable electrical appliances had all been tested and or serviced within recommended timescales. Fire drills had commenced and a building health and safety check had been carried carried out in November 2008. What the care home does well: What they could do better: Care Homes for Adults (18-65 years) Page 5 of 10 All care staff need to be trained in infection control, manual handling and safeguarding adult protection awareness. New staff must be provided documented induction training as soon as they commence working at the home. There needs to be sufficient numbers of staff trained in first aid to ensure that a first aider is on duty at all times, and all staff must receive regular recorded 1 to 1 supervision. The system in place for reviewing and improving the level of services provided by the home must include evidence that actions are taken on any shortfalls identified. 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 set out on page 2. Care Homes for Adults (18-65 years) Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 17 18 (1) a - c The registered person shall, 15/12/2007 having regard to the size of the care home, the statement of purpose and the number and needs of service users and shall ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. This with specific reference to the employment of staff for specific roles such as cleaning and cooking. Arrangements must be made 15/12/2007 to ensure that all parts of the home to which service users have access are, so far as is reasonably practicable, free from hazards to their safety. This with particular reference to window restrictors being robustly fitted and tamper free. 2 24 13(4) Care Homes for Adults (18-65 years) Page 7 of 10 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 1 35 13 There must be sufficient 29/05/2009 numbers of staff trained in first aid to ensure that a first aider is on duty at all times. This is to meet service users welfare needs. 2 35 18 All new staff must be 30/04/2009 provided documented induction training as soon as they commence working at the home. To show that staff are trained for their roles. 3 35 18 All care staff must be trained 30/04/2009 in infection control, manual handling and safeguarding (adult protection awareness). This is ensure they are trained for their roles and service users are protected. 4 36 18 All staff must receive regular 29/05/2009 recorded 1 to 1 supervision. To evidence that they are supported in their roles. 5 39 24 The system in place for 30/06/2009 reviewing and improving the Page 8 of 10 Care Homes for Adults (18-65 years) level of services provided by the home must include evidence that actions are taken on identified shortfalls. This is to show that service users views and opinions are listened to and acted upon. 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 20 All staff who administer medication should be given update training to ensure they are trained for their roles. This to include safe handling of medication procedures and an observed competency assessment of practice. Care Homes for Adults (18-65 years) Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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