Care Home: Stambridge Meadows

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What the care home does well The organisation have appointed 2 activities co-ordinators for Stambridge Meadows. Records showed that people who live at the home are now receiving an opportunity to participate in a varied social care programme that meets their needs. Formal staff supervision is being undertaken regularly. Medication practices and procedures have improved and there was evidence available to indicate that improvements are being sustained. What the care home could do better: Ensure that the home`s Statement of Purpose is reviewed, updated and readily available for people to view and that the information recorded is accurate. Ensure that improvements are made to the home environment (first floor) and that it issuitable and `Fit for Purpose` to specifically meet the needs of people who have a diagnosis of Dementia. Staff receive appropriate and comprehensive training relation to Dementia and Challenging Behaviour. Random inspection report Care homes for older people Name: Address: Stambridge Meadows Stambridge Road Great Stambridge Rochford Essex SS4 2AR one star adequate service 01/04/2010 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. 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: Michelle Love Date: 1 3 0 7 2 0 1 0 Information about the care home Name of care home: Address: Stambridge Meadows Stambridge Road Great Stambridge Rochford Essex SS4 2AR 01702258525 01702258229 stambridge.meadows@ashbourne.co.uk www.southerncrosshealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ashbourne (Eton) Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 49 Number of places (if applicable): Under 65 Over 65 0 49 dementia old age, not falling within any other category Conditions of registration: 21 0 The maximum number of service users who can be accommodated is: 49 The registered person may provide the following categories 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: Old age, not falling within any other category - Code OP, maximum number of places: 49 Dementia - Code DE, maximum number of places: 21 Date of last inspection 0 1 0 4 2 0 1 0 Care Homes for Older People Page 2 of 10 Brief description of the care home Stambridge Meadows is a care home for up to 49 older people. The home is situated approximately three miles from Rochford Town Centre and is set in pleasant country surroundings. The home has 40 single bedrooms, 33 with en-suite facilities and 5 double bedrooms, 2 of which have en-suite facilities. The home has three lounges, one of which has a designated dining area. The home also benefits from a visitors lounge area/reminiscence on the ground floor. The spacious grounds are maintained, with several paved areas. The home is in good decorative order with high quality accommodation for residents. Inspection reports are readily available for visitors to the care home and are displayed in the main reception area. Upon request, prospective residents and/or their representatives can have a copy of the last report and this can also be provided on audiocassette. The range of weekly fees as confirmed by the administrator are £390.39 to £750.00. Respite/Short Term Care is charged at £140.00 per day and after 7 days this reduces to £110.00. If residents are funded by social services then a top-up fee for rooms may be applicable depending on the room chosen and will need to be discussed with the project manager/manager of the home. Additional charges to residents include chiropody, hairdressing, newspapers and magazines, personal toiletries and telephone charges. Care Homes for Older People Page 3 of 10 What we found: This was an unannounced random inspection. The visit took place over one day by two inspectors, of which one was a pharmacist inspector and lasted a total of 4 hours. The purpose of the site visit was to look at progress made since the last key inspection to the service on 1st April 2010 and in specific relation to, medication practices and procedures, social activities, the environment on the first floor (Dementia Unit), Dementia training for staff who work at the care home and staff supervision. We also requested sight of the homes Statement of Purpose and Service Users Guide. At the time of the site visit no one had been admitted to the Dementia Unit. The manager told us that following our visit to the service on 1st April 2010 improvements had been made to address some of the identified shortfalls. This included the purchase of signage to aid peoples orientation within the Dementia Unit, two activities co-ordinators had been newly recruited, a representative from the Alzheimers Society had visited the home in June 2010, staff were now receiving regular formal staff supervision, staff training (Dementia) and the requirements relating to medication practices and procedures had been met. Since 1st April 2010 the registered provider has employed two activity co-ordinators for a total of 40 hours per week. On a tour of the premises we found evidence in several locations of a newly devised activity programme in both a written and pictorial format. While we acknowledge the improvements, care must be taken to ensure the activity programme is current and reflective of the date and day activities are provided. This refers specifically to the activity programme within the main reception area of the home, in the main lounge area and within a random sample of 12 peoples bedrooms being inconsistent, with only one programme on display depicting the correct date. This issue has been highlighted at previous inspections to the service and remains outstanding. From discussions with one activity co-ordinator and from inspection of records, improvements have been made to seek the views of people in the home about their past and present social activities, personal preferences, likes and dislikes. Records showed that Life Story books have been initiated and completed for some people, activity preference forms are in the process of being completed and a diary is being used to record activities undertaken by individual people in the home each day. Activities recorded included, films, arts and crafts, sing-a-long, karioke, bingo, walks in the garden, quizzes and visits by relatives. In addition 3 Memory Boxes are in the process of being finished with more planned in the foreseeable future. The activity co-ordinator told us that since their appointment approximately one month ago they have made a request to the manager for Dementia training and training specifically centred around the social care needs of people with Dementia as they recognised there were gaps in their existing knowledge. The manager was very complimentary about the abilities of his activity coordinator and although he recognised that additional training is required stated shes a natural and talked positively about developments made so far. People who live in the home were also complimentary about activities provided and these included its much better than it was, oh theres more to do now and things are getting there. This requirement is now deemed to have been met. On a tour of the first floor Dementia Unit little has changed to make the environment Care Homes for Older People Page 4 of 10 more user friendly or suitable for people with Dementia, since the key inspection of 1st April 2010. The manager told us that signage to better support recognition and orientation for people with Dementia had been purchased however this had not been put in place at the time of the site visit. There remains one or two pictures on the wall in the corridors but these do little to break up the space and the long corridors and doors to individual peoples bedrooms remain of a similar colour. The doors of the communal bathrooms are of a similar colour and this potentially means that some people may find it difficult to distinguish between the different rooms. There was no evidence that memory boxes, objects of reference or other sensory items that might remind and/or trigger memories of the past and more recent events had been purchased and were in place. No changes have been made to the dining area on the first floor despite concerns raised at previous inspections to the service about potential health and safety issues. We also asked the manager as to what decision had been made with regards to the proposed kitchenette to be installed within the dining area. He told us that he was unaware of the decision for this to be installed and we explained that this had been raised by one of the organisations project managers prior to his appointment in October 2009. During feedback this was discussed with the manager and the Operations Director. The Operations Director gave assurances that improvements to the Dementia Unit would be given priority and stated we will get it done. The Operations Director spoke with us following the site visit and confirmed that an order for sensory items had been placed and that steps were underway to ensure the environment was Fit for Purpose as soon as possible. This requirement has not been met and remains outstanding. Since 1st April 2010 the Service Users Guide has been reviewed and updated. The Statement of Purpose was not displayed and when requested we saw that this remains unchanged as previously highlighted. We requested a copy of the staff training matrix so as to determine if robust Dementia training had been provided since the last key inspection. Records showed that 8 members of staff had undertaken Dementia training since 1st April 2010. It remains of concern from discussions with the manager that no changes have been made to the course content and that staff continue to receive a short course (2 hours) which includes 1 hour relating to Dementia awareness and 1 hour relating to challenging behaviour. The manager confirmed that the ASSET Dementia Course at Chelmsford College is no longer available as a result of funding cuts by the college. The Operations Director confirmed during feedback that it is the organisations intention for all staff to receive the Tomorrows Another Day training as soon as possible. Records of staff supervision showed that 23 members of staff have received regular formal supervision within the past 2-3 months. The Operations Director confirmed that it is the organisations intention for all home managers to receive supervision training as part of their individual development plan. This requirement is now deemed to have been met. During our inspection on 1st April 2010 we found poor practice in the handling, recording and administration of medicines and made a number of requirements. We made two immediate requirements on that date to ensure that medication is given to people in a hygienic manner and that medication must only be given to residents in accordance with prescribed instructions. We visited on 21st April 2010 and found that you had complied with those requirements. During this inspection on 13th July 2010, we also watched medicines being given to people and saw that this was done safely and with regard to Care Homes for Older People Page 5 of 10 peoples privacy and personal choice. We also looked at medication records and found that people had been given medicines in line with the prescribed instructions and that any variation to these instructions was with the documented agreement of the prescriber. We consider that the improvement in practices to meet these requirements have been sustained. We also made a requirement that where people are prescribed medicines on a when required basis or in variable doses (e.g. one or two tablets) there must be clear guidelines for staff on the use of these medicines. This was a repeated requirement with a timescale for compliance of 30th April 2010 as the previous timescale of 30th November 2009 had not been met. During this inspection we looked at medication records and appropriate care records for 3 people prescribed such medicines and found guidance in place to ensure that people are given medicines appropriately. We therefore consider this requirement has been met. We looked at the storage provided for medicines and found that medicines were held securely for the protection of residents in areas which are temperature controlled. We saw that the temperatures are monitored and recorded regularly. So the requirements made on the last inspection to ensure medicines are locked away when not in use and are stored under suitable environmental conditions, have been met. On our last inspection we saw that medicines controlled under the Misuse of Drugs Act were not stored in accordance with the Act and associated Regulations and made a requirement about this. During this inspection we saw that a new cupboard had been installed which meets the requirements of these Regulations and so this requirement has also been met. During our inspection on 1st April 2010 we found that the records made when medicines are given to people had a number of discrepancies and inaccuracies and made a requirement about this. During this inspection we looked at the records for several people resident in the home and did not find any unexplained omissions or discrepancies in the medication records and the records demonstrate that people receive their medicines as prescribed. We therefore consider this requirement has been met. What the care home does well: What they could do better: Ensure that the homes Statement of Purpose is reviewed, updated and readily available for people to view and that the information recorded is accurate. Ensure that improvements are made to the home environment (first floor) and that it is Care Homes for Older People Page 6 of 10 suitable and Fit for Purpose to specifically meet the needs of people who have a diagnosis of Dementia. Staff receive appropriate and comprehensive training relation to Dementia and Challenging Behaviour. 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 Older People Page 7 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 19 23 The home environments 30/06/2010 design and layout must ensure it meets the needs of all people in the home. This refers specifically to the Dementia Unit on the first floor. So that it meets the needs of people in the home. Care Homes for Older People Page 8 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, 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 1 Review and update the Statement of Purpose so as to ensure there is sufficient information recorded relating to the range of service users needs which the service is intended to meet. This refers specifically to the category of Dementia. In addition ensure that the document is up to date. Review the quality of training provided to staff in relation to Dementia and Challenging Behaviour. 2 30 Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission 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 Older People 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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