Care Home: Tendring Meadows Care Home

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What the care home does well Residents and relatives we spoke with and those who responded to our survey told us that they were very happy with the standards of care in the home. A resident told us “I’m very happy, and there is nothing I can think of that I would like to change’. Another resident said “I’m quite happy with the staff and I have many a joke with them. I’m quite content here, staff are now like family”. A resident who was asked what the home did well said “everything, the home is run perfectly”. One person who wrote a complimentary note following a period of respite in the home described their time in the home as “very enjoyable” and said “I am looking forward to my next ‘holiday’ with you”. Residents and relatives told us that the home was kept fresh and clean. One resident described the laundry service as “excellent”. Residents were complimentary about the food and they told us the meals were well presented. Changes to the meals were made following regular consultation with residents. The expert by experience said “I could not help but reflect on the fact that I had not seen the manager in her office at all during the day, as she was totally involved in the day-to-day running of the home, and I should imagine knows exactly what is going on at all times. I popped into the activities room to say goodbye, where she was running a staff meeting, and was so impressed by the lovely friendly atmosphere in that room, and her comment to me of ‘just look how blessed I am with such wonderful staff!’ I left feeling very sure that as a united team, they do all they can to provide loving care with dignity to all those who live at Tendring Meadows”. What has improved since the last inspection? The standards of activities, entertainments and outings had improved and links to the community were being developed. The manager put considerable emphasis on training and supervision of staff and regularly worked on the floor to monitor standards. The overall standard of cleaning had continued to improve. The new dementia care unit was providing an appropriate and caring environment for older people with dementia. What the care home could do better: Communication within the home and with outside professionals could at times be improved. As a result of a number of safeguarding referrals, that highlighted problems with communication, staff had received additional training in communication and customer care. Some improvements in medication were needed and the manager was arranging additional training and supervision of staff. They had also obtained a more detailed medication audit, which was implemented following the inspection. Additional hand rails were needed in some parts of the home in order to assist residents with mobility problems to remain more independent.Tendring Meadows Care HomeDS0000015329.V378485.R01.S.doc Version 5.2 Key inspection report CARE HOMES FOR OLDER PEOPLE Tendring Meadows Care Home The Heath Tendring Clacton on Sea Essex CO16 0BZ Lead Inspector Key Unannounced Inspection 18th November 2009 09:00 DS0000015329.V378485.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.2 Page 2 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 Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tendring Meadows Care Home Address The Heath Tendring Clacton on Sea Essex CO16 0BZ 01255 870900 01255 870973 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) G A Projects Limited Manager post vacant Care Home 53 Category(ies) of Dementia (53), Old age, not falling within any registration, with number other category (53) of places Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 Dementia - Code DE The maximum number of service users who can be accommodated is : 53 17th September 2008 2. Date of last inspection Brief Description of the Service: Tendring Meadows Residential Home is in a very rural position to the north of Colchester. It is registered to provide personal care for up to 53 older people and older people with dementia. The accommodation for residents is on two floors. The home has a mixture of single and double rooms available. The accommodation is divided into four separate units, Clover, Poppy, Primrose and Bluebell. There are communal rooms in each of the four units. One of the lounges is predominantly used as an activities area. The first floor is accessible by both stairs and a lift. The weekly fees at the time of inspection in November 2009 were £390 to £550. There were additional fees for private chiropody, hairdressing and toiletries. For more up to date information on fees please contact the home directly. Tendring Meadows Care Home DS0000015329.V378485.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 two star good. This means that people who use this service experience good quality outcomes. This key inspection was carried out on 18th November 2009. The term resident is used throughout this report to describe people living in the home and the term we refers to the Care Quality Commission (CQC). All the key national minimum standards (NMS) for older people were assessed during the inspection. The report was written using evidence accumulated since the last key inspection on 17th September 2008, as well as evidence found during the site visit. This included looking at a variety of records and inspecting parts of the premises. During the inspection we had chats of various lengths with five residents and five members of staff including the manager. We spoke with two relatives during the inspection. We sent out surveys prior to the inspection and we received fifteen from residents, some of whom had assistance from their relatives to complete the surveys. We received seven surveys from staff. Comments from the surveys and conversations have been included in the report where appropriate. The report was written using evidence provided by the manager and this included the annual quality assurance assessment (AQAA) sent to us prior to the inspection. The AQAA is a self assessment required by law and provides an opportunity for the management to tell us what they do well and areas they are looking to improve and/or develop. It is anticipated that some improvements would be noted, as this contributes to the inspection process and indicates the homes understanding of current requirements, changes in legislation and their own audited compliance. An expert by experience accompanied us for part of the inspection. An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The expert by experience’s views and comments have been included in the appropriate sections of the report. The home’s registration was varied in May 2009 to enable them to admit residents with dementia. Primrose had been designated as the new dementia unit. Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.2 Page 6 What the service does well: Residents and relatives we spoke with and those who responded to our survey told us that they were very happy with the standards of care in the home. A resident told us “I’m very happy, and there is nothing I can think of that I would like to change’. Another resident said “I’m quite happy with the staff and I have many a joke with them. I’m quite content here, staff are now like family”. A resident who was asked what the home did well said “everything, the home is run perfectly”. One person who wrote a complimentary note following a period of respite in the home described their time in the home as “very enjoyable” and said “I am looking forward to my next ‘holiday’ with you”. Residents and relatives told us that the home was kept fresh and clean. One resident described the laundry service as “excellent”. Residents were complimentary about the food and they told us the meals were well presented. Changes to the meals were made following regular consultation with residents. The expert by experience said “I could not help but reflect on the fact that I had not seen the manager in her office at all during the day, as she was totally involved in the day-to-day running of the home, and I should imagine knows exactly what is going on at all times. I popped into the activities room to say goodbye, where she was running a staff meeting, and was so impressed by the lovely friendly atmosphere in that room, and her comment to me of ‘just look how blessed I am with such wonderful staff!’ I left feeling very sure that as a united team, they do all they can to provide loving care with dignity to all those who live at Tendring Meadows”. What has improved since the last inspection? What they could do better: Communication within the home and with outside professionals could at times be improved. As a result of a number of safeguarding referrals, that highlighted problems with communication, staff had received additional training in communication and customer care. Some improvements in medication were needed and the manager was arranging additional training and supervision of staff. They had also obtained a more detailed medication audit, which was implemented following the inspection. Additional hand rails were needed in some parts of the home in order to assist residents with mobility problems to remain more independent. Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.2 Page 7 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. Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.3 Page 8 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 Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.3 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3, 5. (6 not applicable) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be confident that their needs will be assessed before making a decision about admission. EVIDENCE: The home had a range of information for potential residents and their families or representatives. These included a statement of purpose, a guide for residents and a brochure. The statement of purpose had been updated since the last inspection but still stated that the home was registered to admit residents with learning disabilities, which was incorrect. This was be rectified following the inspection. The majority of residents and relatives who completed our survey told us that they had been given sufficient information to Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.3 Page 10 enable them to make a decision as to whether Tendring Meadows was the right home for them. One relative told us that the manager gave them a “really comprehensive” tour of the home with “loads of information” and said that their introduction to the home was “extremely good and much better than other homes I visited”. Prospective residents were encouraged to visit and spend time at the home before making a decision about admission. A trial period of up to six weeks was offered in order to ensure that the resident and their family were happy with the care and services and wanted to accept a permanent place at the home. The home offered respite care for older people and a number of people who stayed for a period of respite went on to take up permanent residency at a later date. One resident said that staff helped them to settle in when they first arrived. They said “I was accepted by everyone right away”. The manager or one of the two deputies carried out the pre-admission assessments. The assessments we looked at generally contained an adequate assessment of residents’ physical needs but the section for assessing potential residents with dementia needed to be expanded. The manager confirmed that a more comprehensive assessment was introduced following the inspection. A social services or health assessment was also obtained where appropriate. Some of the senior care staff were being trained to carry out assessments, first by observing and then by carrying out assessments under supervision. Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.3 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive good care and their health needs are met. EVIDENCE: Residents and relatives we spoke with told us that they were very happy with the care and support they received. One relative told us that they made a positive choice for the resident they visited to return to the home after a spell in hospital “(because) I think they look after residents as well as they could in the home”. The majority of residents and relatives who completed our survey told us that they “always” received the care and support they needed. The majority of staff told us that they “always” or “usually” had up to date information about residents’ needs and felt that the ways they shared information generally worked well. Staff we observed had a friendly and caring Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.3 Page 12 manner and were respectful and supportive with residents. Residents told us that staff respected their privacy and treated their room as their private space. The expert by experience said that they were “instantly impressed by the very patient and caring staff” who worked in the dementia care unit. “One carer was trying to encourage a resident to walk into the lounge, which was clearly quite a major feat but they persevered and gently guided the resident whilst talking in a kind and clear manner. I could see that in terms of staff time and energy it would have been much easier to have wheeled the resident in a wheelchair but I was most impressed that the member of staff had the time, patience, and understanding to know that the walk was far better for them both physically and emotionally”. There was evidence that staff in the dementia unit had closely monitored one resident’s behaviour when they were first admitted as they initially had difficulty settling in. During the inspection we observed a number of staff on the dementia unit demonstrate a calm, gentle and supportive attitude towards another resident who was tearful and distressed for a period of time. We looked at the care records for three residents. The care plans were of a very good standard and focused on the individual needs of each resident. They contained details of residents’ abilities and the assistance they needed with different aspects of their care. One clearly demonstrated how a resident was supported to remain as independent as possible and how staff could respond to their changing needs. The care plans had been reviewed monthly but would have benefited from an evaluation of care and care needs in order to provide more detailed evidence that they were monitoring residents on a continuous basis. The manager confirmed that this was implemented following the inspection. The manager said that they regularly checked the care plans to see whether changes in residents’ condition were being documented and any healthcare concerns were being identified. She also questioned staff about the content of the care plans to check on their understanding and on whether the care was being provided in line with the care plans and in a consistent manner. This is excellent practice. The majority of residents’ care folders were held in their rooms so that staff had access to the up to date care plans and could promptly record any changes in their condition. Residents who did not want their folder in their rooms had their wishes respected. The daily care records were generally of a good standard but on occasions would have benefited from more evidence that staff were monitoring all aspects of the residents’ condition on a daily basis. The home had a range of risk assessments to assess residents condition and take preventative measures when necessary to prevent harm. The assessments included assessing the risk of falls, mental health risk assessments and the risks of moving and handling residents in different Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.3 Page 13 situations. Residents’ weight was monitored monthly unless there were any concerns about their condition or they had unplanned weight loss, in which case they were weighed more frequently. All residents had their daily food intake monitored. However, the manager might want to consider using a more detailed and accurate type of recording and restricting the monitoring to those at particular nutritional risk. The manager said that staff were aware of the links between dehydration and the increased risk of falls and confusion and encouraged residents to have regular drinks. The amount of fluids residents were drinking was monitored if there was any concern about their condition. Staff were keeping good records if residents developed any marks on their skin or injuries. Accident records were well completed and the manager was monitoring accidents in order to establish if there were any patterns in the accidents that might need to be addressed. Relatives whom we spoke with told us that staff always kept them up to date with residents’ condition and that staff always let them know about any accidents or health concerns. The monitoring of residents’ health was continuing to improve and there was evidence that residents were referred promptly and appropriately if they had any nursing or medical needs. The majority of residents who responded to our survey told us that staff “always” made sure that they received the medical care they needed. A resident said “They look after you if you have a cold or aren’t feeling well”. Staff told us that they had excellent support from the local GP. They carried out a surgery at the home every week and also made additional visits when needed. The manager said that there had been some problems with communication with district nurses last year and in the early part of this year but following meetings this had now been satisfactorily resolved. Staff said that they now had good liaison with the district nurses and very good support. Residents told us that they saw the chiropodist on a regular basis and had optical and dental checkups when needed. Medicines were stored securely in a medicines room on each floor. Staff told us that they recorded the temperatures of the rooms where medicines were stored. The record we looked at demonstrated that staff were not recording the temperature at the hottest time of the day or using a maximum/minimum thermometer. The temperature in one room was recorded as being between 26-28c, which is above the safe maximum of 25c, on a number of occasions with no record of any action taken to address this. This could mean that medicines were being administered to residents when they were no longer fit to be used. The home had a fridge to store medicines that needed to be stored at a low temperature. The temperatures were being monitored daily and action had been taken when the temperature was outside the safe limits of 2-8c. The homely remedies on the ground floor were not being accurately recorded. The balance of senna and paracetamol were not correct. In the case of the paracetamol 72 tablets were not accounted for. The manager said that the paracetamol had been removed because it was out of date but had not been Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.3 Page 14 recorded. Staff were in some instances transcribing prescriptions onto the medicine administration records (MAR). There were some good clear entries on the MAR indicating why medication had been changed and who had authorised the changes. However, staff were not always signing and dating entries they made or providing the name of the prescriber. One resident did not receive one of their prescribed medicines for two weeks. A code was used but there was no explanation on the MAR as to why the resident had not received the medicine or what the code referred to. There were systems in place to ensure that one resident who needed regular medication throughout the day received their medication on time. The majority of medicines with a limited shelf life had been labelled with the date on first opening. The manager told us that all staff who administered medicines had received training, had been supervised and had an assessment of competence. Additional training and supervision was being arranged. The manager told us that they were booking advanced medication training for themselves and the deputy managers. The manager sent us a new more detailed medicines audit tool that was being introduced following the inspection and they said that this tool was being used in supervisions to assess and improve staff knowledge and understanding and to monitor staff recording and management of medicines. Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.3 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14, 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have a wide range of activities with links to the local community and are offered a balanced and nutritious diet. EVIDENCE: The home had two activity coordinators. The manager had also advertised for volunteers to help with activities so that residents had a range of people to provide stimulation and interest. The manager said that some people had responded to the adverts and were due to start following their criminal records bureau checks. Residents who responded to our survey told us that there were “always” activities that they could take part in if they wished. The standard of activities, entertainments and outings had improved considerably since the last inspection. The manager said that they tried to take some residents out every week. Trips to bingo in Clacton, fish and chips in Harwich and trips to the local pubs and cafes were among the trips that had been Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.3 Page 16 arranged. Staff had arranged for one resident to go on holiday for a disability weekend accompanied by two carers. The resident told us how much they had enjoyed the holiday. The manager said that they had also booked a holiday for another resident. The home had purchased a Nintendo Wii and said that some of the residents very much enjoyed the games. Staff used an exercise DVD to lead exercise sessions for residents three times a week and had purchased additional equipment for a number of physical games to improve residents’ muscle strength, coordination and mobility. Activities in the home included cooking, crafts, drawing, painting, crosswords, word games, bingo and other games. One of the communal rooms had all the walls decorated with residents’ art work. A fete was held in the summer. The home celebrated Halloween; areas of the home were decorated, a buffet was served and both residents and staff dressed up. A fireworks party was held in the first week of November and hotdogs, burgers, home made soup and sherry was served. Money raised at these events was used to further improve activities for residents. The expert by experience said that “During some of the happy conversation in an activity session, mention was made of various outings that were being planned for the next few weeks, with particular reference to two separate local pantomimes that were being attended by different residents, and the Christmas party plans were also talked about. This was very pleasing, as it showed that the residents were given the opportunity to get involved in the wider community, and they were obviously really looking forward to the Christmas Season coming up”. One of the activity coordinators told us that they were encouraging relatives to help set up memory boxes that could be used for one to one chats with residents and reminiscence. The manager said that residents were offered free massage, pedicures and manicures on two afternoons a week from a volunteer. One resident who did not want to join in the group activities told us that they appreciated the fact that staff came to have a chat with them in their room. They said that they were given the opportunity to go out if they wished but did not feel able to do so because of their condition. The activity records we looked at were of a good standard and showed how individual residents had responded to the activities and interacted with other residents. Residents on the dementia unit who were physically active were involved in day to day activities such as cooking, preparing snacks, laying the table and washing up under supervision. The home held entertainments every month that included fortnightly drama therapy and a visit from a singer on a monthly basis. Staff arranged a party, with a cake and present on residents’ birthdays if they were in agreement. The expert by experience said that they observed an activity session that “was handled brilliantly”. The member of staff “treated the residents with respect and dignity, whilst creating a lovely happy atmosphere of friendly banter with Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.3 Page 17 lots of laughter”. They did say that residents would have benefited from having an additional member of staff to assist when they played bingo so that those furthest away from the activity coordinator could fully join in the game. The home had no restrictions on visiting as long as the resident concerned was happy with this. Relatives told us that they were always made to feel very welcome. The manager told us that they kept in touch with some relatives by email, which they appreciated. One relative who wrote a complimentary letter described “the kindness and consideration not only to them (the resident) but to the family too”. The manager was developing links with the local community. A local cub group were visiting residents at Christmas. The Salvation Army visited and spent time with residents. The manager was endeavouring to establish links with local schools and churches but said that they had not been successful. The vicar who used to visit on a monthly basis had been unable to continue the visits due to work constraints. The manager said that once a fortnight they held a short service within the home with a prayer and some hymns, which residents appreciated. A number of residents told us that they wanted to be as “independent as possible” and said that staff supported them with this. They told us that they got up and went to bed when they wanted and spent their day where they liked. The expert by experience noted that residents chose where they wanted to eat, some in the dining rooms and some in their own rooms. One member of staff who responded to our survey considered that the home could provide “more focus on independence and providing personal services for residents rather than general care”. The majority of residents told us that they “always” or “usually” liked the meals provided, only one resident told us that they “sometimes” liked the meals. The expert by experience noted that residents who needed it were given different levels of assistance with meals depending on their needs. They said “It was lovely to see the manager in the dining room, assisting one of the more vulnerable residents, who needed to be patiently coaxed into eating. I was very impressed to see such a ‘hands-on’ approach from the manager, as it meant she was totally aware of what goes on in the home, and had developed a great rapport with her staff”. The food we saw at lunchtime looked nutritious and appetising. A number of residents commented on how well the food was presented. The menu offered a choice at all mealtimes and different diets were catered for. The manager said that salads had been introduced as an additional third choice at lunch times. The cooks visited residents on a regular basis to get feedback on the food served and suggestions for changes to the menu. The manager conducted regular audits on residents’ satisfaction with the menus and the meals served. There was evidence that actions were taken to address issues raised by residents and they were monitored again to ensure that residents were satisfied with the improvements. A relative said that they appreciated Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.3 Page 18 the “good support and assistance” a resident was given with meals as they could not feed themselves. One relative considered that residents’ “dietary needs not always adhered to, for example diabetics being given biscuits regularly”. Residents had access to drinks and snacks both day and night. There was evidence that staff provided residents with sandwiches and snacks in the night when they felt hungry. One resident said, “The meals are usually excellent, I’ve never had cause to complain”. Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16, 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their concerns are promptly addressed and that steps are taken to protect them from abuse. EVIDENCE: Residents told us that they knew who to speak to if they were not happy with anything in the home and knew how to make a formal complaint if they needed to. The majority of residents told us that staff “always” listened and acted on what they said. Staff told us that they knew what to do if someone had concerns about the home. Verbal concerns and complaints were being well recorded, along with details of any investigation, action taken and feedback to the person concerned. The records demonstrated a positive attitude to addressing any concerns, a willingness to learn from mistakes and a commitment to using complaints to improve standards at the home. A resident told us, “If I have any concerns I mention it to staff and they always sort it out. They always ask if I have any concerns or problems”. Another said that they had never had any complaints in all the time they had been in the home. A relative told us “The family always feels they are able to discuss any problems with the manager, who acts on our requests”. Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.3 Page 20 The home had a safeguarding and a whistle blowing policy and staff told us that they felt confident in reporting any suspected poor care practices or abuse. There had been a number of safeguarding referrals in the past year. The majority had an element of poor communication that had led to the referrals. Two of the referrals had been made due to the problems paramedics had communicating with foreign staff on night duty. The mix of staff had been changed and staff had received additional training on referring residents to the emergency services. Some of the safeguarding issues had resulted following the breakdown in communication between the home and the district nurses and this had been resolved following meetings. The manager had taken swift and appropriate action following the safeguarding referrals. Where the complaints identified individual staff they received additional training and more frequent supervision and monitoring by senior staff in order to ensure that the problems did not recur. A number of staff had received training on communication and customer care in the previous six months. Staff had received safeguarding training and the manager said that they would also be attending an additional six week’s training sessions on safeguarding vulnerable adults. The minutes of staff meetings provided evidence that safeguarding issues were regularly discussed and good practices were reinforced. Two residents told us that they “feel safe in the home”. Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.3 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean and well maintained environment. EVIDENCE: Residents had been encouraged to bring their own belongings and furniture into the home. The expert by experience noted that one resident “had a lovely clean and homely bedroom, which they had personalised with their own table and chairs, a comfortable armchair and lots of family pictures and memories”. The home had baths available on each unit and there was a shower on each floor to enable residents to have a choice of bathing facilities. The double rooms all had an en-suite bath or shower, which made it easier for residents Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.3 Page 22 who wanted more regular baths or showers. None of the double rooms were being shared at the time of this inspection. Some of the toilets in communal areas and in residents’ rooms did not have grab rails to assist residents with mobility problems. This could potentially reduce residents’ ability to remain independent. The home was clean and had no unpleasant odours on the day of inspection. The overall standard of cleaning had continued to improve. The majority of residents who responded to our survey told us that the home was “always” kept fresh and clean. Only one resident said that it was “sometimes” fresh and clean. Staff had the appropriate equipment to handle clinical waste and soiled laundry and had a good supply of personal protective equipment. Residents told us that they were very happy with the standard of the laundry. One resident described it as “excellent”. Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29, 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive care from an adequate number of well recruited and well trained staff. EVIDENCE: The majority of residents who responded to our survey told us that staff were “always” or “usually” available when they needed them. We looked at the rotas for six weeks. The staffing levels were satisfactory for the numbers and dependency of the residents. The majority of staff felt that there was “always” or “usually” enough staff to meet residents’ individual needs. However, one relative considered that “there often seems to be staff shortage, which results in residents having a long wait when requiring assistance”. Some staff were on occasions working long hours in excess of 65 hours in a week. The manager said that they monitored the hours that staff worked and cut them back if they felt that this was impacting on their ability to do their work or their own health. The home had sixteen hours of domestic support every day and eight hours laundry support five days a week. There were two kitchen staff in the morning and one in the evening on three days a week. Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.3 Page 24 The majority of staff who completed our survey told us that they received training that was relevant to their role, kept them up to date and helped them to understand and meet residents’ individual needs. New staff received an induction in line with skills for care. The majority of staff considered that their induction provided the information that they needed to carry out their job. The manager said that they had plans to improve the induction and said that one of the deputy managers was going to take responsibility for the induction programme. The home had a sound recruitment procedure. A criminal records bureau check was carried out and two references were obtained. Potential staff made a declaration in relation to previous convictions and a health declaration. Identification was held on file. A record of interviews was made in line with good equal opportunity practices. Staff confirmed that they had completed criminal records checks and had references taken up before they started work at the home. On the day of inspection a potential job applicant was spending time in the home to help them decide whether they wanted to apply for a carer’s post. A relative told us “They could employ staff that can speak better English so that residents could understand, it’s very hard for the elderly”. The expert by experience said “I noticed that some of the residents had difficulty understanding the foreign accent of one of the members of staff serving tea, although they seemed very pleasant and genuinely caring. I could see how, particularly for those who were hard of hearing or a little confused, misunderstandings could occur through not being able to understand what was being said”. The manager said that they recruited eastern European staff when there were insufficient local staff to fill vacancies. Foreign staff were all enrolled on literacy and numeracy courses as soon as they took up post and on completing the course commenced the national vocational qualification (NVQ) at level 2. A number of staff had also completed training in communication and customer care. The manager had a training programme and was booking training on a rolling basis. Staff were attending a dementia care course over nine weeks. In addition to the mandatory training there was evidence that the manager was arranging training that related to residents’ specific needs. For example care of a tracheostomy and suctioning. Some senior staff had also been trained to monitor the blood glucose levels of residents with diabetes. A number of staff had received training on end of life care. Staff had attended the first wound care training and been supplied with appropriate dressings. This then enabled them to dress any residents’ wounds when they first occurred so that they were suitably covered until they could be assessed by the district nurses. A number of staff had received training on catheter care and the prevention and management of pressure sores. Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.3 Page 25 The manager and deputies had received training in the Mental Capacity Act and deprivation of liberty safeguards. Senior care staff had also received training in the Mental Capacity Act. The manager confirmed that this training would be cascaded to all staff in the near future. A member of staff told us “training is good and always available”. Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.3 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35, 36, 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a well run home that is run in residents’ best interests. EVIDENCE: The manager was appointed to the post in October 2007 and had one full time and one part time deputy as well as administrative support. They had successfully completed the registration process with CQC at the time of this inspection and were waiting for their certificate. They had completed the registered manager’s award. The manager was running the home in the best Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.3 Page 27 interests of residents and was working alongside staff to promote person centred care. Staff described the manager as “very supportive” and told us how much the standards in the home had improved since they took up post. Staff told us that they had excellent support from the manager. We spoke to a number of the staff, who had nothing but praise for her. One member of staff told that they had worked in other homes, but much preferred Tendring Meadows, ‘as I feel very much at home here’. Another member of staff described the manager as ‘absolutely perfect, she is not at all bossy, but explains what she wants us to do clearly and kindly’. A relative described the manager as “supportive”. We looked at a number of very complimentary cards and letters sent to the home by residents and relatives of residents who had spent time in the home. The proprietor carried out monthly visits in line with Regulation 26 and completed a short report. However this would benefit from being expanded in order to provide evidence that they were monitoring the standard of all aspects of care and services provided. The manager and deputies held regular staff meetings and used the meetings to reinforce good care practices and promote good standards in the home. The need to promote residents’ independence and encourage choices was emphasised in the meetings. The manager carried out a number of audits in the home to ensure that equipment was safe for residents to use. These included safety checks of the hoist slings and wheelchairs and ensuring that hoists and the lift were regularly serviced. A cleaning audit was carried out approximately every two months to monitor standards of cleaning and to identify any furniture or furnishings that required replacement and areas that needed to be redecorated. One of the deputies started work at 06:00 three times a week in order to supervise night staff and ensure that residents were getting a genuine choice about the time they got up in the morning. A good observation of a carer’s practice was documented and there were records of 1:1 discussions on the standard of carers’ work and the support and training needed. The manager said that they were working with carers to evaluate their strong and weak points and to provide support, additional supervision and training where needed. The manager was also working on team building concentrating on achievements and building up morale. The home held a small amount of personal money on behalf of residents if they did not wish to hold it themselves. The administrator managed the monies on a day to day basis and liaised with relatives if additional funds were needed for example for toiletries, chiropody, newspapers, sweets or hairdressing. We inspected a sample of residents’ monies. The balances were correct and receipts were available for all transactions. The administrator confirmed that residents signed when they received any money and that relatives signed to confirm that amount of money that they were handing over for residents’ use. The system for managing monies was audited on a regular basis. Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.3 Page 28 There were systems in place for maintenance and servicing to ensure that equipment was safe for residents to use in the home. Portable appliance testing was regularly carried out. The home had a fire risk assessment. There was evidence of fire alarm tests and a fire drill. There were systems in place to regularly check and adjust the water temperatures to reduce the risk of residents scalding themselves. The home had data sheet for all the chemicals used in the home, so that staff knew what to do if any resident or member of staff had accident with any of the chemicals and could provide the appropriate information if they needed to attend the hospital. Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.3 Page 29 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 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 3 3 X 3 Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.3 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement In order to protect and safeguard residents when managing medicines the following must be done: Ensure that residents receive all their prescribed medicines. Take action if the temperature of medicine storage areas goes above 25c. Keep accurate records of all medicines disposed of in the home. 2. OP22 23(2)(n) Grab rails must be installed by all residents’ toilets. In order that residents can maintain their independence as long as possible. 01/03/10 Timescale for action 21/12/09 Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.3 Page 31 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 OP9 Good Practice Recommendations Hand-written changes or additions to medication records should be signed and dated by the person making the change and checked for accuracy by a second person. Tendring Meadows Care Home DS0000015329.V378485.R01.S.doc Version 5.3 Page 32 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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