Care Home: The Meadows

Similar services:

• Flint House
• St Vincents
• The Cotswold Home
• Fairways
• Winton House
• Treloar College
• Rush Court

What the care home does well Prospective service users and their representatives are encouraged to visit the home before making a decision to move in for a trial period. Service users expressed their satisfaction of living in the home, the care provided and the facilities available. The home is run in the best interests of the service users. The home is well maintained, clean and free from unpleasant odours. Service users are confident that any complaints will be listened to, taken seriously and acted upon. What has improved since the last inspection? The manager was registered with the commission in November 2008. A full time head of care and activities organiser have been appointed. The manager has successfully recruited several volunteers to run the home`s shop and assist with the weekly coffee morning. What the care home could do better: Following the inspection we received an action plan from the manager Maria Johnson, detailing actions to be taken in areas identified in the body of the report. No requirements have been made at this inspection. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Meadows Britwell Road Didcot Oxfordshire OX11 7JN     The quality rating for this care home is:   two star good service 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. Lead inspector: Marie Carvell     Date: 2 6 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 28 Information about the care home Name of care home: Address: The Meadows Britwell Road Didcot Oxfordshire OX11 7JN 01235518440 01235518469 manager.themeadows@osjctoxon.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Orders Of St John Care Trust Name of registered manager (if applicable) Mrs Maria Johnson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 68 The registered person may provide the following category/ies of service only: Care home with nursing (N) 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 - OP Dementia - DE Physical disability - PD Date of last inspection Brief description of the care home The Meadows is a purpose built care home that was completed in October 2004. It provides both nursing and residential care to older people. Didcot is an expanding town, approximately 12 miles south of Oxford, with a good mainline rail service and bus links to local towns such as Abingdon and Wallingford. Care Homes for Older People Page 4 of 28 0 0 0 Over 65 68 68 68 care home 68 Brief description of the care home The home is next to a school and the town Civic Centre. Local shops and a major new shopping precinct are nearby. The home has three floors. All floors are served by a lift and stairways. There are 68 single rooms for residents that all have an en suite shower, toilet and hand basin. Each floor has spacious sitting and dining rooms and adapted toilets, bath and shower rooms for disabled residents. The ground floor also has a separate day care facility with its own entrance. There is a hairdressing salon, therapy room and shop just off the main reception area known as the `Heart of the Home. The landscaped gardens have a central water feature, flower and herb beds and planted arbours. The kitchen and laundry areas, staff rest rooms, reception and administration offices and the home managers office are on the ground floor. The current scales of charges as at June 2009 are between 505.00 and 970.00 per week, depending on the level of care required . There are additional charges for hairdressing, chiropody (none diabetic service users), newspapers, toiletries and taxi fares (tokens). Care Homes for Older People Page 5 of 28 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: The last key inspection of this service was completed in June 2007. This inspection was an unannounced key inspection. We( the commission ) arrived at the service at 10.20am and we were in the service until 7.20pm. It was a thorough look at how well the service is doing. It took into account detailed information provided by the manager in April 2009 and any other information that we have received about the service since the last inspection. We looked at how well the service is meeting the standards set by the government and have in this report made judgements about the standards of the service. Time was spent talking to service users and a visiting relative, the manager, area operations manager and staff on duty. We looked at communal areas of the home and examined a Care Homes for Older People Page 6 of 28 sample of records required to be kept in the home, including the case tracking of service user files and staff personnel records. We joined service users in one unit for the midday meal and spent time in each of the units observing how staff interacted with service users and how care was being delivered. 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 set out 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 28 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 28 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. Service users are assessed prior to admission to ensure that their assessed needs can be effectively met by the home. Evidence: All prospective service users are provided with information about the home, including the last inspection report, the homes statement of purpose, which has recently been updated. The homes service user guide is currently being reviewed and updated. Oxfordshire County Council/ Primary Care Trust have a block contract with the home for forty three of the sixty eight beds. Service users and a relative confirmed that they had received sufficient information about the home before moving in for a trial period. Several service users said that they and their family were able to visit the home to look at the facilities available or had stayed in the home previously for respite care. The manager carries out the majority of pre admission assessments of prospective Care Homes for Older People Page 10 of 28 Evidence: service users to ensure that the home is able to meet their needs. This is well documented on service user files. All service users are provided with a contract/ terms and conditions once they have decided to stay permanently. Care Homes for Older People Page 11 of 28 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. Care plans need to be in sufficient detail regarding lifestyle choices and preferences of the service user with regard to how care is to be provided and when. Care plans need to be developed to include how emotional, psychological and social care needs of service users are identified and met. The healthcare needs of service users are fully met. Medication administration, recording, storage and training are maintained to a high standard. Service users are treated with dignity and respect. Evidence: Care plans are drawn up from information recorded on the pre assessment documentation, agreed and signed by the service user/representative, as appropriate. Information regarding health and personal care is well documented. However, care Care Homes for Older People Page 12 of 28 Evidence: plans do not evidence how the emotional, psychological or social care needs are identified and met. Care plans are not in sufficient detail regarding lifestyle choices or the preferences of the service user with regard to when care is to be provided or how, this was discussed in some detail with the manager. This is being addressed by the Trust and is currently being piloted in several of the Trust homes. The healthcare needs of service users are met by three GP practices. Regular meetings are held with GPs, practice managers, the homes manager and head of care. From the evidence seen and in discussion with service users and nursing staff the medical needs of service users are fully met. One service user has behaviours that challenge the service, no guidelines were available as to how the behaviours are to be managed, staff training or whether a community psychiatric nurse is involved in the service users care. Following the inspection we received an action plan from the manager advising us that the guidelines for dealing with the service users challenging behaviours had been re copied and placed at the front of of the care plan she confirmed that each carer knows about the procedure and that training would be provided by the Trust. Service users are encouraged to take responsibility for their own medication following a medication and risk assessment, the majority of service users are happy for their medication to be administered by the staff team. Medication is administered by registered nurses or care staff who have undertaken medication training. From discussion with staff on duty, observation of medication administration by care staff, storage and recording, it is evidenced that medication procedures are maintained to a high standard. Staff were observed to interact with service users in a calm, respectful and kind manner. This was confirmed by service users and a visiting relative. Comments made included The care is excellent, cant fault, We are always made very welcome, Staff always have time to listen, Always very kind, The home is always pleasant and clean, no smells as we found in other care homes, Very happy, have no concerns, All the staff are very courteous. As in many other care homes, there is a wide range of racial,ethnic and faith backgrounds represented within the staff team compared with the current service users. From discussion with the manager, we consider that the home is able to provide a service to meet the needs of individual service users of various religious, racial or cultural needs. However, identified needs must be recorded in the care planning documentation. The religious beliefs of one service user was identified as potentially having an impact on any medical interventions. This was not documented and Care Homes for Older People Page 13 of 28 Evidence: following the inspection we received an action plan from the manager to confirm that the service users care plan for medical/healthcare had been updated and an action plan put into place, signed and dated by the service user. Care Homes for Older People Page 14 of 28 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. Service users are encouraged to make choices and to remain independent for as long as possible. Service users are encouraged to exercise choice and control over their daily lives. A range of activities and community involvement is available to meet the social needs of the service users. The manager is to review how the views of service users are sought and meal times in the home. Evidence: A full time, enthusiastic activity organiser has been in post since April 2009. Information regarding events, activities and outings are displayed throughout the home. Although a varied activities programme is in place, this was not evidenced from information recorded in service user care plans or daily records. The manager confirmed that the new care planning documentation will address this. Since the last inspection the manager has successfully recruited several volunteers to run the homes shop and assist with the weekly coffee morning. All volunteers complete a robust Care Homes for Older People Page 15 of 28 Evidence: recruitment process including satisfactory police checks. Service user meetings are held on a regular basis and service users confirmed that the manager visits each unit daily for a chat. The manager is to hold smaller meetings with service users as larger groups make it difficult for some service users to hear or understand what is being said. A box is to be provided on each unit to encourage service users/representatives to make suggestions/ideas for the running of the homes. Several service users confirmed that the routines are generally flexible in the home, such as how they spend their day, when to go to bed or when to get up. From discussion with service users and staff on duty, many service users retire to bed early, it was unclear whether this is the choice of the service users as this information is not recorded as part of the care plan. This was raised as a concern by relatives at the last key inspection. In one unit at lunch time it was observed that six of the ten service users were in wheelchairs and not transfered to a dining room chair for their meal. This was discussed with nursing staff on duty on the unit, who were unclear and gave one explanation that the service users in wheelchairs would need to be lifted from their wheelchair by a hoist and the limited space in the dining room. This has been raised at a previous inspections at the home, and was discussed with the manager and area operations manager. Following the inspection we received an action plan that the registered nurses and head of care will ensure that information will be written in the service users mobility care plan and the service user given a choice as to whether they prefer to remain in a wheelchair or assisted onto a dining room chair for meals. We joined service users in one unit for the midday meal. Service users are given a choice of two main courses from a menus displayed in the dining room. The meal was hot and tasty. Staff were observed to assist service users in a dignified and attentive manner. Service users said that the food was very good and there was a varied choice of meals. Since the last inspection the home has introduced protected mealtimes to ensure that nursing staff are available to assist service users and to monitor food quality and intake. Breakfast is served from 8.30am, the midday meal 12.30pm, the evening meal at 4.30pm and supper at 8.30pm. At the last inspection a food survey was sent to all service users and their representatives, regarding the time of the evening meal served at 4.30pm, following concerns from service users that this was too early. Forty plus surveys were received by the then manager supporting that the evening meal be served at 5.30pm. This has not been actioned. In discussion with staff on duty, comments made included Many service users go to bed very early, one service user Care Homes for Older People Page 16 of 28 Evidence: goes to bed after 3.30pm tea, Supper is provided if requested by the service user. Some service users said that they were offered a hot drink and a biscuit others said that if they went to bed before the supper drinks were given out then they wouldnt necessarily be offered a drink or something to eat. This was discussed with the manager as potentially some service users may not be offered a drink or something to eat from 4.30pm until the following morning, the manager agreed that this is unacceptable. Following the inspection we received an action plan from the manager advising us that she was to discuss meal times with the chef and change meal times to provide the evening meal ( teatime) to 5.00pm and supper to 8.30pm. She is to put this to the current service users for their views before changes are put into place. It is a good practice recommendation that the manager Maria Johnson, reviews and ensures that procedures are in place that all service users are offered a drink and snack at bedtime, unless requested otherwise. Care Homes for Older People Page 17 of 28 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. Service users are confident that any concerns or complaints will be taken seriously, listened to and acted upon. Policies and procedures are in place to protect service users from possible abuse. Evidence: The homes complaints procedure is displayed in the entrance hall. In the last twelve months the home has received eight complaints received either verbally or in writing. All were seen to be appropriately recorded with action taken and outcome clearly documented. Service users and a visiting relative were clear about the complaints procedure and said that they would speak to the manager or the person in charge at the time. Service users said that the manager always listened to any complaints/ concerns and were confident that their concerns would be taken seriously, listened to and acted upon. All staff receive training in safeguarding procedures including whistle blowing, during their induction and updated regularly. In discussion with staff on duty all were clear about the procedures. Safeguarding training was evidenced in training records. No safeguarding adult referrals or safeguarding adult investigations have taken place in the last twelve months. No referrals have been made for inclusion on the Protection Care Homes for Older People Page 18 of 28 Evidence: of Vulnerable Adults list ( POVA). The home has a copy of the Oxfordshire safeguarding adult procedures, which is available to all staff. Care Homes for Older People Page 19 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides safe, well maintained and spacious accommodation for service users. The home was found to be clean, well maintained and free from unpleasant odours. Evidence: The home is purpose built and is maintained to a high standard. The location and layout of the home is suitable for its stated purpose. There is a rolling programme of redecoration and refurbishment in place. It was observed in one unit that the dining room chairs were low compared with the height of the dining tables. Nursing staff confirmed that they had noticed this and wondered if this was one of the reasons, some service users prefer to stay in their wheelchairs. Following the inspection we received an action plan from the manager to confirm that the Trust will look at chair raisers available or buy chairs at the appropriate height. All areas of the home were seen to be clean, well maintained and free from unpleasant odours. This was commented on by a visiting relative and service users. From discuss with the housekeeping staff and from observation is it evident that staff take pride in maintaining high standards in the home. Care Homes for Older People Page 20 of 28 Care Homes for Older People Page 21 of 28 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. Staffing levels appear to be adequate to meet the needs of the service users. Recruitment procedures are robust. Staff are well trained and able to carry out their duties with confidence. Evidence: From discussion with the manager, staff on duty and observation of duty rosters, staffing level appear to be adequate to meet the needs of the service users. The home currently has vacancies for full and part time care assistants and bank registered nurses. Agency staff are used to cover staff vacancies and the manager tries to ensure that the same staff are used for consistency. Care and ancillary staff are encouraged to undertake national vocational qualification (NVQ) training. Currently 50 per cent of the care staff have achieved or are working towards NVQ at level II or III. All newly recruited staff complete an induction programme that meets skills for care standards. Each member of staff has a training and development programme. Training is well organised with all staff completing mandatory training as well as specialist training, Care Homes for Older People Page 22 of 28 Evidence: appropriate to their role. Updates are provided as necessary. From a sample of staff personnel files and discussion with staff on duty, it was evidenced that the home has robust procedures in place. Staff spoken to said that they enjoyed working in the home, felt valued and well supported by the Trust. Staff were observed to be carrying out their duties in a confident and professional manner. From discussion with staff on duty and observation, we consider that staff morale in the home is good. Care Homes for Older People Page 23 of 28 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. Service users benefit from a well managed home. Evidence: The manager Maria Johnson has been managing the home since March 2008 and was registered with the commission in November 2008. She is a well qualified nurse and experienced manager currently undertaking the leadership and management in care setting course. In discussion with service users and staff on duty all felt that the home was well managed and run in the best interests of service users. Staff described the manager as Always, prepared to roll her sleeves up if necessary, A good listener, Approachable and Firm but fair. Policies and procedures are in place and are reviewed on a regular basis. Procedures for dealing with service users monies and valuables are well maintained in line with Care Homes for Older People Page 24 of 28 Evidence: Trust policies. Nursing and care staff receive formal supervision at least six times per year. Reports written by a provider representative, following a monthly visit to the home, were available for examination. Quality assurance systems are in place and regular internal audits take place. Evidence was seen to demonstrate that the views of service users, representatives and staff are used to measure the homes success in meeting the aims, objectives and statement of purpose. A sample of records relating to health, safety and welfare were examined and found to be up to date and well maintained. Care Homes for Older People Page 25 of 28 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 26 of 28 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 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!