Care Home: The Meadows

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Meadows Meadow Lane, Anstey Way Instow Bideford Devon EX39 4JE three star excellent service The quality rating for this care home is: 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: Joanne Walsh Date: 1 2 0 3 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. They reflect the things that people have said are important to them: 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 Adults (18-65 years) 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. 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. Internet address www.cqc.org.uk Information about the care home Name of care home: Address: The Meadows Meadow Lane, Anstey Way Instow Bideford Devon EX39 4JE 01271861124 01271861124 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Blue Opal Limited care home 14 Number of places (if applicable): Under 65 Over 65 14 0 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary crae needs on admission to the home are within the following category: Learning disability (Code LD) The maximum number of service users that can be accommodated is 14. A bit about the care home 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: three star excellent service Choice of home Individual needs & Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Poor Adequate Good Excellent How we did our inspection: This is what the inspector did when they were at the care home This inspection took place during a week day in March and centered around gaining the views of the people who live at the home and those of the staff who support them. We spoke with eight of the people who live at The Meadows and six support staff, as well as the cook and registered manager. The views of the people we spoken to are included in the main body of this report and have helped us to gain a view and make judgments on how well the home meets outcomes for individuals. Prior to this inspection taking place we sent surveys to people who live at the home , to staff and to health care professionals who visit the service. We received 14 surveys from people who live at the home, 7 from staff and two from health care professionals. Their views have also been included in this report. During the inspection we looked at some of the key documents the home uses including plans of care, pre admission assessments, medication records, staff recruitment and training files and records relating to how the home manages individuals finances. This helps us to understand how well the home runs. Prior to any inspection homes are asked to provide an Annual Quality Assurance Assessment (AQAA), which gives us some key information about how the home is maintained and how well health and safety issues, training and quality assurance is being done at the home. All this information helps to inform the inspection process and helps us to make judgments about the quality of outcomes for the people they provide a service for. What the care home does well The Meadows provides people with complex behaviours a safe, well maintained and homely environment. The home is decorated and furnished to a high standard and individuals are encouraged to make their own room as personalised as they wish. People who live there say This is the best home I have been in. I like it here very much. Too much noise but I do like living here sometimes. The home has really good systems in place to ensure that a detailed pre admission assessment is completed prior to new people being offered a place. This ensures that the home can meet all assessed need and that they can plan for any additional staffing and begin to prepare detailed plans of care that give staff good information allowing them to understand individuals complex behaviours. Personal and health care needs are well planned, and individuals social and diverse needs are clearly identified and planned for. The home provides an excellent range and choice of activities and high staffing ratios to enable individuals to access community facilities safely and on a regular basis. Meals are planned around healthy eating, special diets and the likes and dislikes of individuals. There is a good range and choice offered and everyone spoken to expressed a high level of satisfaction for the meals. The staff team are well trained supported and in high ratios to provide quality support to individuals. The management is open and inclusive and ensures that the home is run in the best interests of the people who live there. What has got better from the last inspection What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Joanne Walsh 33 Colston 33 Colston Avenue Bristol BS1 4UA 0117 930 110 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 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home ensures that detailed pre admission assessments are in place prior to a placement being offered in order to ensure they can meet all assessed needs. Evidence: Pre admission assessments were looked at for the three newest people to the home. The files contained detailed information about each individual and showed that a very detailed assessment had been completed via visits to the individuals, and in some instances them coming to the home for a visit. The home ensures that they obtain all other assessments completed by their previous placement, hospitals and funding authority as well as making sure medical and emotional well being information is collated from their previous GP and/or consultant psychiatrist. This high level of information gathering and assessment allows the senior team to make an informed decision about whether they are able to provide a service for the individual and what level of staff support they will require. Some individuals have been assessed as needing one to one additional support and this is factored in to staffing levels prior to them coming. Staff spoken to on the day of the inspection and those who returned surveys confirmed that they have good pre admission assessment information on any new individuals and this helps them to plan for their care and support. One individual spoken to said that they had visited The Meadows before moving in and thought that it was good that they had had the opportunity to meet the other people and to talk to staff and see their new room. Judgement: The registered manager and the senior team explained that they ensure that they have completed their own detailed assessment so that they can get the staffing levels right and help to plan for how they will deal with behaviour that challenges. They will have begun a positive handling plan for an individual based on the assessment information before they move in. Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 . Care and support is well planned for individuals so that they are enabled to take risks as part of an independent lifestyle. Evidence: Three plans of care were looked at and discussed with staff. The plans are well written and give staff clear information on how to support each individual to ensure their personal, health care and social needs are met. Plans are reviewed monthly and any changes to plans are clearly identified. Plans are shared with individuals where possible and each person has a plan that is person centered and includes the use of photos to help them understand what goals their plans include. Risks are clearly identified with strategies identified to reduce or minimize risks. Any restrictions on choice or freedom of movement are clearly identified in plans and these are also reviewed monthly. This ensures that the home are not restricting individuals choice unnecessarily. Plans include positive handling plans, which give staff very clear bullet point information about known triggers for challenging behaviors, explains what signs to look for and clearly details the types of challenges likely to occur for each individual. The plan also gives staff very clear strategies to follow in order to reduce and deescalate any potential challenges. The information is reviewed by the senior team leader who is also the physical intervention tutor. Staff spoken to said that the information in plans of care was very detailed and gave them a good insight into the best ways of working with individuals. They also have detailed handover meetings between shifts to ensure that staff are fully aware of each individuals emotional well being, what they have been doing and any potential tigers Evidence: for challenging behaviours that have been observed. One staff member said we work really well as a team and make sure that information is shared about people who live here so we are all aware of their needs and how to support them. Individuals spoken to who live at Meadowside said that their needs were well met and most said that staff were good and helped them with their needs and wishes. Comments included I have never been to a home as good as this. It is good here, but I want to move on in the future. Its alright here, staff are okay, I would like to do gardening and growing veg and stuff. Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 . Individuals social and diverse needs are well met. Evidence: Plans of care and daily records show that individuals are offered a range of activities to suit their needs and wishes. Individuals spoken to said that they did a variety of activities including, trips to the local town, lunch out, drama group at the local college, swimming, riding push bike, arts and crafts at college and local evening clubs. Staff spoken to and those who returned surveys said that they team work hard to ensure that people have planned activities and holidays to suit their needs and preferences. There are some restrictions for individuals in accessing the kitchen for example. This is well documented in the individuals plan of care and risk assessments and is reviewed on a regular basis. The home offers a wide range and choice of meals. The cook ensures she is ware of individuals likes and dislikes and can cater for special diets. Individuals are offered a choice and comments included The food is really good here. We are given healthy food. I like the meals, I like fagots and chops. Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Individuals personal and health care needs are well met. Evidence: Plans of care and daily records show that staff clearly record individuals physical and emotional well being. They follow up and document any health care appointments, and the home pays for a retained service from the local GP surgery, which gives them access to one named GP who knows and understands the needs of people with challenging and complex behaviours. The home also pays for a retained service for a consultant psychiatrist who visits on a regular basis and provides advice, support and training in specialist mental health areas. Individuals spoken to and those who returned surveys said that their health care needs were well met and that they got to see health care professionals when needed. One person said They have been looking at my medication and I am really pleased about this. Another person said we can see the doctor when we are not well and staff help us with any appointments. The staff give me my medication because I would not be good with it. Two surveys returned from health care professionals said that health care needs were always well met and comments included usually manage correctly the individuals medication rather than them self administering. Provides a safe and supportive environment that is client centered and The home manages all aspects well especially individual rights and concerns. The home ensures that all medication is kept secure and only staff who have had training are able to take on the task of administering medications. The medication records are well maintained and appeared accurate. Senior staff confirmed that they Evidence: audit medications and check individuals staff competencies to ensure a safe system is in place. Staff spoken to appeared to have a good working knowledge of the types and medications individuals were prescribed and the reasons why. If any errors have occurred, these have been reported immediately and staff have undergone further training. The home are advised that it is good practice to use a bound and numbered pages book for any controlled drugs received and administered. Currently the home have a bound book, but the pages are not numbered. Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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 . Individuals views are listened to and acted upon. Evidence: As stated in the previous section, one doctor commented in their survey about what the home does well all aspects especially individual rights and concerns. Individuals spoken to who live at The Meadows said that they could make their concerns known to Sue the manager or their key worker. Two people said they wanted to move on and that they had discussed this with the staff. One person commented this is the best home I have been in, but I want to be near my family. Another newer person to the home said I think it is good here but I do want to plan to move on in the future. The registered manager is very active in ensuring that individuals views are listened to as part of their review, so that funding authorities are aware of individuals needs and wishes for the future. The home has a stated complaints process and this is made available in an easy read format for people. Everyone has a copy of the complaint process and all complaints have a record of what actions have been taken to rectify and resolve any issues identified. The Commission have received one complaint since the last inspection, which was anonymous and we are satisfied that the registered manager answered the issues raised fully. Staff spoken to said that they have received training in the protection of vulnerable people and had a good understanding of what constitutes abuse and who this should be reported to. The management team are aware of what they should do if they have evidence that someone may no longer be suitable to work with vulnerable people. Evidence: The home has very clear policies, procedures and training in respect of when physical intervention is used, and this is clearly detailed for each individual as part of their positive handling plan. Staff have training in breakaway techniques and only use physical intervention when their is a significant risk to safety for an individual or themselves. The home has robust systems in place for the handling of individuals finances and these were checked during the inspection. Three individuals monies were checked and there was an accurate and robust audit trail available. 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 Meadows provides people with a homely well maintained safe environment Evidence: During this inspection all communal areas were seen and some of the individual bedrooms. The home is very well maintained and decorated and furnished to a high standard to provide people with a homely environment. Since the last inspection two new bedrooms have been built. These are bed sitting type rooms with their own external entrances and afford people a greater degree of independence. The service are hoping to move this a step further with building some self contained accommodation for people on the same site. These would be a stepping stone to moving on and planning has been granted now and building work should start soon. Individuals are encouraged to personalize their rooms and a few were keen to show us their own rooms. The newer bed sitting rooms were looked at. These two newer rooms have a kitchen area each and their own entrance. Both rooms are sited at the back of the building and allow those individuals to have a greater degree of independence. One person said that due to having falls, the home have put an additional door in for them to enable them to access the main house without having to walk outside. All parts of the home were seen to be clean and free from any odors. There is a separate laundry and the home has policies and procedures in place to ensure that infection control is not compromised in any way. The kitchen staff use the Food Standards agency Safer food, Better Business and were not given a green light for health and hygiene in the kitchen by Environmental health department. 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 . Staff are well trained and supported to do their job. Evidence: Staffing levels are high and reflect the complex needs of the people who live at The Meadows. Some individuals require one to one or two to one support for going out into the community and staff rotas are planned so that additional staff are available throughout key times of the day to enable access to activities and into the local community. Six members of care/support staff were spoken to during this inspection and 7 returned surveys. All said that they received a good level of training and support including regular one to one supervision. One person did comment that they would like some training in sex offenders. This was discussed with the registered manager who has looked into getting training for this specific subject, but has been informed that the current information and planning the home do is in line with current thinking and good practice. Staff are either working toward or have achieved national vocational training in care. Training records show that staff have more than three paid days training and cover all aspects of health and safety and areas that are specific to the needs of the people they support. Staff have regular team meetings and most said that there is a good team spirit and the management of the home was supportive. Three staff recruitment files were looked at. They contained all checks and references that show the home have a robust recruitment process and only employ people who are suitable to work with vulnerable people once all checks are completed. Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 is well run and managed in the best interests of the people who live there. Evidence: The registered manager is qualified and experienced to run the home. She has recently completed the higher professional diploma in learning disabilities awarded by LDAF (Learning Disability Award Framework). She shows a commitment to her own ongoing training and for staff. This diploma has helped the registered manager look at empowering other staff and the senior management team have been taking on greater responsibility for certain areas such as recruitment and training. This in turn has allowed other roles to filter to less senior staff, and several commented that they had more recently enjoyed a greater degree of job satisfaction from having increased roles and responsibilities. The home has effective quality assurance systems in place that ensure the views of people who live there are considered as part of the review of the quality of service they provide. They have surveys, regular meetings and one to one time with individuals to ensure their views are listened to. Those people spoken to who live at the Meadows said that they could talk to the manager. One person said Sue will always make time to talk to us. The registered providers complete unannounced monthly visits and audit some of the important records, talk to staff and to the people who live at the home. This contributes to the overall quality assurance programme of the home. The AQAA provided us with information about how the home ensures a safe Evidence: environment via training, safety checks and servicing of equipment, so this was not checked specifically during this inspection. Staff spoken to did confirm that good training was available and knew where the policies and procedures were to be found for reference. The home have a proven record of ensuring that all accidents, incidents and anything effecting the well being of the people who live there is reported to the right body including us. Staff confirmed that induction training was completed and the senior staff member said that it did follow the skills for care framework. Any risks are well documented with comprehensive assessments and what should be done to minimise risks. Are there any outstanding requirements from the last inspection? Yes  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, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 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 Description 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 Description 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 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. 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