Care Home: The Meadows Care Home

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What the care home does well The home ensures an suitable admission process for people and continues to effectively monitor and demonstrate their capacity to meet peoples needs. Peoples health care needs are well met and accounted for from a person centred approach that focuses on promoting their dignity and privacy. Peoples rights and choices and their inclusion in home life are well promoted and they receive nutritious food in accordance with their assessed needs. Complaints, concerns and suggestions are taken seriously and acted on and people are suitably safeguarded from harm and abuse. People live in a home that is overall well maintained, clean and safe and which suits their needs. People may be assured that they will receive care and support from staff that is effectively recruited, inducted, trained and deployed. The home is well managed and run in peoples best interests by a competent and dedicated manager. What has improved since the last inspection? The home has complied with all requirements made at our last key inspection, which includes, Areas of identified upgrading, repair and renewal to the environment. Review of room provision for one service user with specialist mobility needs. Review of arrangements for the maintenance and repair of wheelchairs. Development of arrangements for the promotion of good infection control. The home gave us a lot of information in the AQAA about improvements they have made to their service over the last 12 months and since our last key inspection visit, which we saw at this inspection visit. These are detailed under the relevant outcome sections of this report. Some examples include, Developing their approach to pre admission assessment of individuals needs. Developments in their approaches to clinical and care care practises, including for infection control, falls management, end of life care and support and nutrition. Ensuring these continue to accord with recognised national and clinical standards. Improvements and changes to their activities and entertainments programme arising from what people who use the service have told them. Developments in their staffing arrangements. Including for staff NVQ training by employment of a dedicated and suitably qualified training co ordinator. Palliative care training for staff and including service users in staff recruitment and interviews.Renewal of moving and handling equipment. What the care home could do better: The service continues to show us that they run the home in peoples best interests and that they ensure effective quality monitoring systems based on seeking peoples views. So as to measure their own success in meeting their service aims and objective. This means that they usually know what they need to do to improve. They told us about their plans for further improvement in our AQAA return and also at our visit. These are detailed under the relevant outcome sections of this report. Examples of two stated of key improvements aimed for include, Ensuring the development of policy and procedural guidance and training for staff, so as to fully implement the considerations of the Mental Capacity 2005 in to their care practises. Replacement of their heating system in Rose Court. We also made one requirement and one quality recommendation at this inspection concerned with ensuring residents safety from potential burns and scalds from some radiators in Rose Court and for their medicines stock rotation system. Key inspection report Care homes for older people Name: Address: The Meadows Care Home Mansfield Road Alfreton Derbyshire DE55 7JL     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Susan Richards     Date: 2 5 1 1 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 31 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. 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 Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: The Meadows Care Home Mansfield Road Alfreton Derbyshire DE55 7JL (01773)520452 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: meadows@milfordcare.co.uk www.milfordcare.co.uk Mr Gerald Hudson,Mr Keith Sidney Dobb care home 70 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: 1. The registered person may provide the following category/ies of service only: Care home with Nursing Code N 2. The maximum number of service users who can be accommodated is: 70 To register 1 place for DE(E) for 1 individual named in the Notice of Proposal. 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 Physical disability Code PD Date of last inspection Brief description of the care home The Meadows Care Home is located in the town of Alfreton on a local bus route with access to a traing station and the M1 motorway. Accommodation provides two separate purpose-built units, each with accessible gardens and car parking provision. Care Homes for Older People Page 4 of 31 Over 65 70 0 0 10 Brief description of the care home Rose Court provides nursing care for up to forty older persons. There are thirty-four single and three shared bedrooms. Lavender Court provides personal care only for up to thirty older persons, with twenty-eight single rooms and one shared room. There are also ten places included in the overall registration for persons with physical disabilities. Each unit provides lounge and dining facilities with a choice of bathroom and toilets and dedicated kitchen and laundry facilities. People are provided with care and support from a team of care and hotel services staff, including registered nurses for Rose Court. Led by a registered manager and with external management support. The range of fees charged per week is 373.97 to 800.00 pounds. These are agreed by way of individual private contract or for those who may be eligible to assistance with funding. Determined via the local authority for accommodation and personal care and/or the primary health care trust for free nursing care. Care Homes for Older People Page 5 of 31 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 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 quality rating for this service is 3 stars. This means the people who use the service experience excellent quality outcomes. The focus of our inspection is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on any aspects of the service that need further development. We looked at all the information we have received, or asked for, since the last key inspection. This included: the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also has some numerical information about the service; surveys returned to us by people using the service and from other people with an interest in the service; information we have about how the Care Homes for Older People Page 6 of 31 service has managed any complaints; what the service has told us about things that have happened - these are called notifications and are a legal requirement; the previous key inspection and the results of any other visits we have made to the service in the last 12 months; relevant information from other organisations; and what other people have told us about the service. This inspection visit includes assessing compliance with previous any requirements made and the meeting of key national minimum standards. We sent out 10 surveys to people living in the home and received 9 responses. We sent out 10 surveys to peoples relatives or representatives via individual service users and 5 staff surveys. We received 8 responses from peoples relatives or representatives and 4 from staff. There were 52 people accommodated at the home on the day of the inspection visit. People who live in the home, visitors and staff were spoken with during the visit. We were assisted by the registered manager. Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Case tracking was used during our visit where we looked more closely at the quality of care and services received by some people living in the home. We did this by speaking to them and/or their relatives, observation, reading their care records, and talking to staff. All of the above was done with consideration to the diversity needs of people accommodated at the home. At the time of our visit all people accomodated were of British white Christians, male and female and with a range of disability needs, including sensory and physical. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? The home has complied with all requirements made at our last key inspection, which includes, Areas of identified upgrading, repair and renewal to the environment. Review of room provision for one service user with specialist mobility needs. Review of arrangements for the maintenance and repair of wheelchairs. Development of arrangements for the promotion of good infection control. The home gave us a lot of information in the AQAA about improvements they have made to their service over the last 12 months and since our last key inspection visit, which we saw at this inspection visit. These are detailed under the relevant outcome sections of this report. Some examples include, Developing their approach to pre admission assessment of individuals needs. Developments in their approaches to clinical and care care practises, including for infection control, falls management, end of life care and support and nutrition. Ensuring these continue to accord with recognised national and clinical standards. Improvements and changes to their activities and entertainments programme arising from what people who use the service have told them. Developments in their staffing arrangements. Including for staff NVQ training by employment of a dedicated and suitably qualified training co ordinator. Palliative care training for staff and including service users in staff recruitment and interviews. Care Homes for Older People Page 8 of 31 Renewal of moving and handling equipment. 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 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 9 of 31 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 10 of 31 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 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 an suitable admission process for people and continues to effectively monitor and demonstrate their capacity to meet peoples needs. Evidence: In our AQAA the home gave us all the information that we asked for, including some statistical information about the needs of people who live in the home. They described a comprehensive approach in ensuring that people have the information they need about the home to help them in choosing to live there and in ensuring that their needs are fully assessed with them before they move there. They also told us about service improvements they have made here. These relate mainly to developments in the way they assess peoples needs, including for increased consultation and involvement of prospective service users and their representatives. Outside health and social care professionals and also in assessing potential impacts on existing service users. Care Homes for Older People Page 11 of 31 Evidence: Improvements they say they aim to make over the coming months, focus on further promoting peoples rights, including in accordance with the principles of the Mental Capacity Act 2005 and seeking to obtain pre admission assessment information from placing authorities in a more timely manner. At this inspection people told us that they received the information they needed to help them choose the home and we saw that key service information is provided in a range of formats to help people who may have sight problems. People also told us that their needs are met. One person who was very recently admitted said they had visited the home before moving there and chose their room and decor therein. They also said they were involved in agreeing their care plan. We received many postive comments from people including, The home is friendly and welcoming. We were able to ask lots of questions and were well informed about the home. We saw that comprehensive needs assessment information was recorded for people we case tracked, based on a recognised model for individual and clinical needs asssessment. Including for personal safety and risk, for carer and family involvement and other social contacts and relationships. Together with daily living plans. All of these had recorded reviews. The home also routinely measures its own performance against the standards in this section by way of a formalised quality assurance and monitoring system. This includes for consultation with people and also their regular review of staff skills and experience. The home does not provide for intermediate care. Care Homes for Older People Page 12 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health care needs are well met and accounted for from a person centred approach that focuses on promoting their dignity and privacy. Evidence: In our AQAA, the home gave us with the information that we asked for for this outcome section. They described an inclusive approach to peoples individual care planning. In promoting peoples rights to dignity and privacy and to ensuring peoples access relevant health care services in accordance with their assessed needs and by promoting collaborative and partnership working with outside health and social care professionals. They told us that they seek to underpin practise with effective record keeping, including for peoples written care plans and by ensuring that staff receive the necessary traning to ensure peoples needs are met. They told us about twenty one areas of improvement they have made. These relate to health promotion and changes arising from local and national developments in Care Homes for Older People Page 13 of 31 Evidence: recognised care practise and for their quality monitoring of these. They also told us about improvements aimed for over the coming months. These include development of their strategic plan for implementing Living Well, the national dementia care strategy. Ensuring the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards 2009 are fully integrated into their needs assessment and care planning process and by finalising their End of Life policy strategy and related procedures. At this inspection we received many comments from people about the care and support they receive. These include, From the manager, nurses and carers, all do an excellent job. Support for the majority of the time is second to none. My mother is treated as a person. Staff are caring and she is happy at the home. Some people surveyed told us about a few improvements that could be made, including relating to the replacement of hoist equipment. We saw that these had been replaced and arrangements for providing regular physical exercise for people had also been revised with them. We saw that people case tracked had comprehensive and person centred written care plans in accordance with their risk assessed needs, with regularly recorded reviews. These were reflective of up to date and recognised clinical good practise guidance concerned with the care of older people and in promoting peoples equality and diversity. We also saw that the home has made considerable and successful progress in implementing their of End of Life strategy so as to promote quality and choice for care for the dying person. Records of the homes formal consultation with people about their experiences from this were extremely positive, with numerous written plaudits and we could see how peoples views were being used to further benefit others end of life experiences and from individually planned care. Also for the considerations of the Mental Capacity Act 2005 into their pre admission assessment and end of life care arrangements, including by way of planned staff training, instruction and resource information packs to support these developments. A relative of one person had written, Your team ensured my grandma spent the last 2 weeks of her life in comfortable surroundings, well looked after and that she passed away with dignity. Your team are wonderful. Care Homes for Older People Page 14 of 31 Evidence: Throughout our visit, we observed staff to be courteous, respectful and sensitive in their approaches with people, including assisting people with mobility problems, which they did so safely and patiently. People case tracked were provided with the equipment they needed in accordance with their assessed needs and written care plans. The arrangements for the ordering, receipt, storage, administration and disposal of peoples medicines and staff training for these, were in accordance with recognised practise and the homes own policy and procedural guidance for these. Although we found that stock rotation arrangements for some medicines did accord with best practise. We discussed this with the lead nurse and manager, who agreed to take the necessary action to address these. Care Homes for Older People Page 15 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples rights and choices and their inclusion in home life are well promoted and they receive nutritious food in accordance with their assessed needs. Evidence: In our AQAA the home gave us the information we asked for for this outcome section. They told us about their ethos and aims to promote peoples rights within their daily lives. Including for flexible daily living routines and maintaining contacts with families and friends in accordance with peoples choices and wishes. In establishing links with the local community, promoting a calendar of events that people can engage in both within and outside the home and in seeking to promote good nutrition for people. They gave us a range of examples as to how they achieve these and told us they regularly seek peoples views about their daily living arrangements, including by way of satisfaction surveys. Improvements made are said to be mainly as a result of feedback they have received from people, including from their formal satisfaction survey of December 2008. Examples given include for social activities and entertainments, exercise and physical activities, developing menus with people, provision of information for people about the Mental Capacity Act 2005 and Deprivation of Liberty Safeguarding 2009, improving Care Homes for Older People Page 16 of 31 Evidence: community links and development of a reminscence room at Lavendar Court. At our visit the home was in the process of repeating the satisfaction survey with people to determine their success of the improvements made. Improvements aimed for over the coming months include continuing to listen to peoples views so as to best inform their activities and events planning. Secure a mobile library service to visit the home and to develop one to one menu planning with people. At this inspection people told us that activities and events are regularly organised in consultation with them, that they can choose to join, both in an outside the home. Many people commented on the good food provided, although one person said improvements could be made by listening when they ask for a small portion. All said relatives and friends are made very welcome and can visit at any time. Lunches served were attractively presented, with a menu board displayed. People were asked given choices and received assistance where necessary. We saw that residents have recently become involved in the staff recruitment process by taking part in interviews and meeting applicants. The home provided us with feedback they had obtained from people about this. Comments included, It makes me feel like I have a real say in making decisions about the home. The home has also recently taken part in a European exchange visit via their local authority centre for voluntary services with representatives from Holland, Finland and Hungary visiting the home. One visitor commented, It was very interesting to see the wonderful work and standards that you and your staff achieve. One person recently admitted to the home, told us that a staff member was spending time with them to find out about their personal daily living routines and lifestyle preferences. People told us about recent activities and events they had particularly enjoyed. Examples include seasonal celebrations held at Halloween and Bon Fire night, craft sessions, a holiday to Skegness where a group of residents had chance to meet with residents from other homes in the group. Holiday to Butlines, trips to Twycross zoo and Butterley rail, canal trips and a shopping trip to a local designer outlet. Regular fund raising events are held, the proceeds of which go to the residents social Care Homes for Older People Page 17 of 31 Evidence: fund. One resident recently celebrated her 100th birthday with a party held for with family and friends, including a folk music duo. Milford Care groups twentieth anniversary celebrations provided entertainments, including a magic artist and flute player and Pimms and refreshments served. Some residents were involved there with fund raising stalls for the residents fund. Milford Group produces a quarterly newsletter for residents, which is displayed in the home along with information about weekly activities, entertainments and forthcoming events. The latter are also provided in large print picture format, together with photographs of various residents engaged in various social and recreational events. The latter included photographs of resident representatives from Milford Care group homes who attended and spoke at the most recent Caring Times congress. Minutes of residents and relatives meetings, including dedicated menu planning meetings were displayed on the residents noticeboard, along with information about local and community events and local advocacy services. Forthcoming events in the home included a wildlife workship where people can see and touch reptiles and small animals and regular pet therapy days are held. On the day of our inspection a choir visited the home during the afternoon, which people said they enjoyed. Plans and discussions were also in hand for forthcoming Christmas celebrations, including parties, a pub lunch and Christmas meal outing and Christmas card making competition. Care Homes for Older People Page 18 of 31 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. Complaints, concerns and suggestions are taken seriously and acted on and people are suitably safeguarded from harm and abuse. Evidence: In our AQAA the home told us they believe they are successfull in their service aims. To promote peoples independence, rights and responsibilities as ordinary citizens, enabling them to raise concerns and to make complaints or suggestions about the care and services they receive. They also told us some of the ways in which they do this, including by way of providing people the the information they need to assist them and by asking people about their experiences and satisfaction here. They told us they have continued to maintain and promote staff awareness about peoples rights to complain and for safeguarding people from harm by way of regular discussion, policy guidance and training. Together with providing training for senior staff in the Mental Capacity Act 2005 and its implications for care home. Improvements they aim for over the coming year include further training and information provision for all staff in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguarding 2009. They gave us some statistical information that we asked for. This tells us that they have received four complaints, including one that was reported and investigated via Care Homes for Older People Page 19 of 31 Evidence: joint agency safeguarding procedures. At this inspection people told us they know who to speak to if they are unhappy about anything in the home and how to complain. People told us that any issues or concerns raised are usually dealt with without the need to make a formal complaint. We also saw that people are provided with written information about how to complain and that the complaints procedures is openly displayed in the home. Staff spoken with were conversant with the homes policy and procedures relating to complaints handling and safeguarding people from harm and abuse and confirmed that they are regular opportunities for their training and instruction in these areas. We also saw that there are suitable and safe arrangements in place concerned with the use of bed rails, which accord with recognised safe practise guidance. Care Homes for Older People Page 20 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is overall well maintained, clean and safe and which suits their needs. Evidence: In our AQAA the home told us that their focus is on ensuring the home is clean and well maintained and with encouragement for people to personalise their own rooms. They told us some of the ways they achieve this, including by way of their annual maintenance plans, quality monitoring systems and by way of relevant staff guidance, training and instruction. They told us they regularly ask people about their satisfaction with their environment and about recent routine inspection visits they had received from outside agencies. These included Environmental Health, Health and Safety and Local Fire Authority officers. They told us about improvements they have made and are making concerned with infection control and specified areas of renewal and upgrading, including equipment to aid peoples mobility and their moving and handling. At this inspection people told us the home is kept clean and odour free and expressed their overall satisfaction with their environment. We received some comments from people about improvements that could be made, which we discussed with the manager. These included needing more hand rails in some toilets and better Care Homes for Older People Page 21 of 31 Evidence: ventilation in toilets where there are no windows, especially those close to the lounge and dining rooms. Toilets that we saw were provided with more than one hand rail and we did not smell any malodours during our visit. The manager agreed to review all existing provision and take action where necessary. All areas that we saw were clean and mostly free from observable hazards, with the exception of some storage heaters in Rose Court. These were scalding hot to touch, with no suitable guarding provided and no risk assessments undertaken for these. We saw from a written report, that the home had requested advice about these from the Health and Safety Inspector at their recent visit. We were advised of longer term plans for their replacement with more suitably type, although we discussed with the manager the need to undertake risk assessments for these in the interim, together with any necessary action arising from them to ensure peoples safety. We saw many areas of upgrading and renewal. Including for replacement of some moving and handling equipment, provision of additional profiling beds for people with signficant mobility problems, redecoration and furniture renewal. We also saw the homes infection control management plan detailing the action taken by the home from an initial infection control audit undertaken by the local primary care trust. At that time the manager advised they were awaiting the results from a second audit undertaken by the trust and since our visit the results of this have been provided and shared with us. This tells us that their score rose to 99 percent. Overall results from all nursing homes audited by the primary care trust within Derbyshire tells us that The Meadows are placed in joint first position within Amber Valley and joint second within Derbyshire. The home has established links with the trust, by way of an identified link nurse employed in the home. This nurse attends regular meetings via the PCT concerned with promoting good infection control practise. Undertakes regular infection control audits in the home and promotes recognised practise. Since our visit Peoples rooms that we saw were personalised and equipped in accordance with their individual needs assessments and care plans. All areas that we saw were clean and odour free. Care Homes for Older People Page 22 of 31 Evidence: When we looked at the reports of recent visits from the Environmental Health Officer and Local Fire Authority Officer we saw that each had made some requirements. We saw that a declaratoin of compliance was submitted by the home to the Environmental Health Officer following their visit and we were advised that works recommended by the Fire Officer were almost complete. Care Homes for Older People Page 23 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People may be assured that they will receive care and support from staff that is effectively recruited, inducted, trained and deployed. Evidence: In our AQAA the home described a comprehensive approach to staff recruitment, induction and training based on valuing people. Including people who use the service in their recruitment of staff. They gave us statistical information that we asked for their staffing arrangements. They said that their group had won a national award for the best medium sized care group in central England during 2008 and also advised of improvements they have made over the last 12 months. These included developing their arrangements for staff to undertake NVQ training with employment of a dedicated group training co ordinator. Review of staff skill mix to provide male care staff. Developing palliative care training for staff and the homes involvement in a local primary care trust project concerned with enhancing peoples lives in the care homes. Improvements for the coming months include introducing a formal training evaluation form for staff for them to give their views about any training they receive. To increase the number of staff completing food hygiene and infection control training and to offer support and language training for staff whose first language is not English. Care Homes for Older People Page 24 of 31 Evidence: At our visit we received many positive comments from people about the care and support they receive and their relationships with staff. Discussions with staff and examination of related records told us that they are well supported, inducted, trained and effectively recruited and deployed. 20 out of 33 staff have achieved at least NVQ level 2, with many achieving above this level and with further staff undertaking these at the time of our visit. Senior staff had undertaken training for the Mental Capacity Act 2005 and Deprivation of Liberty safeguards 2009. All staff were provided with written information about these and the manager advised that formal training will be provided to all staff along with the introduction of written policy and procedural guidance for staff to follow here. We saw that residents who choose can be involved in the interviewing of new staff. We have referred to this under Section 3, Daily Life and Social Activites in this report, including peoples comments about this. Care Homes for Older People Page 25 of 31 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 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 managed and run in peoples best interests by a competent and dedicated manager. Evidence: In our AQAA the home told us they strive to ensure the home is run in peoples best interests. That they have formal quality assurance and monitoring systems in place, based on seeking peoples views and to measure their success in meeting their stated service aims and objectives. They told us they promote a welcoming atmosphere with openness and respect for poeple and are committed to policy implementation and development with a strong and established senior management team. Key improvements they identified over the last 12 months included developments in their staff training programme and quality monitoring measures and renewal of moving and handling equipment. Key improvements identified for the coming months focus on developing specified systems and policy development. Care Homes for Older People Page 26 of 31 Evidence: Other information they gave us, told us they have suitable arrangements in place for the servicing and maintenance of equipment in the home. That they have made significant progress in providing infection control training to staff and ensure staff receive core health and safety training by way of a rolling programme. At this inspection, discussions we held with people who use and work in the service and examination of associated records supported the information provided by the manager in our AQAA return. People told us the home is welcoming and well managed. Staff said they are well supported in their role. They described effective arrangements for their supervision and for ensuring they receive the information they need to provide the necessary care and support to service users. The registered manager is professional, organised and thorough and successfully demonstrated how she keeps up to date with current practise, including by way of training. We saw many examples of strategies employed for enabling staff, service users and other stakeholders to affect the way in which the service is delivered. Including for formal consultation with people, by way of individual and group meetings and satisfaction surveys. The manager collates the results of surveys undertaken with people and shares these with them. We saw that the results of last years surveys are displayed for people to see, indicating overall a high level of satisfaction with the service. Surveys for this year were in progress the time of our visit with some returns received. Comments received in these, included, Very impressed with the care taken over feeding people. Good communication, therefore the need to complain does not arise. This home is tops. Other survey returns told us the home welcomes advice and input from outside health and social care professionals and works well with them. The manager advised us that an audit of clincal approaches to care had recently been undertaken in the nursing unit by a representive of the local primary healthcare trust, with their report awaited. That verbal feedback to date indicates good care outcomes for people concerned with tissue viability, end of life care, falls prevention and management, nutrition, dementia and infection. control. Care Homes for Older People Page 27 of 31 Evidence: There are satisfactory arrangements in place concerned with service users monies and financial affairs, which accord with recognised good practise and also for the reporting and recording of accidents and incidents in the home. Staff described suitable arrangements to ensure safe working practises, including for their training and provision of equipment. Care Homes for Older People Page 28 of 31 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 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 25 13 Risk assessments must be undertaken for radiators that do not have these, in areas accessed by service users. With action taken as may be necessary as identified from these. So that unnecessary risks to peoples health and safety are identified and so far as possible eliminated. 31/01/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 Where there is more than one box or bottle of a prescribed medicine supplied into the home for any service user. Only one box or bottle should be used at a time. So as to ensure effective stock rotation and to facilitate audit and to minimise the risk of any descrepancies in controlled drugs records. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 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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