Care Home: The Meadows Care Home

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What the care home does well Comments received from all the people spoken to said that the home was `clean, and tidy, staff all very helpful, I can`t complain, I need help they give it to me, I am happy but miss my home, I get my hair done every two weeks, everything satisfactory, happy with my care, we could do with more activities, staff very nice and work hard, they look after you well, food very good I enjoyed it, food good but give me small portions, not bad enjoyed my dinner, the food has always been ok`. For tea it was said that they had a choice of `sandwiches or cheese or egg on toast`. One person said `we are having bacon sandwhiches for tea` and it was said that they were looking forward to having this. Another person said `if I was not feeling well, they would soon get the doctor out` and when asked who they would tell if they were not happy, it was said `I would soon tell the bosses and they do listen`. The staff told us that the cook in the morning asks the people what they want for lunch and two choices are provided. One person told us that if they did not like what was on the menu, they could have another choice. This was confirmed by talking to other people. The menu for the day was recorded on the board in the dining room. We looked at the menu book and evidence showed that the people are offered different variety of traditional cooking. Discussion with the cook showed that they had very good understanding of the food the people enjoyed and of the different diets some of the people were on. The cook had attended training on nutrition recently.The staff we spoke to informed us that they knew how to feed people with thickened fluids, and it was said that they were shown how to do this. We observed the people having their lunch. This was eaten in a peaceful atmosphere with soft music playing in the back ground. The staff were observed talking to the people and offering drinks and asking them if every thing was ok. The people who needed help with feeding were supported by staff sitting next to them and they were observed assisting in an unhurried and respectful manner. Positive comments were received from relatives spoken to at the home about the care the people received in the home. Some of the comments include, `it`s a nice home and its clean, treats the individual with respect, respects their wishes, food smells lovely and their family member had put on weight, female cook very good, looks after their health needs well, staff informs us when mum is not well, mum very well looked after, medical needs looked after well, and any queries gets sorted, every one helpful and nice`. We were also told by relatives that they had `no concerns, tell staff or the owners if I had any concerns, owners always here to listen and try to be helpful, happy home and mother likes it here, lovely lady does tea, nice chap does the gardening, bedrooms and bathrooms clean, good cleaners, residents have clean clothes every day and they match, appears to be having good staffing levels, I have no complaints at all about the level of service provided, Its like one big family home`. Concerns were raised by some families regarding why the manager and the previous staff that worked at the home had left. Families also told us that they were very happy with the home and did not want their relatives to move to another home. We were informed by some families and a few people that they needed more activities in the home. At present the home had activities carried out mainly by volunteers, and some by one of the proprietors. This was discussed with the proprietors and we were told that the staff in the home were going to do more activities with the people and there were now more staff working at the home. One staff was put on activity training but this did not take place due to not being given the correct address of where the activity was held. Comments received from two professional people said the home was `friendly` and `welcoming`. One person said that they had observed working practices of 5 staff with the people. This was part of staff NVQ training and it was said that they had no concerns. At present there were two staff completing NVQ level 2 in care. We inspected two staff files and information showed that the people had criminal records burea (CRB) checks, and two references were obtained from their relevant work place. A medical questionnaire and the home`s induction booklet were also completed. The staff were given the new staff hand book. The home had started a new file for storing staff`s training records. Information was easier to find under staff names. A separate file was kept for CRB checks. We discussed with the proprietors about recording the dates the information was received about staff recruitment in the front of the staff files. This was to make it easier and quicker for the home to provide the information required when needed for monitoring purposes. The proprietors agreed that they would undertake this task.The home had started a training matrix and this was still being completed. Evidence showed that the staff in the home had attended many courses in May and June 2010. Some staff told us that they had attended training on communication, safe guarding of vulnerable adults procedures. Some staff told us that they had covered safe guarding information in their NVQ training but had not completed a separate safe guarding training. We were told that most staff have completed the health and safety, first aid, Fire training, COSHH, and manual handling training. Five nurses had attended training on medication and two nurses and the cook had attended nutritional training. Two kitchen staff attended food hygiene training. We were informed by management that training was on going. The staff on duty informed us that there are enough staff on each shift when training takes place at the home. We were told that the tissue viability nurse is going to do some training on pressure area on the 8th of July 2010. There was also wound care training being offered on the 2nd of July 10. Food hygiene awareness training was booked for 7th of July 2010 for some staff. The proprietors told us that the Mental Capacity and Deprivation of Liberty training was being offered by some one from the safe guarding team. A copy of the booklet about the Mental Capacity Act was displayed at the front of the home. The senior carer told us that they had started in house fire training. The home had also started a key worker system where by each What the care home could do better: Provide more structured activities for the people. This is so the people receive sufficient stimulation to maintain a satisfactory level of social and emotional well being. Ensure that the people`s files are all updated and old information is taken out. This is to ensure that all staff have up to date information about the needs of the person they are meeting. Provide all staff with at least 6 supervisions that is recorded and signed and dated by both the supervisor and supervisee and a copy is given to the supervisee. This is to ensure that staff practice is being monitored to improve the quality of care for the people. Provide a front page in staff recruitment files with information of when the recruitment information is received. This is to ensure that information is easy and quick to locate. Ensure that the training matrix is fully completed with all the training the staff have completed including in house and training undertaken in their previous employment. The full date of the training undertaken needs to be recorded. This is to ensure that the training information is up to date for each individual staff. Random inspection report Care homes for older people Name: Address: The Meadows Care Home 48 Moorend Road Yardley Gobion Towcester Northants NN12 7UF one star adequate service 15/03/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Ansuya Chudasama Date: 1 7 0 6 2 0 1 0 Information about the care home Name of care home: Address: The Meadows Care Home 48 Moorend Road Yardley Gobion Towcester Northants NN12 7UF 01908543251 01908543234 meadowscarehome@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Rising Meadows Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 34 Number of places (if applicable): Under 65 Over 65 34 old age, not falling within any other category Conditions of registration: 0 That the home continues to be registered to accommodate 34 service users in the category of OP, for either Personal or Nursing Care Date of last inspection Brief description of the care home The Meadows is situated in Yardley Gobion a village location midway between Northampton and Milton Keynes. There are local shops and amenities and the home has good links with the community. The home is an extended original building set in its own grounds with extensive views of the local countryside from the rear of the property. It is registered for up to 30 Care Homes for Older People Page 2 of 12 1 5 0 3 2 0 1 0 Brief description of the care home service users with nursing needs and up to 10 service users requiring personal care, with a total of 34 service users accommodated. Accommodation is over two floors with a passenger lift and staircase for access to the first floor. There are a range of communal areas including two lounges and service users are able to enjoy the garden areas. Bedrooms are located on both floors and there are 21 single rooms with ensuite facilities, a further 2 single rooms with was hand basins and 5 double rooms available. Care Homes for Older People Page 3 of 12 What we found: This inspection was carried out in accordance with the Care quality Commission (CQC) policy and methodologies that takes account of the peoples views and information received about the service since the last inspection. This Random inspection was undertaken to check compliance with requirements made at the last inspection. We also case tracked two peoples care planning to find out how their needs were being met by the home. The report refers to we this is because the report is written on behalf of the Quality Care Commission. Documentation relating to complaints and safe guarding were also examined. The home has not received any complaints since the last inspection. A safe guarding investigation was being investigated by the safeguarding team of Northamptonshire County Council and the outcome of this was not known at the time of writing this report. We had the opportunity to talk to some of the people who live at the home and some relatives who were visiting the home. We spoke to staff on duty and some professionals who were visiting the home to find their views on how the home was meeting the needs of the people. What the care home does well: Comments received from all the people spoken to said that the home was clean, and tidy, staff all very helpful, I cant complain, I need help they give it to me, I am happy but miss my home, I get my hair done every two weeks, everything satisfactory, happy with my care, we could do with more activities, staff very nice and work hard, they look after you well, food very good I enjoyed it, food good but give me small portions, not bad enjoyed my dinner, the food has always been ok. For tea it was said that they had a choice of sandwiches or cheese or egg on toast. One person said we are having bacon sandwhiches for tea and it was said that they were looking forward to having this. Another person said if I was not feeling well, they would soon get the doctor out and when asked who they would tell if they were not happy, it was said I would soon tell the bosses and they do listen. The staff told us that the cook in the morning asks the people what they want for lunch and two choices are provided. One person told us that if they did not like what was on the menu, they could have another choice. This was confirmed by talking to other people. The menu for the day was recorded on the board in the dining room. We looked at the menu book and evidence showed that the people are offered different variety of traditional cooking. Discussion with the cook showed that they had very good understanding of the food the people enjoyed and of the different diets some of the people were on. The cook had attended training on nutrition recently. Care Homes for Older People Page 4 of 12 The staff we spoke to informed us that they knew how to feed people with thickened fluids, and it was said that they were shown how to do this. We observed the people having their lunch. This was eaten in a peaceful atmosphere with soft music playing in the back ground. The staff were observed talking to the people and offering drinks and asking them if every thing was ok. The people who needed help with feeding were supported by staff sitting next to them and they were observed assisting in an unhurried and respectful manner. Positive comments were received from relatives spoken to at the home about the care the people received in the home. Some of the comments include, its a nice home and its clean, treats the individual with respect, respects their wishes, food smells lovely and their family member had put on weight, female cook very good, looks after their health needs well, staff informs us when mum is not well, mum very well looked after, medical needs looked after well, and any queries gets sorted, every one helpful and nice. We were also told by relatives that they had no concerns, tell staff or the owners if I had any concerns, owners always here to listen and try to be helpful, happy home and mother likes it here, lovely lady does tea, nice chap does the gardening, bedrooms and bathrooms clean, good cleaners, residents have clean clothes every day and they match, appears to be having good staffing levels, I have no complaints at all about the level of service provided, Its like one big family home. Concerns were raised by some families regarding why the manager and the previous staff that worked at the home had left. Families also told us that they were very happy with the home and did not want their relatives to move to another home. We were informed by some families and a few people that they needed more activities in the home. At present the home had activities carried out mainly by volunteers, and some by one of the proprietors. This was discussed with the proprietors and we were told that the staff in the home were going to do more activities with the people and there were now more staff working at the home. One staff was put on activity training but this did not take place due to not being given the correct address of where the activity was held. Comments received from two professional people said the home was friendly and welcoming. One person said that they had observed working practices of 5 staff with the people. This was part of staff NVQ training and it was said that they had no concerns. At present there were two staff completing NVQ level 2 in care. We inspected two staff files and information showed that the people had criminal records burea (CRB) checks, and two references were obtained from their relevant work place. A medical questionnaire and the homes induction booklet were also completed. The staff were given the new staff hand book. The home had started a new file for storing staffs training records. Information was easier to find under staff names. A separate file was kept for CRB checks. We discussed with the proprietors about recording the dates the information was received about staff recruitment in the front of the staff files. This was to make it easier and quicker for the home to provide the information required when needed for monitoring purposes. The proprietors agreed that they would undertake this task. Care Homes for Older People Page 5 of 12 The home had started a training matrix and this was still being completed. Evidence showed that the staff in the home had attended many courses in May and June 2010. Some staff told us that they had attended training on communication, safe guarding of vulnerable adults procedures. Some staff told us that they had covered safe guarding information in their NVQ training but had not completed a separate safe guarding training. We were told that most staff have completed the health and safety, first aid, Fire training, COSHH, and manual handling training. Five nurses had attended training on medication and two nurses and the cook had attended nutritional training. Two kitchen staff attended food hygiene training. We were informed by management that training was on going. The staff on duty informed us that there are enough staff on each shift when training takes place at the home. We were told that the tissue viability nurse is going to do some training on pressure area on the 8th of July 2010. There was also wound care training being offered on the 2nd of July 10. Food hygiene awareness training was booked for 7th of July 2010 for some staff. The proprietors told us that the Mental Capacity and Deprivation of Liberty training was being offered by some one from the safe guarding team. A copy of the booklet about the Mental Capacity Act was displayed at the front of the home. The senior carer told us that they had started in house fire training. The home had also started a key worker system where by each person had a named nurse and carer to ensure that the persons needs are being met. The staff say that the home is very good and the care for the residents is very good, the home is lovely and clean and caters for each residents needs whilst maintaining their independence, making improvements all the time, good team, and training is better. It was also said that they are all enthusiastic, we are happy, plenty to do all the time, have no concerns, good support from senior carer and nurses and we get guidance, I enjoy the job, residents make it worth while, can go to any one for advice. It was said by staff that it has been hard work getting there. We were told that they had staff meetings and the last one was carried out on the 28th of May 2010. We were told by staff that they had received fire training and fire drill practices were being undertaken. Fire records seen were being fully completed by the handyman. Most of the staff informed us that they were happy with the working rota. However we were told by some staff if the rota could be done on a 4 weekly basis so they could plan a head. We were told that the working rota was done on a two weekly basis after the manager left. This was because the senior lead nurse was taken off the shifts and was working 08:00 to 18:00 hours per week. This was discussed with the proprietors and it was said that the rota will be done on a 4 weekly basis. The staff told us that they had three care staff and one nurse working on each shift. This did not include the hours worked by the senior lead nurse. The home also had the following staff working on the rota. One cook worked 08:00 to 14:00, 1 Kitchen assistant worked 08:00 to 14:00, another kitchen assistant helped out from 16:00 to 19:00, the handy man worked 08:00 to 14:00, 1 Laundry person worked 08:00 to 14:00, and two cleaners worked 09:00 to 14:00. The proprietors also helped out in the home. The home did not use any agency staff and we were told if there were any hours to cover due to sickness, the staff or the bank staff covered the hours to provide continuity to the people. Care Homes for Older People Page 6 of 12 We were told that at the time of the inspection there were 19 people living in the home and one person was in hospital. We were told that the manager had started supervision but this stopped when they left. The staff did not receive a copy of the supervision notes but this information was typed on to the computer. We were told by the proprietor that the senior care staff was going to supervise the care staff and carry out inductions for new staff. The senior lead nurse staff was going to supervise all the nurses. The proprietor had attended a course on supervision and he was going to cascade the information to the senior staff. We were told by some staff that sometimes they did not know when a new member of staff was starting work or leaving. This was discussed with the proprietors and they agreed that they were going to have monthly meetings with the senior staff to discuss how the home is running. This was welcomed by the senior staff. It was said that a record of the minutes of the meeting was going to be maintained. We looked at two peoples care planning information to find out how the peoples needs were being met. The plans had information about how the peoples personal and health care needs were being met. There was information being recorded when the home asked the health professionals to visit the people. There was information about the equipment the staff used to help the people stay safe. Information and risk assessments on mobility, tissue viability, wound assessment and progress sheet, body charts, nutrition, water low score, mental capacity assessment, risk of falls was completed. There was information on night care plans and these were also being reviewed by staff. When bedrails were used, a risk assessment was undertaken and a consent form was signed by the relevant people. The senior staff told us that they had a mattress setting folder to ensure that these mattresses were set at the right level. The suction machine was also being tested regularly to ensure this was working properly. A record was kept of this check. We were told that the tissue viability nurse had visited and informed the home that the pressure relieving cushions used by the home were not suitable for people with high needs. It was said that the home was going to purchase the ones recommended by the nurses as they were suitable for people who sat in chairs for long periods. The turn charts were being used at night time how ever it was recommended by the tissue viability nurse that these needed to be done on a 24 hour basis. The home informed us that they had already started doing this in the day time. The care plans were now being reviewed by staff on a monthly basis. We observed in one file that there was old information kept in the file and this at times was confusing to understand and information needed to be better arranged. This was discussed with the senior nurse in charge. We were told that they were reviewing all the care plans and the senior nurse was going to put the old information in a separate file and involve other staff when reviewing the care plans. We were told that the last manager did not involve staff when writing new care plans. We sometimes found the writing of some staff difficult to understand. We were told that all the care plans were going to be typed. We were shown a copy of a care plan that was typed and this was clear and easy to understand. There was evidence of daily notes being recorded for each person. Care Homes for Older People Page 7 of 12 We spoke to a few of the staff on duty and asked them about how they met the needs of the two people that we case tracked. All the staff spoken to had a very good understanding of how the peoples health care needs were being met. This included information on how to deal with some one who was choking, managing pressure areas, and special diets. We were told by staff that they would ask the nurses for advice about the peoples medical conditions or if they had any concerns about a persons condition. The home has introduced new charts that are kept in the peoples bedrooms and this has information recorded about bathing, and when creams were being applied to the person. We observed staff completing these records. The staff also told us that they receive a hand over on each shift and this was mostly undertaken by the nurse. They now have new hand over sheets which were kept in the office. We observed staff when using the hoist to transfer people from the chair to the wheel chair. This was done safely and the staff were observed talking to the people and explaining to them what they were doing in a kind manner. We observed the nurses giving out medication and this was found to be satisfactory. We were told by the staff spoken to that medication was given out promptly. We were told that the nurses gave out medication and five nurses had completed the medication training. The medication cupboard was inspected and evidence showed that medication was properly labelled and paper work in the room was well recorded. The medication records of the two people we case tracked were being completed fully. A cream chart for recording topical medication was kept in each persons room. Daily care and house keeping record chart was introduced in each persons room. This recorded information on when the people had a bath or shower, hair care, mouth care, and personal care. The health and safety folder was inspected and this had information about all the safety checks carried out in the home. We discussed with the proprietors the management arrangements of how the home was being managed since the new manager resigned. We were informed that the lead senior nurse took on the responsibility of managing the clinical side of the home, medication, care plans and management of the day to day running of the home. Evidence showed that the lead nurse was working hard and had made many good changes in the home. This was also confirmed by talking to some professionals who had visited the home. After the inspection we were informed that the lead senior nurse had taken on the role of the acting manager until a suitable experienced manager was recruited. The lead nurse was going to undertake NVQ level 4 training in Management on the 24th of June 2010. We were also told that an experienced consultant was going to support the new acting manager. Improvements made since the last inspection A new induction booklet for new staff starting at the home was introduced. This was to ensure they understood their rights and responsibilities. Care Homes for Older People Page 8 of 12 A folder for recording the setting of the mattress at the right level was introduced to ensure that the peoples health care needs are met. New charts for monitoring peoples personal care, cream charts, Peg feed charts, turn charts, wound progress charts, food and fluid intake charts, and water low score assessment form were introduced to ensure the peoples needs were being met and they were kept safe. Hand over sheets were introduced so staff had the information recorded to meet the needs of the people. More training was undertaken by staff to ensure they had the skills and knowledge to meet the specialist needs of the people. A risk assessment for bed rails and a consent form was completed to maintain the safety of the person and to respect their rights. Mobility assessments were carried out for all the people to minimise the risk of falls to keep the people safe. A key worker system was started for each individual person living in the home. This was to ensure that the named staff would be responsible for ensuring the persons needs were being met. 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 2. Care Homes for Older People Page 9 of 12 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 30 18 All staff must receive training 30/06/2010 in Mental capacity and deprivation of liberty. This is to ensure that people using the service are supported in choosing how they live their life. The time scale for this requirement date was not up at the time of undertaking this inspection. 2 36 18 All staff must receive formal supervision This is to ensure that staff are developed and supported to undertake their role. The time scale for this requirement date was not up at the time of undertaking this inspection. 30/06/2010 Care Homes for Older People Page 10 of 12 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 12 of 12 - 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. 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