Care Home: The Meadows Nursing Home

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What the care home does well The food provided is of good quality and each person has the option to choose what he or she wants to eat. The meal times are social events and staff are sensitive and caring when assisting people with their diets. The management of the medication is good and ensures that the people living there receive their medicines as required and the nurses assess and assist individuals to manage their own medication. The relationship between the staff, people who live their and their relatives is good and enables smooth communication. There are a variety of activities, which each person can participate in and be part of the community. Families and friends are made welcome and can visit at any time. One visitor told us `I am always made welcome and the staff always inform me of changes` All the staff communicate well and have a good understanding of the needs of each person living at this home. The staff have a good understanding of how to manage concerns and complaints. One visitor told us ` I made one complaint and it was dealt with quickly and to my satisfaction` The manager has an open door policy and staff; people who live at the home and their relatives told us that she is approachable and always willing to listen. What has improved since the last inspection? The manager has addressed all the requirements and recommendation from the last inspection carried out in 2008. The planning of care now clearly states the needs of each person and is up dated and evaluated regularly to check that the care provided is appropriate. This ensures that staff have guidance and increases the consistency of care. Either the person living at the home or their representative is consulted about the care provided and invited to attend reviews of care. This ensures that all parties are aware of the care being given, why and what this achieves. The staff are knowledgeable about the people they care for and were able to tell us what care was needed and why. They are also caring and professional in their approach to the people they are caring for. The health care assistances now work in a designated area, this has increased consistency in care, staff moral and has used the skills and knowledge of staff more effectively ensuring that the people using the service get the best care possible. New systems have been put into place to manage each person`s personal money. The administrator is responsible for this. Further improvements were made between the two dates of this inspection. This process ensures that the risk of financial abuse is minimised and each person can be sure that his or her money is managed appropriately. All newly employed staff have a full induction in line with the Skills and Learning Council to ensure that they are fully aware of their role and what is expected of them. The systems used to ensure that new employees are suitable to work with vulnerable people are robust. Training for the nursing staff and health care assistance has improved and this ensures that they can all meet the needs of the people they care for. The activity organiser has developed an activity programme that meets the needs of those who live there. This will ensure that social and spiritual needs will be met. Varies meeting have started to ensure that all staff, people who live at the home and their relatives are involved and informed of changes. What the care home could do better: It is important to remove plans of care from the files that are no longer being used to prevent any confusion. The AQAA told us that the manager intends to improve in the following ways over the next 12 months. Improve systems of recording activities and individual participation To further investigate the need for each person to exercise. The introduction of assessment for nurses` competency in medication administration. To explore the possibility of a grant to enhance the outside patio areas and build raised flowerbeds. To involve the people who live in the elderly frail unit to develop plaques for their doors. Improve the way responses are made to concerns and complaints. To continue to improve the environment and to ensure that the unit for people with dementia is in line with current research. Involve the people who live at the home in choosing furniture, paint colours and design. To improve and continue to audit processes and practices in the home which will show any areas for improvement. CARE HOMES FOR OLDER PEOPLE The Meadows Nursing Home 656 Birmingham Road Spring Pools Bromsgrove Worcestershire B61 0QD Lead Inspector Suzette Farrelly Additional Inspection 13:00p 10 February 2009 th X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Meadows Nursing Home Address 656 Birmingham Road Spring Pools Bromsgrove Worcestershire B61 0QD 0121 453 5044 0121 453 0212 themeadows@asterhealthcare.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern CC Ltd Manager post vacant Care Home 36 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (36), of places Physical disability over 65 years of age (36), Terminally ill (4) The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The Home may also accommodate three persons under 65 years with a learning disability. The Home may also accommodate a maximum of three people aged between 55 - 64 years with a physical disability. The Home may also accommodate 1 person aged between 50 - 64 with a physical disability. Date of last inspection Brief Description of the Service: The Meadows Nursing home is one of two homes, which are now owned by Southern CC Ltd. It is registered to accommodate a maximum of 36 residents. The home is divided into two units, Pine/Willows and Beeches. Pine and Willow units are on the ground floor and care for frail older people and the Beeches unit is located on the first floor and cares for those with dementia related illness. A passenger lift provides access to first floor rooms. With the exception of one bedroom all rooms are single occupancy. The home is situated in a rural setting near to the Lickey Hills and is also five minutes from the motorway. The range of fees for this service is not published in the statement of purpose. The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this care home is 2 Star, which means that the outcomes for people using this service are good. This was an unannounced key inspection that took place over two visits; the first visit took place on the 10th February 2009 from 14:30 until 20:15 enabling us to see the activates in the afternoon and meet the night staff. The second visit on the 6th March 2009 took place from 10:45 until 18:00. The purpose of this inspection is to look at all areas of the service to ensure that the outcome for people living there is good, safe and appropriate. This inspection also enables us to ensure that the service runs according to legislation and regulations. During these visits we case tracked four people, this involves reading their records, discussing their care with staff, visiting each person and discussing their experience where possible. We also looked at policies and procedures related to safeguarding, concerns and complaints and medication. New policies and procedures were also examined. Discussion with the manager and deputy manager took place on both days as well as discussion with the nurses, health care assistants and other visiting professionals and entertainers. Where appropriate information from these discussions have been referred to. The manager also supplied us with an up dated Annual Quality Assurance Assessment [AQAA]. Each registered service is required to submit an AQAA each year; this is a form of self-assessment. The previous manager had submitted one for 2008-09, however, due to many improvements the present manager wished to up date us. Information from this has been used in the following report. During the process of the inspection we viewed a variety of areas of the home including the kitchen, laundry and the communal and some private rooms of the people who live there. The manager has worked hard with the staff in the home to make improvements to the delivery of care and to ensure that the outcomes for the people living there is good and safe. What the service does well: The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 6 The food provided is of good quality and each person has the option to choose what he or she wants to eat. The meal times are social events and staff are sensitive and caring when assisting people with their diets. The management of the medication is good and ensures that the people living there receive their medicines as required and the nurses assess and assist individuals to manage their own medication. The relationship between the staff, people who live their and their relatives is good and enables smooth communication. There are a variety of activities, which each person can participate in and be part of the community. Families and friends are made welcome and can visit at any time. One visitor told us ‘I am always made welcome and the staff always inform me of changes’ All the staff communicate well and have a good understanding of the needs of each person living at this home. The staff have a good understanding of how to manage concerns and complaints. One visitor told us ‘ I made one complaint and it was dealt with quickly and to my satisfaction’ The manager has an open door policy and staff; people who live at the home and their relatives told us that she is approachable and always willing to listen. What has improved since the last inspection? The manager has addressed all the requirements and recommendation from the last inspection carried out in 2008. The planning of care now clearly states the needs of each person and is up dated and evaluated regularly to check that the care provided is appropriate. This ensures that staff have guidance and increases the consistency of care. Either the person living at the home or their representative is consulted about the care provided and invited to attend reviews of care. This ensures that all parties are aware of the care being given, why and what this achieves. The staff are knowledgeable about the people they care for and were able to tell us what care was needed and why. They are also caring and professional in their approach to the people they are caring for. The health care assistances now work in a designated area, this has increased consistency in care, staff moral and has used the skills and knowledge of staff more effectively ensuring that the people using the service get the best care possible. The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 7 New systems have been put into place to manage each person’s personal money. The administrator is responsible for this. Further improvements were made between the two dates of this inspection. This process ensures that the risk of financial abuse is minimised and each person can be sure that his or her money is managed appropriately. All newly employed staff have a full induction in line with the Skills and Learning Council to ensure that they are fully aware of their role and what is expected of them. The systems used to ensure that new employees are suitable to work with vulnerable people are robust. Training for the nursing staff and health care assistance has improved and this ensures that they can all meet the needs of the people they care for. The activity organiser has developed an activity programme that meets the needs of those who live there. This will ensure that social and spiritual needs will be met. Varies meeting have started to ensure that all staff, people who live at the home and their relatives are involved and informed of changes. What they could do better: It is important to remove plans of care from the files that are no longer being used to prevent any confusion. The AQAA told us that the manager intends to improve in the following ways over the next 12 months. Improve systems of recording activities and individual participation To further investigate the need for each person to exercise. The introduction of assessment for nurses’ competency in medication administration. To explore the possibility of a grant to enhance the outside patio areas and build raised flowerbeds. To involve the people who live in the elderly frail unit to develop plaques for their doors. Improve the way responses are made to concerns and complaints. To continue to improve the environment and to ensure that the unit for people with dementia is in line with current research. Involve the people who live at the home in choosing furniture, paint colours and design. To improve and continue to audit processes and practices in the home which will show any areas for improvement. The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 and 4 [Standard 6 is not applicable] Quality in this outcome area is good. Each person can be confident that their needs will be assessed before admission and that the service will be able to meet all their needs at the point of admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four residents care files were examined this confirmed that there is a preassessment completed for each person, prior to admission to the home. This ensures that the service can meet all the assessed needs. From this assessment initial care plans are developed, all equipment is put into place and any training required is completed. This ensures that each person’s needs can be fully met at the point of admission. The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 11 In each file there was also a copy of the care plan from the Social Service case Manager, this was also referred to when the manager assesses the person and when developing initial care plans. The manager told us that she considers not only if the staff have the knowledge, but also the dependency level of the person and the overall dependency level in the home to ensure that there is sufficient staff and time to meet assessed needs. In the dementia unit consideration of challenging behaviour is taken into account to ensure that the person would be able to live with those who are already there. A relative told us they choose this service as the home had all the requirements, was comfortable, staff were efficient and kind and the manager was good. They also told us that they had all the information required to assist them to make a decision. A person living at the home told us that they had chosen to live there and was happy with the care and the way the home discussed the care needed before admission. The Statement of Purpose and Service Users Guide were not examined at this inspection as six months previously it had been updated. The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 7, 8, 9 and 10 Quality in this outcome area is good. Each person can be confident that thy will be consulted about their care and that the staff are trained and competent. They can also be confident that they will receive their medication as prescribed by their doctor to maintain their health. Each person is treated with dignity and respect and can be confident that the staff are trained in dignity and equality issues. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four people were ‘case tracked’; two people from the elderly frail unit and two people from the dementia care unit. This involved reading all the records related to these people, visiting them, discussing their care with staff and judging the outcomes of the care provided. The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 13 In each care file it was found that there were care plans and risk assessments that enable us to determine the needs of each person. Each care plan gave the staff sufficient information to enable them to deliver good and consistent care. There are also short term care plans which give staff information required to deal with changes in health and well being such as chest infections, wounds and other health matters. All care is evaluated monthly, or more often if needed. The evaluation explained if the care given had the desired outcome or if changes were required. New care plans were seen to reflect any changes. It is recommended that care plans no longer used should be filed to prevent possible confusion. From discussion with staff it was clear that they were fully aware of each persons needs and what was required to meet these. The risk assessments cover areas such as mobility and falls, the risk of skin breaking down and developing sores, moving and handling and nutrition. These risk assessments are completed monthly and supportive plans of care are available. Since the last inspection relatives have been invited to attend a review of care with the manager and the person living at the home. Any changes agreed at this meeting is recorded and signed by all who attend. In the elderly frail unit most people has ‘profile beds’ [these are beds that have specialised mattress to minimise the risk of skin breakdown, and attached bed rails that reduce the risk of entrapment or injury]. Those individuals that use the bed rails are fully assessed and a risk assessment is completed. A form is signed to state that this was discussed with the individual or their relative and they agree to these being used. All people in the home have access to other professional such as the GP, district nurses, tissue viability nurse, community mental health nurses and consultants. They also have access to the optician, dentist and chiropodist. The chiropodist told us that he visits the home on a regular basis and that the staff share appropriate information with him. If he leaves information behind about treatment this is always done. He also told us that the home had improved since the new manager started in August 2008, he stated that ‘ the staff are more efficient, there is a better system in place and each person is escorted to their own room for treatment to be carried out’. A visiting nurse who was assessing the needs of some people for National Health Service Funding told us ‘Improvements in care planning have taken The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 14 place these are now more person centred, detailed and contain the information required and up to date. Has given guidance to improvement. General atmosphere is better and is more homely. The moral of staff is better; staff are helpful, friendly, knowledgeable about their residents, proactive in recognising needs and asking for other professionals to assist.’ On the dementia care unit there was clear written evidence in the care files that the staff have an understanding of how to assess and manage aggressive and challenging behaviour, which can be experienced with people who have dementia. It was observed that the nurses and health care assistants knew each person and managed their frustrations and distress appropriately minimising the effects and ensuring a good outcome. Discussion with three staff told us that they had received some training and were looking forward to further training to assist them to deliver good care. A relative told us ‘My wife is well cared for and all her needs are met, the staff tell me if anything changes and I can discuss her care with them.’ Another relative told us ‘Mum has settled well here and the staff are kind and caring and Mum is well looked after’ We were informed that Lloyd Pharmacy had conducted an audit on 3rd March 2009 and the report was shared with us. There were a few items that needed addressing and these had been completed. The medication ordering, storage, administration and disposal was examined to ensure that this is safe and meets the needs of the people living there. We found that the medication management is good and ensures that there is sufficient medication for each person. Records are signed and this shows that the medication is given as prescribed by the doctor. The storage of medication is safe and the room is an appropriate temperature. Staff have sufficient knowledge about the medication to ensure that they know why they are giving it and the side effects. There is suitable storage for Controlled Drugs and the recoding system is good ensuring that the nurses know what medication and how much should be available. From discussion with the manager and records it was confirmed that the staff have received training in the use of syringe drives [this is used to give medication at a regular controlled dose]. Auditing of medication has also started to ensure that all staff manage the medication safely. The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 15 The information in the AQAA informed us that the manager is developing a format for testing the competency of all nurses in the management and administration of medication. During the two days we saw that staff spoke appropriately to each person and addressed him or her, as they would wish. All care was undertaken in private and it was observed that they were taken to their rooms to receive treatment from the chiropodist. On person living at the home said ‘ All the girls respect me and listen to me when I have something to say’ The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14, and 15 Quality in this outcome area is good. Each person’s lifestyle experiences match their expectations and satisfy their social, cultural, religious and recreational interests. Each person is assisted to maintain contact with family and friends and are encouraged and assisted to have control over their own lives. The food is to their expectations and is nutritious and well balanced. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an activity organiser, whom we have been informed is leaving the home. The manager has advertised the post and will be interviewing soon. The present activity organiser told us that she spends time between the two areas and carries out varies activities and also encourages the health care assistants to participate. All activities are recorded, this is not consistent and the manager informed us in the AQAA that this is an area that requires improvement. The care files now The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 17 have information about the person, stating their hobbies, previous lives and important events. The manager told us that she would like to expand on this information further. At Christmas time, the people at the home made and sold 60 Christmas cards, the proceeds from this sale are in a fund that the people at the home can spend on item they want in relation to their social and recreational lives. The manager told us that there is a meeting in April for the families and the people at the home to discuss how this fund will be best spent. Once a month there is a ‘Group Birthday Party’ where the birthdays of anyone in that month are celebrated. On the second visit this was seen. Staff, families and the people living there were enjoying a buffet tea with birthday cake, music and singing. One relative told us ‘ This is always a nice time, fun and everyone enjoys it’. One person told us ‘ I don’t always attend but I always get offered some cake’. The cook ensures that all cakes and other items of food are suitable for diabetics; this ensures that they are included and can enjoy the party. Some of the people in the home have recently been out to a Garden Centre; the manager ensures that there is one health care assistant to each person so that they can go where they want. The group meet at an agreed time and have a drink and a cake. One relative told us that they went with the group and that it was well organised and fun. There is regular entertainment from outside. Two favourites are a guitar player, who sings well-known songs and encourages each person to join in. He told us that the home has improved in the last six months and the staff join in more. He told us that the home is friendly and that the staff are good with all the people who live there. They also invite in ‘Animal Mania’ this is a group who bring in a variety of animals such as rabbits, spiders, snakes and other small animals. The staff told us that this was well received and there was a lot of laughter and the people at the home have requested that they return again. On the dementia Care Unit it was noted that there are a variety of ‘Baby Dolls’, which are recommended as part of the process to reduce anxiety and frustration. Staff were seen to offer these appropriately to the people on this unit. There is also a ‘Snoozelum’ this area is designed to relax the person and has gentle music, fibre optics and a bubble tube. This room also has a large pull down screen and movie projector. Once a week the home show a movie and the people living there can attend and eat popcorn. One person told us that she enjoyed this. The Catholic and Methodist churches visit and it has been agreed that the Methodist vicar will carry out a service at Easter. The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 18 There are photos of events that occur at the home for anyone to view and these are also used to help people remember events. The manager told us in the AQAA that she would like to improve the facilities outside. There are various outside areas available to the people at the home. The large patio area is sparse and it is planned to build raised flowerbeds, hanging baskets and more flowers to add some shade and colour. One person was seen in her room knitting, she told us that she has knitted bed socks for the people in the home and she knits baby clothes for the hospital. The home supplies the materials for her. She told us that she was happy at the home and that the staff were kind and caring and that all her needs are met. The manager is planning a meeting in April for the people at the home and their relatives and will discuss activities and how these can be improved. The cook works five days per week and a second cook covers the remaining days. Through discussion we found that he had experience of working in this type of environment and knowledge of special diets. The cook uses full fat milk and cream and ensures that meals contain a lot of calories so that each person maintains their weight. The meals on both days were colourful, tasty, hot and filling. Three people in the elderly frail unit told us that the ‘food is lovely’ and ‘we always have more than enough’. There are always two choices and there is other food available if required. At tea time one person likes prawn salad and this was seen. Environmental Health have recently visited and awarded the home 4 Stars ‘ Very Good’. There were three minor areas for improvement, which have been met. The cook carries out a six monthly ‘Food Hygiene’ Audit, which is now due. This audit shows areas that are working well and where improvement is required. A clear plan is made. It is recommended that as the improvements are made that this is dated and signed to indicate this. The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good. Each person can be confident that any concerns or complaints will be listened to and dealt with. The policies, procedures and staff knowledge minimises the risk of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a clear complaints procedure and process which staff are aware of. There is a record of any concerns or complaints raised. The manager shared these with us; there were three concerns raised in November 2008. Each had been investigated and the person making the concern known was informed verbally of the outcome and actions taken. It is recommended that the manager confirm verbal information in writing. A relative said ‘I know how to make a complaint; I have only had a minor one about items of clothes missing. This was dealt with while I was hear and I was happy with the response and promptness of action.’ Another relative said ‘ I haven’t had to make a complaint, but I would speak to the staff or manager and feel confident that they would deal with it’. The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 20 There is a clear policy in place regarding the recognition of abuse and the actions to be taken. On the second visit this had further been improved with a poster so that people living at the home and relatives also had this information. Staff spoken with knew what was expected of them and had knowledge about abuse and how to recognise this. There is further training in the next three months, one session will deal with abuse itself and the other is from the Bromsgrove Safeguarding team. There have been no safeguarding issues since the last inspection. Two nurses have attended training in ‘DOLs’ [Deprivation of Liberties Safeguarding]. This examines how risk assessments and decision to restrict someone’s liberty such as movement, leaving the home or making decisions for themselves should be done to ensure that their liberty is not denied. The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 22, 23, and 26 Quality in this outcome area is adequate. The home offers safe indoor and outdoor facilities, some areas are not comfortable and this impacts on the outcomes for those people living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Most bedrooms were viewed on the ground floor. These had been personalised with photographs and other small personal affects making these rooms individual and personal. The manager told us that they are happy for people to bring small items of furniture and any items that make them comfortable. The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 22 Most bedrooms in the Elderly Frail Unit have ceiling tracking hoists to assist the person with mobility in getting into and out of bed and specialist beds with integrated bedrails are used. The lounge on the ground floor has an open fire effect fire, fish tank and TV, video, DVD and music machine. This area was clean no smells, tidy but lived in. There are some recliner chairs available for those people who have difficulty sitting in normal seating. The dining area in the Elderly Frail Unit has a long table, the people are able to chat with each other is they wish. The table is laid with a tablecloth, condiments, and small vase of flowers. There is hatch directly to the kitchen with a notice board with today’s food clearly marked. Most people remained in their wheel chairs, as it is not appropriate to hoist each person. The manager stated that each person was happy with this but that this was not recorded and she would ensure this was clearly stated in his or her mobility care plans. The upstairs unit has an integrated communal area consisting of a small sitting area and dining area. People were seen after tea sitting in easy chairs watching television. A staff member was sitting with one person and showed that they understood their needs and showed knowledge is working with people with dementia. Two people had dolls, these are used to improve communication and give a sense of self worth, and both people were reacting well to this. One person talked about her life and recognised the needs of other people in the room. There was a relaxed and comfortable atmosphere and the staff were relaxed and conversed with ease with each person. Health care staff were seen to use aprons and gloves when necessary. The bathroom/toilets have liquid soap and paper towels and the disposal of incontinence produces is appropriate. It was also noted that there are different linen bags for different items of laundry such as one for personal clothes and a further on for towels and sheets. Using cloth laundry bags means these can be laundered, which minimises the risk of cross infection. The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is good. Each person can be confident that they are care for by a competent and suitably skilled staff at all times that are employed using processes that ensure they are suitable to work with vulnerable people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was established that there are sufficient staff on duty at all times to meet the needs of the people living there. From the 9th January 2009 the manager had organised for one health care assistant to arrive at work at 06:30 hours and a further health care assistant to finish work at 22:00 hours. As these are busy times of the day and it increases the number of staff available. The manager told us that they would trial this and if successful would implement it permanently. Staff were pleased with this and had a choice if they wished to work these hours. On the second visit the manager informed us that this was now working well and that she was increasing the early and late shift further. There are ancillary staff employed which means that the health care assistance can concentrate on the direct needs of the people living there. The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 24 The manager has made improvements to way that the health care assistants work, the staff have been divided into groups so that they work mainly in one of the areas in the home. This has helped to increase consistency in care and also has assisted in using the skills of the staff appropriately. All staff that work in the dementia care unit will receive training in the care of people with dementia. A visiting professional who visits the service regularly to assess people living there told us that there have been –‘General atmosphere is better – more homely. The moral of staff is better, staff are helpful, friendly, knowledgeable about their residents, proactive in recognising needs and asking for other professionals to assist.’ The manager is committed to ensure that staff are trained to meet the varied and complex needs of the people at the home. Qualified staff have completed training in diabetes, catheterisation, nutrition, palliative care, syringe driver use and tissue viability with wound care. This will ensure that they are skilled at managing various medical and health issues that may arise. All staff have had or will have training in Dementia care, Safe handling of medicines, and infection control. There are over 50 of the health care assistants trained to a minimum of National Vocational Qualification in Care level 2, and the manager stated that it is the home’s intention that all staff receive this training, to ensure they are competent. Two new employees records were examined and it was established that all checks necessary had been made to ensure that they were suitable to work with vulnerable people. All new employees now have an initial induction programme to introduce them to the home and the home’s policies. They then complete the induction programme from the Skills for Care. Both folders for the two new employees were seen. Staff spoken to told us that they felt supported and that the home had improved in the last eight months since the new manager took up her post. They felt that there was more training and that skills amongst the staff are shared. The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35, 36 and 38 Quality in this outcome area is good. Each person can be confident that the management of the home is open and transparent and run for the benefit of the people living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The present manager has been in post since August 2008, she has not yet applied for registration with us. This was discussed and she will contact our Registration team for information about the process of registration. The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 26 The manager has managed before and is a qualified nurse with a Certificate in Health Education. She is aware that she will need to commence the Leadership and Management Skills Training as part of her registration. Since August the manager has worked hard to address the previous requirements and has improved many areas in the home, improving the outcomes for the people living there and the moral of the staff. Five staff spoke to told us that there had been improvements and that they were happier, they also told us that the organisation of care and the support had improved. The manager has an ‘Open Door’ policy and people who live there, their families and staff can see her at any time to discuss concerns, issues or new ideas. She has also commenced meeting for all the people in the home and their families to discuss changes in the home, and to share ideas for further improvements. There are meetings held for staff. There is a senior staff meeting where discuss about how improvements will be implemented and what responsibility each senior member of staff has. There is a Health and Safety meeting which looks at infection control practices, risk assessments and the general health and safety in the home. There is also an operational/quality meeting for the senior person in each department to discuss quality and change. These meetings have enables all those involved in the home to take part in the improvements and bring ideas to the manager. The manager has also commenced a quality assurance system, looking at various areas of practice to ensure that these meet the standards and also to ensure that continued improvement happens. The audits fro the kitchen and medication were seen, these showed where improvements were required and what needed to be done. From this visit it was found that the areas for improvement had been actioned. It is recommended that when the improvement has been completed that the action plan is signed and dated. All staff receive two monthly supervision. The supervision is a shared responsibility of the senior team. The manager supervises the nurses and the nurses and one senior health care assistant supervise the junior staff. The cook supervises the kitchen staff. There is a list of who is responsible for the supervision and the dates are entered when this is completed. The cook told us that this is working well with the kitchen staff and has enabled him to formalise certain aspects of the work and to ensure that the staff are full aware of all activates required of them. Three staff told us that they have received supervision and that this is helpful. The process was examined and two peoples supervision notes were read. This The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 27 shows that the process is designed to look at areas of practice and to support staff with training and dealing with the people they care for. There is also a yearly appraisal for all staff, which will be carried out later this year. The home manages the personal monies of most of the people at the home. This means that they have access to their own money to pay for extra items when needed. On the first visit this system was not robust, however, at the second visit the manager had changed a number of aspects to ensure that the system was safe. All money is now kept in a safe in a locked room, there is also a locked post-box so that staff can deposit money, cheques and small items for the administrator or manager to log in. There are clear records available of transactions and receipts are kept. The policy and procedure for managing this money has been up dated and is clear and robust, therefore protecting people from possible financial abuse. There is a maintenance person who carried out basic repairs and ensures that the fire checks are carried out. There is up to date information tells us that the gas, electric and fire systems are safe and appropriate for this service. The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X 4 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Care plans that are no longer used should be removed from the care files to avoid any confusion with the care required. AN audit of medication management should take place more frequently to ensure that all staff continue to manage this area well. All improvements made from the home’s action plan should be dated and signed to show when they were completed and by whom. The telephone numbers for other social service departments that fund people who live at the home should be made available for use in the event of a safeguarding issue. 2 OP9 3 OP33 4 OP18 The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 30 6 OP19 The décor in the Dementia Care Unit should be addressed and be in line with current research to ensure the best outcome for those living in the unit. The Meadows Nursing Home DS0000004124.V374581.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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