Care Home: The Meadows Residential Care Home

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What the care home does well The premises are purpose built, well maintained, furnished and equipped, and are kept clean and hygienic. Good quality assessments are undertaken. Detailed care plans are in place. High standards of care are provided. The routines of the home are flexible. Good quality food is served. The home is fully staffed, and staff are well trained. Proper records are kept. The home has obtained the Investors in People Award The home is well managed and is a pleasant place to be. Quality assurance surveys are undertaken. What has improved since the last inspection? The admission assessment form has been improved to improve the history taking for new residents. Residents and their relatives receive sight of the latest CSCI inspection report. The reminiscence programme has been updated, and a general knowledge quiz introduced. The variety of food served has been improved, and fresh fruit added to the menu. The menu displayed in the dining room is now easier to read. A conservatory has been added at the rear of the premises. Corridors, landings and three bedrooms have been decorated. Some new carpets fitted. Most baths have been replaced by showers. A new sluice room has been installed. Additional staff training has been provided, which includes dementia care, diabetes control, infection control, medication, food hygiene, moving and handling, fire training, and death and dying. The manager individually records resident`s views. What the care home could do better: The whole of the CSCI registration certificate, and the most recent insurance certificate, should be displayed in the home in order to fully inform residents and their visitors. A new Service Users` Guide and new service user contracts should be issued to inform residents and their relatives about the change in registration of the home from sole trader to limited company. The eating experience for residents would be enhanced by relocating the large and noisy refrigerator that is currently in the dining room. The home`s fire evacuation plan must be reviewed in terms of making sure that residents and staff can safely leave the agreed assembly area without reentering the building. There is a trip hazard present when entering the conservatory from the dining room. A new Criminal Records Bureau disclosure has to be obtained by The Meadows when a new employee is recruited. A review of the administrative and clerical aspects of the home should be undertaken as the Manager does not receive help with these aspects at present. CARE HOMES FOR OLDER PEOPLE The Meadows Residential Care Home 288 Oldfield Lane North Greenford Middlesex UB6 8PS Lead Inspector Robert Bond Unannounced Inspection 22nd January 2009 10:00 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 Residential Care Home DS0000072531.V373790.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 Residential Care Home DS0000072531.V373790.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Meadows Residential Care Home Address 288 Oldfield Lane North Greenford Middlesex UB6 8PS 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) 0208 575 3320 0208 575 8666 Ashvin & Company Limited Mrs Mary Roarty Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20), Physical disability (20) of places The Meadows Residential Care Home DS0000072531.V373790.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC 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 2. Physical disability - Code PD The maximum number of service users who can be accommodated is: 20 6th February 2007 Date of last inspection Brief Description of the Service: The Meadows is a residential care home for 20 older people. It is purpose built with two floors. The home is wheelchair accessible and has a passenger lift for easier access to the first floor. The home has twelve single bedrooms and four double bedrooms. Eight single bedrooms and all double bedrooms have en suite facilities. There is a lounge and dining room on the ground floor. The home has a rear garden and seating provided. Activities are provided daily including weekends. Residents may attend acts of worship on Sundays and at other times in accordance with their wishes. The home has close links with the local Roman Catholic Church, Church of England and Pentecostal Church. A hairdresser visits every two weeks. The home is close to shops, amenities and public transport. The home also has a resident dog. Fees are between £500 and £550 per week. The Meadows Residential Care Home DS0000072531.V373790.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 service is 2 star. This means the people who use this service experience good quality outcomes. This was a key inspection, which assessed the home’s performance against the anticipated outcomes of the key National Minimum Standards (NMS) for Care Homes for Older People, as written by the Department of Health. The last key inspection took place on 6th February 2007 but a random inspection was also undertaken on 1st July 2008. In advance of the current inspection, the home submitted to us on 4th September 2008 a completed Annual Quality Assurance Assessment (AQAA), which is referred to in this report. During the inspection we interviewed the Registered Manager, met other staff, talked to residents and visitors, toured the premises, and examined a variety of documents. Equality and Diversity were considered throughout the inspection, and no adverse issues came to light. Since 20th November 2008, the home has been registered in the name of Ashvin and Company Ltd., with the previous owner remaining as the Responsible Individual. What the service does well: What has improved since the last inspection? The Meadows Residential Care Home DS0000072531.V373790.R01.S.doc Version 5.2 Page 6 The admission assessment form has been improved to improve the history taking for new residents. Residents and their relatives receive sight of the latest CSCI inspection report. The reminiscence programme has been updated, and a general knowledge quiz introduced. The variety of food served has been improved, and fresh fruit added to the menu. The menu displayed in the dining room is now easier to read. A conservatory has been added at the rear of the premises. Corridors, landings and three bedrooms have been decorated. Some new carpets fitted. Most baths have been replaced by showers. A new sluice room has been installed. Additional staff training has been provided, which includes dementia care, diabetes control, infection control, medication, food hygiene, moving and handling, fire training, and death and dying. The manager individually records resident’s views. What they could do better: 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 Residential Care Home DS0000072531.V373790.R01.S.doc Version 5.2 Page 7 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 Residential Care Home DS0000072531.V373790.R01.S.doc Version 5.2 Page 8 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): 1, 2 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standard 6 does not apply. The quality of assessments is good but the information made available to residents of the home and their representatives is not wholly accurate, as the change in legal status concerning the registration of the home has not been disclosed. We are seeking clarification from the provider concerning the above. EVIDENCE: We examined the home’s registration certificate, which showed that the home was re-registered by the CSCI in November 2008 in the name of a limited company. Only the first page of the two-page certificate was displayed. We also examined the home’s certificate of insurance that was also displayed in the foyer. This insurance was not in the company name, but the correct insurance certificate was subsequently made available to us. The current Statement of Purpose concerning the operation of the home was not available for inspection, but has been supplied to us since. The Meadows Residential Care Home DS0000072531.V373790.R01.S.doc Version 5.2 Page 9 The home’s Service Users’ Guide has not yet been amended in order to show the change of registration of the home. We examined two of the residents’ care files in order to judge the quality of assessment information. In both cases comprehensive assessments had been provided to the home by the referring agency. The home had also undertaken their own written assessment to make sure they could meet the person’s needs in The Meadows. The Meadows Residential Care Home DS0000072531.V373790.R01.S.doc Version 5.2 Page 10 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): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health, personal and social needs are well documented within their care plans, and their care needs are being met. Residents are well protected by the home’s medication policy and procedures, they are treated with respect and their privacy is maintained. EVIDENCE: We examined two care files and found care plans in each. The care plans were written in two formats, one using a ‘Training Masters’ printed booklet format which is very detailed and good, and the other in a simplified two page version. Monthly reviews of the assessment and care plan are undertaken. All the placements in the home made by local authorities have been recently reviewed. The files also contained risk assessments, which are reviewed six monthly. Both of the residents had two identified key workers each. Personal care and health care issues are identified within the care plans. Monthly dependency ratings are undertaken. Residents weight and blood pressure are recorded monthly. Community nursing staff and a specialist Alzheimer’s nurse visit the home as necessary, and residents are enabled to access hospital and paramedical appointments. Residents have a choice of GP. The Meadows Residential Care Home DS0000072531.V373790.R01.S.doc Version 5.2 Page 11 We examined the medication storage arrangements and the records of medication administration. In one case it was found that an incorrect code letter was being used to explain why a specific medicine was no longer being administered. We observed the residents being treated with respect and their dignity maintained. There are screens in place to aid the privacy of residents who share a double room. Staff knock on residents’ bedroom doors before entering, each resident has a lockable cabinet, and keys to lock bedroom doors are available. A resident we spoke to said, “It’s very good living here. You can please yourself when you get up and when you go to bed.” A relative we spoke to said, “The home provides excellent care. My mother is loved here and well looked after. There is a lovely atmosphere.” The Meadows Residential Care Home DS0000072531.V373790.R01.S.doc Version 5.2 Page 12 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): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ social, cultural, religious and recreational needs are well met by the home. Residents are encouraged to maintain choice and control over their lives. Community and family links are greatly encouraged. The food provided is of a high standard but the dining room ambience suffers because of the large and noisy refrigerator. EVIDENCE: Several relatives and visitors were in the home on the day of the inspection. The home has a seven-day a week advertised activity programme. A Sing along took place during the morning and Karaoke was on offer during the afternoon of our inspection. A lot of television and DVDs are watched. Some residents have a television and a telephone in their own rooms. On Sundays residents are escorted to the local Church of England or Roman Catholic Church, and representatives of the Baptist church visit the home. This range is commended. Residents meetings are held, informally on a daily basis, and formally on a quarterly basis. The Meadows Residential Care Home DS0000072531.V373790.R01.S.doc Version 5.2 Page 13 We checked the food menu, which was varied and included choices. A roast chicken dinner was being enjoyed on the day of the inspection. The Manager reported that ethnic meals, diabetic food and pureed food were all available. A resident told us, “The food is very good here.” A large industrial style refrigerator/freezer is being kept in the dining room, and the ambience of the room, and the eating experience for residents, are adversely affected by the loud noise from its motor. The Meadows Residential Care Home DS0000072531.V373790.R01.S.doc Version 5.2 Page 14 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): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives are confident that any complaints will be fully investigated. Residents are protected against all forms of abuse. EVIDENCE: The home has in place a comprehensive complaints procedure that is well known to residents and relatives. In the two years since the last key inspection, only one complaint has been received, which was from an exmember of staff. The complaint was fully investigated, a Safeguarding Adults strategy meeting was held, and the CSCI undertook a random inspection of the home. None of the aspects of the complaint were substantiated. Staff in the home have been trained in Safeguarding Adult procedures, with the most recent training being in December 2008. The Meadows Residential Care Home DS0000072531.V373790.R01.S.doc Version 5.2 Page 15 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): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, pleasant and hygienic. The home is well designed, furnished, equipped and decorated, but some potential hazards have been identified in this report. EVIDENCE: We toured the premises with the Manager, and alone to meet residents and relatives. A new and attractive conservatory has been added to the rear of the premises but there is a trip hazard when leaving the dining room and entering the conservatory. We noted that ensuite baths have been replaced by showers, but that one communal bath remains. Several areas of the home have been redecorated and re-carpeted. No malodours were noted and the home was clean and hygienic throughout. We tested the hot water supply and the call-bell system of the home. The home has its own laundry, and a new sluicing facility has been purchased. The Meadows Residential Care Home DS0000072531.V373790.R01.S.doc Version 5.2 Page 16 We found that the glass box designed to hold a key for the upstairs fire exit was empty, but a key was replaced in the box whilst we were still on the premises. We also found that the internal kitchen door, which is a fire door, did not close firmly. This was also corrected before we left the home. The assembly area in case of fire is in the home’s back garden. However there is no clear way out of the garden as exits are blocked, so expert advice is necessary concerning the home’s fire evacuation plan. The Meadows Residential Care Home DS0000072531.V373790.R01.S.doc Version 5.2 Page 17 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): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are looked after by an appropriate number of care staff who have been extensively trained. The home’s recruitment procedure is generally sufficient but must include obtaining new CRB disclosures for new staff in order to fully protect residents. EVIDENCE: We examined the home’s staffing rota, and noted that sufficient care staff were deployed on the day of our inspection. There is however no administrative or clerical support for the manager. The AQAA states that 15 out of 16 permanent care workers have NVQ level 2 or above in care. This high proportion is commended. We examined the recruitment records of a recent recruit to the workforce. Appropriate checks had been undertaken except that the Criminal Records Bureau disclosure had been undertaken by another employer, not by The Meadows. CRB’s are not transferable for care workers, and so a further disclosure check is necessary. Training records evidenced the large extent of training that staff members have received. Induction for new staff lasts up to three months and follows the Skills for Care format. The Meadows Residential Care Home DS0000072531.V373790.R01.S.doc Version 5.2 Page 18 The Meadows Residential Care Home DS0000072531.V373790.R01.S.doc Version 5.2 Page 19 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): 31, 33, 35, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and is operated in the best interests of the residents. The administrative and clerical aspects of the running of the home require some attention, as do a couple of health and safety matters. EVIDENCE: The Manager has completed her Registered Manager’s Award. She has 34 years experience working in health and social care and keeps up to date by attending additional training. She does not have a designated deputy manager, as this task is shared amongst senior care workers. The Manager also does not have any administrative or clerical support. The rota showed that she often works six days a week. She also lives on the premises. Residents told us that they were able to make choices themselves, and that the home is run flexibly to help meet their needs. Relatives and visitors we The Meadows Residential Care Home DS0000072531.V373790.R01.S.doc Version 5.2 Page 20 spoke to praised the work and dedication of the Manager. The home undertakes its own quality assurance surveys, but the proprietor visits to make his own checks. The Manager reported that the home does not administer any money on behalf of residents. In terms of record keeping, there were some problems unearthed by this inspection. For instance, the Manager had difficulty locating certain documents, such as safety certificates and a risk assessment, which had to be faxed to us subsequently. The home’s current insurance certificate and full registration certificate were not displayed, and other documents such as the Service Users’ Guide had not been updated following the change in the registration. Given the Manager’s many other duties, which she does very well, administration and filing were falling behind the required standard. Considering the size of the home and the complexity of the tasks required by the Care Standards Act, some additional administrative or clerical input is indicated for The Meadows. With regard to health and safety, we saw evidence of professional testing of the lift, the boilers, and the electrical appliances of the home. We tested the hot water temperature and the working of the call bell system. We have made two requirements concerning risk management, which relate to fire evacuation procedure, and an identified trip hazard when entering the conservatory. The Meadows Residential Care Home DS0000072531.V373790.R01.S.doc Version 5.2 Page 21 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 2 3 3 x x N/A 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 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 4 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 4 x 3 x 3 2 The Meadows Residential Care Home DS0000072531.V373790.R01.S.doc Version 5.2 Page 22 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. 1 Standard OP1 Regulation 5 Requirement The Service Users’ Guide must be amended and re-issued in order to show the contact details of the new registered provider. A CRB disclosure has to be applied for by The Meadows for every new employee, in order to fully protect residents. Plans for the evacuation of the home in the event of fire must be reviewed in order to protect residents and staff. The trip hazard when entering the conservatory must be eliminated in order to protect residents and staff. Timescale for action 01/05/09 2 OP29 19 01/03/09 3 OP37 23 01/03/09 4 OP37 23 01/03/09 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 OP1 Good Practice Recommendations Both pages of the CSCI registration certificate should be DS0000072531.V373790.R01.S.doc Version 5.2 Page 23 The Meadows Residential Care Home 2 3 4 5 OP1 OP2 OP15 OP37 displayed as essential information appears on each. The insurance certificate displayed in the home should be the most recent one. Service users should be issued with new contract terms and conditions that quote the name of the new registered provider. The ambience of the dining room would be enhanced by relocating the refrigerator. A review of the administrative and clerical needs of the home should be undertaken by the proprietor. The Meadows Residential Care Home DS0000072531.V373790.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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. Extracts may not be used or reproduced without the express permission of CSCI The Meadows Residential Care Home DS0000072531.V373790.R01.S.doc Version 5.2 Page 25 - 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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