Random inspection report
Care homes for older people
Name: Address: The Old Vicarage Stockton Road Ryhope Sunderland SR2 0LS two star good service 10/12/2008 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: Janine Smith Date: 1 5 0 6 2 0 1 0 Information about the care home
Name of care home: Address: The Old Vicarage Stockton Road Ryhope Sunderland SR2 0LS 01915211980 01915214029 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Sharon Melissa Cowburn Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Stephen Potts care home 34 Number of places (if applicable): Under 65 Over 65 0 34 0 0 dementia old age, not falling within any other category physical disability sensory impairment Conditions of registration: 20 0 4 4 The maximum number of users who can be accommodated is: 34 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, maximum number of places: 34 Dementia - Code DE, maximum number of places: 20 Physical disability - Code PD, maximum number of places: 4 Sensory impairment - Code SI, maximum number of places: 4 Care Homes for Older People Page 2 of 15 Date of last inspection Brief description of the care home 1 0 1 2 2 0 0 8 The Old Vicarage is a detached Victorian building set in its own grounds in the former mining village of Ryhope. It has operated for many years as a care home for older people. It provides up to 34 places for older people some of whom may have dementia care needs or physical disabilities. It does not provide nursing care, so people continue to receive local community health care services. The home was purchased by a new Provider in June 2008, who has operated similar homes for older people in the North East. The home provides all single bedrooms, except one room that can be shared on request. There are lounges, bathrooms and bedrooms on both of the two floors, which are served by a lift. There is level access into the home and around the ground floor, and ramped access into the rear garden. Main corridors are wide enough for wheelchairs. The weekly fees are in line with those set by the local authority. Care Homes for Older People Page 3 of 15 What we found:
Before this visit we looked at information we have received since the last visit on 10th December 2008; any changes to how the home is run and the providers view of how well they care for people. An unannounced visit was made on 15th June 2010 by one inspector. The term we is used throughout the report to describe what the inspector did. The reason for this visit was to check how people were being cared for and what action had been taken to meet requirements made at the last visit. We were looking in particular at how people with mobility difficulties were helped, how people were safeguarded and how well staff were trained in these areas. This was because the Commission have received information about an investigation carried out by the local authority after it received a number of concerns, including about the way people were being cared for. During the visit we talked with five service users and observed how they were cared for. We talked with the manager and two staff. We looked at the care records of three of the people we spoke to and saw some other documentation. We looked around parts of the building to see that it was safe, clean and comfortable. We also checked what improvements had been made since the last visit and what action had been taken to address requirements made following the last inspection. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. On arrival at the home, both the manager and senior carer were on duty, but the manager was engaged in painting a bedroom. The senior carer was managing the care being provided. Both the manager and the senior carer said they both helped with the redecoration of the home and had done so for many years. The manager said she did not think carrying out such tasks made her less able to carry out her full managerial duties. The senior carer is currently working seven days a week to cover staff absences due to maternity leave and holidays. Some of these extra working hours are spent on food preparation and some working as a carer, as distinct from a senior carer role. There were eighteen people living in the home at the time of this inspection. The manager said that the low occupancy had led to delays in the refurbishment and also a reduction in staffing. There were two carers on duty from 7.30 am to 9 am; three carers between 9 am to 1 pm; and then two carers from 1 p.m. through to 7.30 am the next morning. One of these carers is designated a senior carer. A cook, a kitchen assistant, a laundry assistant and two domestics are also employed through part of the day. A handyman works in the home three days a week. Care Homes for Older People Page 4 of 15 The manager felt that the current service users were not highly dependent and they could manage with these staffing levels. However, at least five service users need to use wheelchairs and some need the help of two staff to move through the home. When two staff are needed to assist one person at times when there are only two staff on duty, there is no-one to assist the other service users. A carer described daily routines, which were mainly task orientated although she mentioned service users listen to music and play bowling on a Wii machine, which staff bought for the service users. Carers come in before their shift starts or stay later so that they can have a handover of information from the previous shift. This is unpaid. The carer felt that more staff would be nice but that no-one suffers due to the staffing levels and they are able to attend to everyones needs. She said she had a one to one meeting with a senior member of staff every couple of months to discuss her work and the managers door is always open if anyone has any concerns. Six surveys were received from service users before this inspection. Staff had assisted them to complete the surveys. All six indicated they received the care and support they need and staff are available when they need them. Commments included, the care tends to my needs. Very happy at the Old Vicarage, Im happy at home at the Old Vicarage, Staff look after me well, happy with the care and meals. We made observations and had discussions with some of the service users during the day. Those service users expressing a view during the inspection said the staff gave them the help they needed when they needed it. They also said they would tell the manager if they had concerns about anything. Mid morning most of the service users were sitting in a small lounge next to the conservatory. There was little space between most of the chairs. They had been provided with beverages. One person had the use of side table but most service users were seen holding their drinks in their hands or drinks were placed on the floor. Lunch was taken with the service users. They were offered a choice between mince and leek pudding with vegetables or ham, fried egg and chips. This was followed by apple and rhubarb crumble or yoghurt. Staff provided assistance to service users who needed help. People were observed enjoying their meal. In the afternoon, some service users were sitting in a lounge. Two service users were sitting very close together. One pulled the large back cushion of the chair over her head and put it on the floor. She also tried to remove a zimmer frame belonging to the service user sitting next to her. This service user tried to retrieve her zimmer and told the other service user not to take it. There were no staff in the lounge at the time. One of these service users has dementia. Records and discussion with staff indicated that she can exhibit some difficult, though not unusual, behaviours at mealtimes and when personal care is being provided. Staff had sought advice from a dentist, which is good, to see if this lady was experiencing pain and possible treatments were being discussed. However, her plan of care was limited in scope and did not identify, for instance, how she was affected by the dementia and how this impacted on her day to day life. There was no plan of care to to advise staff how to respond to the behaviours she presented or how she
Care Homes for Older People Page 5 of 15 could be helped with these, other than a note that staff should sit with her at mealtimes. There are indications that staff are not keeping social workers fully informed of behavioural issues when reviews of care are carried out. Staff were of the view that they did not want to make any fuss about the behaviours presented and should accept this as part of the job. However, with advice and more specialist training about dementia, they could reduce the potential for such incidents to occur. The other care plans seen were also narrow in scope and lacked information, for instance about specific health conditions. The last inspection identified that whilst there had been some improvement in the care planning, further work needed to be done and specifically pointed out the need to have care plans in place for specific health conditions and more regular checks on peoples weight. Nutritional assessments have been introduced since the last inspection and staff have had some training about nutrition for older people, which is a positive step. However, service users are not having their weight checked frequently enough and insufficent action is being taken to address peoples weight loss. For instance, records showed that there was a six month gap between the last weighing and the previous one for a service user. The records indicated that her weight had dropped from ten stone to under seven stone over 29 months. The local authority recently investigated concerns that a service user in the home had been restrained against her will to prevent her from falling. Whilst this had been done with the best of intentions, there had been a lack of thorough assessment of the risks involved and possible alternative courses of action. Discussion with staff during this inspection indicates that they need to have a greater understanding of risk assessment and restraint and appropriate care practice. There also needs to be sufficient staff to monitor people at risk of falls. Concerns have been identified by a local authority expert about staff not having up to date knowledge and training in safe techniques for helping people with mobility problems and that there is a lack of appropriate up to date moving and handling equipment in the home. The manager said that staff were not using unsafe techniques when assisting service users with mobility difficulties. She said that the staff had some equipment to help people move safely such as swivel boards, slide sheets and belts but that some equipment was old. She also said that the home had a hoist but service users did not like to use this and it was too big to use in some smaller rooms. A carer confirmed that the home had this equipment but another one said that the home did not have a hoist now. There were moving and handling risk assessments in the records seen but these had been written a long time ago and were not as detailed as they need to be to ensure staff are clear about how to assist someone who needs help with moving. Mention was made at the last inspection that there was a lack of evidence staff had had updated moving and handling training and that they were using outdated techniques when assisting people with mobility problems. A requirement was made for staff to receive updated training. The manager and staff spoken to confirmed that they had since
Care Homes for Older People Page 6 of 15 completed a correspondence course about moving and handling but felt that this had been unhelpful as it had no practical training element. She was looking into other training courses. The manager said that if service users have falls, then they make a referral on their behalf to the Health Falls Adviser. Steps had been taken to reduce the risk of a person having falls by moving them to a ground floor bedroom. The Care Home Regulations require that the owner makes an unannounced visit at least monthly to check on the quality of care being provided and that the owner write a report of their visit to the manager and the Commission. The owner was reminded at the last inspection that reports need to be available for inspection. The manager and staff said that the owner of the home made frequent visits but the reports of his visits are being written by the manager instead of himself and are insufficiently detailed about what he did, who he spoke to and his findings. The owner of the home recently investigated allegations of abusive practice by a carer brought to his attention by the local authority. The owner has not yet advised the local authority of the outcome of the investigation and whether he intends to make any referral to the Independent Safeguarding Authority, a body set up to help protect vulnerable service users from unfit carers. A report of his investigation has not been provided to the Commission. A recommendation was made at the last inspection to improve staff records so that it could clearly be seen what training staff had completed and when this was done. Two staff records were looked at during this inspection. Some certificates were on file providing evidence of some training, but there was a lack of certification for other training, such as medication, protection of vulnerable adults, a National Vocational Qualifications, although two staff spoken to confirmed the training they had done. Certification was not yet available for a moving and handling course completed by staff last year. The manager said some staff have had training about the Mental Capacity Act and Deprivation of Liberty safeguards and others are booked to do this training. This training needs to be completed as soon as possible as the legislation has now been in place for some and local authorities have offered extensive help to the care sector with staff training about this. The manager had copies of the government guidance and said she was confident that she understood her own responsibilities and duties under the legislation. What the care home does well:
The manager and staff work closely together and the home has low staff turnover, which helps to provide consistency. Staff show commitment and concern for service users, for instance, using their own time for essential handovers between shifts. Staff have tried to improve service users social activities by buying them a Wii games machine with their own money. Service users see general practitioners when they are unwell and they have access to routine health care, such as dentists, opticians and chiropody. Care Homes for Older People Page 7 of 15 Good nutritious meals are provided and service users have choices at meal times. What they could do better:
The quality rating given at the last inspection in December 2008 was two stars good but the findings from the information we have gathered before and during this inspection, indicate that the home is not currently operating at the level expected for a two star service. During this inspection, service users spoken to raised no concerns about the quality of care they received. Discussions with the manager and staff lead us to believe that whilst the manager and staff work hard and want to do the best for the people living here, they are not fully aware that the standard of care can be much improved. The owner needs to be more proactive in ensuring that the managers role is focussed on managerial tasks, such as monitoring and improving the quality of care through leadership and development of the staff team, rather than on maintenance and other tasks that should be done by other staff/outside services. He also needs to ensure that the manager has sufficient support and resources from him, such as good staffing levels and training so that the quality can consistently improve. Staffing levels must be increased to ensure all service users can be met at all times. If there are only two staff on duty for large parts of the day and evening, there will be times when service users cannot be observed. Without adequate staff, there will not be enough time for thorough risk assessment and care planning, reassuring and occupying people. Staff should also be paid to participate in essential information handovers between shifts. He also needs to drive through some cultural change so that the manager and staff understand the importance of working closely with other professionals and keeping them informed of changes in service users and ensuring that help and advice is sought where difficulties are encountered, such as behavioural issues. When service users present behaviours that challenge, advice must be sought from relevant health and social care professionals. This helps staff to understand the reasons why such behaviours happen and draw up appropriate strategies to help reduce them. If care plans detail how individual service users daily lives are affected by the health conditions they have, staff can be much better informed about how to care for them. For instance, dementia progresses at different rates in people, so each person needs their care plan to describe how it affects them during different activities, such as eating meals, personal care, mixing with other people. This helps the staff to understand how best to care for them and helps ensure consistent care. Service users need to be weighed at least monthly so that staff are quickly alerted if they are losing weight. This ensures appropriate action can be taken to improve their nutrition. Service users who cannot weight bear need to be weighed on appropriate sit on weighing scales, which the owner needs to provide. The home is registered to provide care for people with physical disabilities, so must have appropriate equipment to meet the needs of people with mobility problems. The owner
Care Homes for Older People Page 8 of 15 needs to act on the concerns expressed by a specialist in moving and handling about the equipment and training provided. Staff need to be given suitable practical training in moving and transferring skills which should include use of specialist equipment, including hoists, as the last training provided has not met their needs. The current hoist is not suitable for use in the home and some of the other moving and handling equipment is old. Specialist advice must be obtained from a suitably qualified person who can advise on the type of moving and handling equipment necessary to meet the needs of people living in the home. If staff have specialist training about risk assessment and restraint in care environments, they would be better informed and knowledgeable about the types of strategies that can be taken if people are at risk, for example, through falls, wandering, etc. Managers and care staff are often faced with difficult moral dilemmas when caring for people, and appropriate training helps them think through all the issues involved. Staff records need to include evidence of the training people have done, such as certificates. This helps the manager to ensure that staff have the training they need. Staff should be given training about their responsibilities and duties under the Mental Capacity Act and Deprivation of Liberty safeguards. This legislation was introduced to protect people who are not always able to make decisions for themselves due to mental incapacity and everyone who works in the care field needs to know what it is about. The owner needs to write a detailed report of what he did, who he spoke to and his findings, when he makes unannounced visits to comply with Regulation 26 of the Care Homes Regulations. The owner needs to notify the Commission of details of the recent investigation he carried out and the action he intends to take. Regulations require the owner to notify the Commission of any allegation of misconduct of any person who works at the care home. It would be better if there was more space between chairs in the lounge and side tables available. This would reduce the potential for accidents with hot drinks because service users have to currently hold onto their drinks or reach down for drinks placed on the floor. 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 15 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 10 of 15 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 1 7 15 Care plans must detail how each service users daily life is affected by any specific health conditions they have, for instance dementia. This helps the staff to know how best to help each service user and ensures consistent care. 31/10/2010 2 8 13 Staff must be given up to 31/10/2010 date practical training about safe techniques for moving and handling service users, including using hoists and allied equipment. Moving and handling risk assessments must contain sufficient detail about the service user, help needed and equipment and techniques to be used when assisting each service user. This helps reduce the potential for injury to service users and staff. 3 8 12 Information must be shared with other health and social care professionals when 30/07/2010 Care Homes for Older People Page 11 of 15 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 appropriate, for instance if service users are presenting behaviours which are challenging. This helps ensure that staff receive expert advice and guidance as to how best to support the service users and ensure that all their needs are being met. 4 18 37 The registered provider must 30/09/2010 tell us about the disciplinary investigation he has carried out and the outcome of this and whether he has made any referral to the Independent Safeguarding Authority. This helps to protect the people living in care homes. 5 18 13 Accredited training about managing risk, making good risk assessments and understanding restraint, must be provided to the manager and care staff. This helps ensure service users rights are understood and respected and staff develop good practice. 6 22 23 The provider must take 31/10/2010 account of the recent findings of the local authority moving and handling expert and provided suitable disability equipment to meet the needs of the service users living in the home. This
Page 12 of 15 31/10/2010 Care Homes for Older People 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 may include provision of a suitable hoist, beds, moving and transferring equipment. This will help ensure that service users have access to the specialist equipment they require to maximise their quality of life. 7 27 18 Care staffing levels must be 31/08/2010 increased through the afternoon and early evening as currently there are only two care staff on duty after 1 p.m. on weekdays. Better staffing levels would enable service users to be monitored more closely and given more support with day to day living. For instance, care staff would have more time for care planning, weight monitoring, keeping service users safe, helping people when other care staff are busy. 8 37 19 Staff records must include documentary evidence of relevant qualifications and training obtained. This helps show that each member of staff has been given the training they need. 9 38 26 The registered provider must 31/08/2010 prepare a written report of the unannounced visits he makes to the home at least monthly and make these available to the manager and
Page 13 of 15 31/08/2010 Care Homes for Older People 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 commission. This helps the provider to monitor the quality of care provided. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 8 Service users should be weighed at least monthly and more often if they are losing weight and a record kept. This helps staff to monitor their nutritional wellbeing and helps them to know when to seek further expert help. The provider must confirm when staff have completed training about the Mental Capacity Act and Deprivation of Liberty safeguards and that staff are aware of their legal responsibilities under this legislation. Provide side tables and more space between chairs in the lounge, so that service users have a safe place to place drinks. This helps reduce the potential for accidents. Sit-on weighing scales should be provided so that service users with physical disabilities who cannot weight bear can still be weighed regularly. Record any falls service users have in the accident book. This helps staff to monitor the number of falls someone has and the circumstances in which they happened, so that referrals for expert help can be made promptly and steps taken to help reduce the risk of falls. The registered manager needs to devote 100 of her working time to managerial tasks, such as monitoring and improving the quality of care, providing leadership and developing the staff team, rather than carrying out maintenance of the building and other tasks that can be undertaken by other staff. This helps ensure staff have a clear understanding and apply best practice within their roles.
Page 14 of 15 2 18 3 20 4 22 5 38 6 38 Care Homes for Older People 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 15 of 15 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
