Inspection on 13/08/10 for The Old Vicarage Residential Home

This is the latest available inspection report for this service, carried out on 13th August 2010.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Old Vicarage Residential Home 07/09/09

The Old Vicarage Residential Home 09/07/08

The Old Vicarage Residential Home 18/05/07

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/06/2011.

Random inspection report Care homes for older people Name: Address: The Old Vicarage Residential Home 2 Tibberton Road Malvern Worcestershire WR14 3AN zero star poor service 12/03/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Andrew Spearing-Brown Date: 1 6 0 8 2 0 1 0 Information about the care home Name of care home: Address: The Old Vicarage Residential Home 2 Tibberton Road Malvern Worcestershire WR14 3AN 01684569523 01684569523 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Annette Hoskins Type of registration: Number of places registered: Conditions of registration: Category(ies) : SJS Care Ltd care home 17 Number of places (if applicable): Under 65 Over 65 2 17 17 mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Conditions of registration: 0 0 0 The Home may also accommodate a maximum of 9 people over 65 years of age with dementia illnesses. Date of last inspection Brief description of the care home The Old Vicarage is situated a short distance from Malvern town and all the towns amenities. The Provider owner, S.J.S. Care Ltd., was registered with the commission in November 2006. Dr. R.C. Sumanasuriya has been nominated as the responsible Care Homes for Older People Page 2 of 16 1 2 0 3 2 0 1 0 Brief description of the care home individual who supervises the management of the care home on behalf of the Provider company. The home is a Victorian house on three levels that has been adapted to provide care for older people. There are thirteen single bedrooms, seven of which have en-suite facilities, and two shared bedrooms. In addition, there is a communal lounge and conservatory and a communal dining room. A stair lift is fitted to the main staircase to facilitate movement between the ground and first floor. A small number of steps do have to be negotiated, as the stair lift does not reach the first three or four steps from the ground floor. Grab rails are, however, provided. The house is surrounded by a well-established, accessible garden. The home is registered to accommodate 17 residents who have care needs arising from the ageing process or who are over 65 years of age and have care needs arising from physical disability. The service can accommodate up to nine residents over 65 years of age who have care needs arising from dementia and two residents over 65 years of age who have care needs arising from mental health problems. Up-to-date information relating to the fees charged for the service is available on request from the home. Care Homes for Older People Page 3 of 16 What we found: Following this inspection we were informed that the service can be contacted on sjscare@gmail.com. In addition the service has a web site www.theoldvicaragemalvern.co.uk. Mrs Annette Hoskins is no longer the registered manager. This unannounced inspection of The Old Vicarage commenced on August 13th and continued on August 16th 2010. The reason for the inspection was to monitor the homes progress following the requirements reported upon within our previous inspection report. Following the last key inspection the service was assessed as a zero star rated service. A warning letter was issued in April 2010 to the Responsible Individual for the home to address the areas of non compliance with regulations. The manager designate who works at the home three days per week was on a day off when we commenced this visit. She did however attend the home for a period of time. She was present throughout our second visit. In addition to the manager designate we also spoke to the deputy manager, the administrator, some care staff and some people who reside within the home. While at the home we looked at some records such as those relating to care, medication, staffing and health and safety. We had a look around the home and observed what was happening. There is a communal lounge, a dining room and a conservatory in which people are able to spend the day as well as their own bedroom. At the time of our visit there were 14 people residing within the home plus 1 resident in hospital. The service therefore had 2 vacancies one of these was within a single room while the other was in a double bedroom. Information about the home is available by the front entrance. A copy of the Service Users Guide is available in bedrooms. We noted that the Guide gave the name of the manager designate as the registered manager. This is not the case as no application has been made to the commission for registration. However, having information available may assist people in their decision making process regarding moving into the home. The home has since our recent inspections received support from the Care Quality Team employed by Worcestershire Adult Services. This support has included guidance regarding care planning. The progress made in this area is therefore disappointing as it appears that the service has reviewed and up dated only one persons plan. A care plan is a document designed to give staff guidance in order that they are able to carry out the required care in a consistent way meeting identified needs. We viewed the care records for some people living within the home and found shortfalls in the record keeping that could potentially compromise the care that people receive. We previously wrote care plans and assessments were not being reviewed and up dated Care Homes for Older People Page 4 of 16 frequently this was also the finding of this inspection. One person had a pressure sore assessment showing the person to be medium risk. The assessment was done in March 2010 and had not received any up date since then. The assessment showed the person to have broken skin however no care plan in relation to pressure care and skin care was done. The same person had a nutritional risk assessment also dated March 2010. The document stated that it should be reviewed in April, no review had happened. The care plan entitled pressure areas and skin care for one person mentioned creaming to parts of the body but gave no details regarding the name of the cream or frequency. The same plan stated that all pressure areas were intact. The daily records showed that the same person did at a later date have a very small open wound. The care plan was not reviewed in relation to this development. Furthermore the same care plan stated that the person concerned was nursed in bed. However, other records showed that the person was getting out of bed for short periods of time. The pressure risk assessment was not reviewed throughout these changes. We saw a dietary care plan reviewed in June 2010. A weight chart showed that the person had lost weight when checked in August 2010. The care plan was not reviewed in the light of this change. The nutritional risk assessment was not reviewed and therefore did not take into account the change in skin condition and weight loss. Care plans generally were not reviewed as needed or if an entry was made it was not a review of care but often a record of some care intervention such as xx given a shave today. We saw on other files examples whereby no risk assessments existed for example somebody who needed assistance into the bath but no moving and handling assessment done or someone who fell and assessments were not reviewed. Although we saw gaps within the care records we did nevertheless see evidence that the service has in the past contacted professionals such as the district nursing service when they have had concerns about peoples skin condition. We also saw records showing that urine samples were obtained if staff had reason to believe somebody could have an infection and that these were taken to the GP surgery for testing. We spoke to people within the home who appeared happy with the care they were receiving. People sat in the lounge appeared to be appropriately attired taking into account gender and weather conditions. Within our previous report we highlighted the need to improve certain aspects in relation to the management and control of medication. We reported that a new fridge had arrived in the home awaiting installation. During this visit we saw that a dedicated fridge is in place and that staff are regularly recording the temperature. Furthermore staff are recording the temperature of the room where medicines are held. The vast majority of the MAR (Medication Administration Record) sheets were completed to show that staff had administered medication as prescribed. Staff were however recording their initials in block capitals rather than a signature to demonstrate the administration of medication. Care Homes for Older People Page 5 of 16 Generally medication is stored satisfactorily. However, somebodys medication was left out for a period of time when the person returned to the home from hospital. Leaving medication un-locked could be a potential hazard and could also result in it going missing. We were assured that the newly fitted cabinet for controlled drugs was fixed to the wall using the required bolts. We viewed some of the MAR sheets and checked them against the medication held and found some discrepancies. Staff on duty were unable to account for any of these. We were unable to balance the number of laxatives held for one person. It appeared that there were too many remaining which indicated that on one occasion during the previous 10 days the person had not receive the medication as recorded upon the MAR sheet. Similarly somebody was prescribed a steroid whereby it was necessary for staff to break a tablet in half to ensure the correct dose was given. We audited the records and found 1.5 tablets too many remaining. Therefore, it appeared that medication was given incorrectly on at least one occasion during a period of 12 days. The MAR sheet for one person stated course finished in relation to some medication. The correct number of signatures were recorded upon the MAR sheet. However, we found a tablet remaining within the cupboard. It was therefore evident that one member of staff had recorded that medication was given when it was not. We saw some handwritten notes from the manager designate informing staff that a night sedative was only to be given as necessary and recorded as needed. Despite the change in medication routine it was evident that a member of staff had administered the medication and not signed for it or recorded the reason why the drug was needed. Some medication is prescribed on a variable basis. It was not always apparent what dose staff had administered, making auditing difficult. The home had available a small number of household remedies. These were viewed and we found that the number of painkillers held did not balance with the records. We viewed the revised medication policy dated June 2010. The policy stated When signing the MAR sheet you should sign as you pop the tablets out of the blister packs This is incorrect as the MAR sheets should be signed once the medication is administered and not beforehand. As part of this inspection the manager designate informed us that she is planning to rearrange the furniture within the lounge as a means of encouraging more social interaction. The television within the lounge was on throughout most of the time we spent within the home. Any activities undertaken within the home have to fall within other duties undertaken by care staff. During our inspection we did see care staff sat in the lounge with people. However, the amount of interaction taking place appeared minimal. Interactions witnessed both within the lounge and during other times were however calm and respectful. Within the dining room was a display of art work done by people using the service. Towards the end of our visit a clothing party was taking place whereby an external company had brought to the home a selection of clothing able to be purchased should people be interested. Care Homes for Older People Page 6 of 16 We were informed that the Music man visits the home on a monthly basis. The cost of these visits are shared between people who partake in the event. Although this extra charge did not appear within the homes terms of residency a separate document was seen whereby people have agreed to this arrangement. We have previously reported that there is an open visiting policy within the home. Therefore people can see visitors as they choose and maintain friendships and relationships that are important to them. Within the previous report we stated that staffing levels need to be closely monitored to ensure that there are always sufficient people available to meet the dependency levels of people using the service. We looked over recent rotas and saw that during the morning there were three carers on duty. Other people work within the home such as catering staff and domestic staff. During the later part of the afternoon and into the evening there are also three carers on duty. However, it was clear to see that at times during the middle of the afternoon only two people are in the building. We were told that at the time of our visit nobody needed more than one carer to provide their personal care and that levels would be increased once somebody returned from hospital. However, the daily records of one person clearly stated assisted in to the lounge by 2 carers. The number of staffing on duty during part of the afternoon is therefore of concern and needs to be reviewed to ensure care needs are able to be meet. Details regarding some forthcoming training was displayed within the staff room. This training was in relation to nutrition and safeguarding. We were informed that staff have recently received training in moving and handling and the use of the hoist. We viewed the recruitment file for a recently appointed member of staff and found that the home had carried out checks prior to the individual commencing duties. We have previously been informed of plans to extend the home and that these plans would include the instillation of a passenger lift. Currently it is recongised that the accommodation is not ideal for people who have mobility difficulties because the stair lift can only be accessed via a short flight of internal steps. People residing at The Old Vicarage are able to personalise their own bedrooms with items such as ornaments, photographs and furniture. We brought to the attention of the manager designate that wardrobes were not always secured to the wall to prevent accidental toppling. We previously reported upon the home having broken furniture within bedrooms. We did not see any as part of this visit. We were also informed that some of the chairs in the conservatory were new. The carpet in the main lounge is worn and stained. The manager designate believes that it is due to be replaced. We were informed that the carpet in the hallway and up the stairs is going to be cleaned. We have previously reported that a risk assessment was done on all windows above two meters from the ground where people who reside within the home have access. As part of this visit we were informed that checks on the means of restricting the opening of windows are not recorded to demonstrate that they are functional and that people are not at risk of falling either accidentally or deliberately to the ground. Care Homes for Older People Page 7 of 16 Reference to a call bell not working within the last report seemed to relate to a particular bathroom. This room was checked and the call bell was found to be functioning. Due to the use of energy saving bulbs the lighting levels in communal areas such as toilets was initially dim. The gardens were well maintained with seating available for people to enjoy the surroundings. Access to the garden could be reached via a ramp from the conservatory. Some external decorating is needed, the manager designate was aware of this. Personal protective equipment such as disposable gloves and aprons were available for staff to use. We have previously reported that a note was placed in the laundry about the washing of clothing. We saw that this states All communal washing is to be washed on a programme which is at least 65 C. Following our inspection, but prior to making this report final we were supplied with information to demonstrate that the machine has a sluice facility. Since the last key inspection in March 2010 the then registered manager has left her employment at The Old Vicarage. In May 2010 a new manager, yet to be registered with the commission, commenced duties. This person was a previous manager at the home and therefore aware of many aspects of the service. Within our previous report we stated that the registered provider had actioned our requirement to carry out monthly unannounced visits to the home and write a report following the visit. During this visit was saw evidence that these visits continue to be taking place. At the time of the previous inspection we wrote that The service should also provide CQC with information in the form of a regulation 37 for all significant accidents and incidents that occur in the home. Although we were informed of some events, including a matter reported to the police under safeguarding, there were some events that we were not informed about. We saw records stating that for a period of time people were unable to have a bath due to a lack of hot water, we were not told about this. We also read of a number of concerns made to the home in relation to external drainage, again this was not reported to us. We viewed the fire records and found shortfalls. The most recent fire risk assessment was dated June 2007. Within our last report we stated that it was last up dated in December 2008, this up date was not however seen during this visit. We were unable to see any up dates to this document and could not see any reference to the digital lock on the front door. As the code is only known to staff people would be unable to escape from the building, via this exit, without a member of staff. The assessment itself stated that the home needs to ensure that up to date records are kept on fire evacuation, drills, staff fire training, fire alarm tests, fire extinguisher tests and emergency lighting. The last recorded weekly test of the fire alarm was on the 26th April 2010. Therefore it appeared that over three months had passed since the last test. Neither the manager designate or administrator were able to provide us with any indication that these tests had taken place. We saw no evidence to show that visual checks had taken place regarding the fire extinguishers and the emergency lighting. Records showed that some people have no recorded fire training or no recent fire Care Homes for Older People Page 8 of 16 training. These people included staff who have responsibility for certain shifts or are in the home during the night when people are likely to be at their least responsive. We saw records regarding the testing of hot water. The most recent monthly test was carried out during April 2010. The records showed some outlets whereby the temperature was too high. These were of concern because they were in places where full body immersion could take place such as a bath. We checked some of these and found the hot water temperature in one bathroom to be 54 degrees Centigrade which is well in excess of the guidelines from the Health and Safety Executive. The manager designate took immediate action in that she closed the bathroom off so that the potential risk of somebody getting scalded was removed. We asked to view the records regarding the testing of portable electrical appliances. These were not available. We did see stickers on appliances which showed that testing had taken place. However, we were unable to establish whether any items had failed and the action taken as a result. We viewed the service records for lifting equipment. Records were available for the portable hoist and the stair lift. Records were not however available for the hoist over a bath. We were therefore unable to establish whether this equipment had received the required safety check. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 9 of 16 Care Homes for Older People Page 10 of 16 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 Regulation 15 a b c All people living in the home should have a care plan which accurately reflects their health and welfare needs and provides clear guidance for the staff to follow. This should be reviewed and updated to reflect any changes or at least monthly To ensure that peoples health and personal care needs are met. 28/05/2010 2 8 12 Regulation 12 1 a The home 28/05/2010 should ensure that appropriate risk assessments have been completed, and any potential risks are dealt with to ensure that the persons health and welfare is not being compromised. This includes referring to other professionals for advice and treatment for people where it is required. To assist in protecting people who live in the home. 3 9 13 Regulation 13 2 The service 30/04/2010 must make arrangements to ensure that medication administration records are Page 11 of 16 Care Homes for Older People 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 accurately maintained; that the reasons for nonadministration of medication are recorded by the timely entry on the medication administration record; that the meaning of any codes are clearly explained on each record; and that the person administering the medication completes the medication administration record in respect of each person at the time of administration. So people have their prescribed medication correctly. 4 9 13 Regulation 13 2 To make 30/04/2010 arrangements to ensure that care plans include detailed information and instructions for staff in respect of administration and management of medicines, including the reasons to give medicines when required and what constitutes needed for the named person. This is to ensure that there are clear directions for staff to give medicines prescribed when required. People have their prescribed medication correctly. 5 9 13 13(2) To make arrangements 31/10/2009 to ensure that records are kept of all medicines received, administered and leaving the home or disposed of. Page 12 of 16 Care Homes for Older People 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 To ensure that there is safe control and handling of peoples medication. Remains outstanding 6 9 13 Regulation 13 2 To make 30/04/2010 arrangements to ensure that records are kept of all medicines received, administered and leaving the home or disposed of. This is to ensure that the care service maintains accurate records of medicines. So the home can account for all the medication in the home at all times. 7 9 12 13(2) To make arrangements 31/10/2009 to ensure the administration of all prescribed medication is recorded on the medication records. To ensure people who use the service are receiving the medication as prescribed. Remains Outstanding 8 12 12 Regulation 12 1 There must be sufficient staff on duty to ensure people who use the service are supported to continue to enjoy their hobbies and interests in and outside of the service. To ensure people have access to social stimulation suited to their needs and Care Homes for Older People Page 13 of 16 28/05/2010 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 expectations and which support them to retain their mental and physical capacity. 9 37 37 The home should notify CQC 29/04/2010 about any event in the home which affects the well being or safety of anyone. To protect people living in the home. 10 38 12 The service should ensure that all policies, procedures and risk assessments are reviewed and updated to ensure best practice. To further protect people living in the home. 30/07/2010 Care Homes for Older People Page 14 of 16 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 38 13 Regulation 13 (4). Systems must be reviewed to ensure that equipment and facilities are checked, tested and serviced as necessary. This is to ensure that peoples health and safety is maintained within the care home. 08/10/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 15 of 16 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 16 of 16 - 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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