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Inspection on 18/06/09 for The Old Vicarage [Stockland]

Also see our care home review for The Old Vicarage [Stockland] for more information

This is the latest available inspection report for this service, carried out on 18th June 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The AQAA states "We provide a very high standard of care in a comfortable, homely environment. We are in a lovely rural setting and the residents enjoy wonderful views. Our high level of staff selection and training ensure that our staff work to consistent standards providing a caring and understanding environment. All residents coming in to the home are assessed thoroughly pre -admission to ensure that all placements are appropriate so that we are fully able to meet their needs." The inspection findings support this view of the home. People who live in the home appeared well cared for and comfortable. There is a good standard of personal care with support from local health care professionals. There were many comments from people praising life in the home. One person said that she "thoroughly enjoyed" living at the home and could think of "nothing better". People said that staff were "very kind" and "always helpful". Two comments seen in the homes` 2009 quality audit were typical. "I feel I receive all necessary care here in a kind and cheerful way." And "I am very happy here and hope to stay till the Lord calls me." The home is clean, well maintained and pleasant. The gardens that surround the home are accessible and lovely. One person said that "walking in the garden" was a favourite pastime. There is a committed and established work force at the home. Some people have been members of staff for many years and there is a strong team culture . Staff are well trained with 82% of staff being qualified to National Vocational Level 2 or 3. 7 staff (32%) have NVQ level 3.

What has improved since the last inspection?

The manager of the home has introduced a series of audits to monitor in more detail key areas of the home`s performance such as menus, care plans, medication and falls. The home has responded to comments from people who live in the home for amendments to the menu and has varied the venues for trips out in the mini-bus.

What the care home could do better:

Although the home is comfortable and clean some areas would benefit from some updating. There has been much discussion about the provision of a second assisted bathroom and the existing bathroom would benefit from up-dating. The provision of a small hairdressing room and the opportunity to have hairdressing appointments in private is good practise. As the needs of people who live in the home change and in some cases become more complex the care plans need to be further developed. The manager will review the care plans to ensure that there are clear directions given when people have been assessed as having a high Waterlow score so that staff have written guidance of what care should be given. The manager will review the way in which weight loss is monitored in the home and consider introducing the MUST system.

Key inspection report Care homes for older people Name: Address: The Old Vicarage [Stockland] The Old Vicarage [Stockland] Stockland Bridgwater Somerset TA5 2PZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Shelagh Laver     Date: 1 8 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: The Old Vicarage [Stockland] The Old Vicarage [Stockland] Stockland Bridgwater Somerset TA5 2PZ 01278652352 01278652185 sue@restcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Sean James O`Brien,Mrs Samantha Jane O`Brien care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: On the termination of the placement of the named service user, the registered person will notify the Commission in writing and the particulars and conditions of this registration will revert to those held on the 27th March 2006 The maximum number of persons accommodated at the home, including the named service user, will remain at 26 To admit one named person outside the categories of registration as detailed in the notice dated 6th April 2006 Date of last inspection Brief description of the care home The Old Vicarage is a large three-storey property set in extensive grounds in the village of Stockland Bristol. The Registered Providers are Mr and Mrs O?Brien, and the Manager is Mrs Susan Thomas. The home is registered with the Commission for Social Care Inspection to provide accommodation and personal care to up to twentysix people over the age of 65 years. The home provides accommodation to up to Care Homes for Older People Page 4 of 25 Over 65 26 0 Brief description of the care home twenty people within the main building, and a further six service users can be accommodated in the bungalows within the grounds. The bungalows are connected to the homes staff call bell system. The home works closely with local health services. The weekly fee charged varies from room to room, private fees start at #420.00 in the main home and the bungalow accommodation is currently #495.00. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: As part of this Key Inspection we (Care Quality Commission) visited the home for one day. Before the visit we had requested and received an Annual Quality Assurance Assessment . This gives us information about the achievements of the home in the previous year and indicates plans for the future. It was completed by the manager Susan Thomas. Mrs Thomas was on duty for most of the inspection and offered all possible help by ensuring records and information were available. We sent out comment cards to people who lived and these were returned with positive comments about care and support. We were able to meet most of the people who were living in the home and some of the staff. We made a tour of the home visiting communal rooms and individual bedrooms. This was a positive inspection of a good home. Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? 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 on page 4. Care Homes for Older People Page 7 of 25 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available to assist people in making the choice to come and live in the home. People receive a thorough assessment before they come to live in the home. Evidence: There is information available for people who want to come and live in the home. People are encouraged and welcomed to visit initially although some people said the home had been chosen by their relatives. People talked about moving to be closer to families who lived locally. Other people knew of the home for many years. One person said I used to visit here...I always knew it would suit me. We saw the care records for three people. There was evidence that people had an assessment before they came to the home. There was evidence that information from other health and social care professionals had been taken into account when admitting people to the home. People are able to come for a trial visit to the home and some people come initially fora short stay before deciding to come and live in the home Care Homes for Older People Page 10 of 25 Evidence: permanently. Contracts for three people were seen to be comprehensive and appropriate. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in the home receive a good standard of health and personal care. People are treated with respect and kindness by staff. Staff receive training in medication administration and administer and store medication safely. Evidence: Overall people receive a good standard of health and personal care. Care plans are clear and showed that there is regular support from the GP and community nursing team. Care plans reviewed showed that the nurses came to do dressings and to monitor and give treatment to a person with diabetes. On the day of the inspection the optician was visiting. People were being escorted politely and kindly to have their eyes tested. The medication system in the home is supplied by the local surgeries using dossette boxes. Staff said that it worked well and there have been no problems with administration. Staff have received training in administration and on the day of the inspection records were up to date and complete. People are encouraged and supported to take charge of their own medication and Care Homes for Older People Page 12 of 25 Evidence: healthcare when appropriate. The dependency levels and needs of some people in the home are increasing and we discussed with the manager the need to include new information in the care plans and to formalise some areas of recording. For example Waterlow scores are recorded but if someone has a high score indicating that they are at risk of pressure damage there is no clear guidance to staff regarding what should be done to prevent further damage. Staff spoken to however were very clear about what they should be doing and were knowledgable about peoples needs and care provided. We also discussed the inclusion of a more formal assessment of nutrition and the use of short term care plans to cover events such as urine and chest infections. Examination of care files indicated a training need regarding the care needed by people with diabetes and this has been addressed. People who live in the home spoke of the kindness and respect shown to them by staff. Throughout the inspection staff were seen to talk to people and provide assistance in a cheerful and polite manner. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to make choices about how they spend their days. There is an interesting programme of activities and social events that people can participate in if they wish to. People can chose from a varied and appetising menu which meets their needs. Evidence: People make choices about how they spend their time in the home. Some people spend a lot of time in the sitting room whilst others are happy in their rooms. The people who live in the small bungalows appreciate the option to prepare their own breakfast or suppers. The bungalows offer comfortable private accommodation with the immediate support of the larger home. One person spoke about having her own books, furniture and television. There was a chance to plant out a small garden area and to pursue an interest in birds. Some people spoke positively about the activities programme that is available in the home. People access as much or as little as they chose. People said there were quizzes and trips out. Once a week there is Gardening without a plot which is an innovative idea for growing plants on a small scale. Trips out in the minibus are enjoyed especially because they are local and often end with tea or fish and chips. The activities co-coordinator is planning to introduce a Care Homes for Older People Page 14 of 25 Evidence: monthly newsletter to ensure all people are informed of the planned events for example the musical entertainment. Some people still said the days were long and there may be scope for more in depth discussions with some people about what they would like to be doing. Visitors are welcomed in the home and people are supported in spending time with their families whenever posible or appropriate. People said the food was very good. Each morning people choose from the lunch menu. There is a choice of two main meals and desserts however people said that the cook would also offer a further alternative if people were unwell or did not like the main meals. On the day of the inspection one main choice was roast beef with fresh vegetables and Yorkshire pudding. One person said We are so well fed here. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are policies and procedures in the home to protect people from abuse. There is a clear and accessible complaints system in the home. People felt able to raise concerns both formally anfd informally and were confident that their concerns would be addressed. Evidence: The complaints policy is displayed clearly in the hall and people said that they knew who to complain to. Most people said they could always talk to the manager about anything serious although they felt they could talk to most staff. There had been no formal complaints. One person said that issues can be raised and resolved informally and that people felt happy about speaking out if they wanted to. There is a safe system in place to manage peoples finances. Staff have received Safeguarding Adults training in 2008 and the manager had recently made people aware of the Deprivation of Liberty Act. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy living in a home that is clean, warm and attractive. There should be a review of the bathing facilities. Evidence: Overall the home is clean, warm and welcoming. People in the home were pleased with the environment . The gardens that surround the home are of a particularly high standard being level and accessible. Many rooms have views of the surrounding countryside and people spoke of their enjoyment of the environment. The main sitting room and dining room are decorated and furnished in a pleasant and attractive style. The main sitting room looks across the lawns and is light and airy. Bedrooms are vary in size and aspect but have been personalised and it is clear that people feel at home in them. There is an on-going programme of decoration and maintenance and some areas of the home would now benefit from some up-dating and refurbishment. The home has been considering making changes to the environment and there have been plans to up-date and improve the bathing facilities at the home for some time. Bathing is an important part of a persons care and it is important that the facilities and equipment do not detract from peoples enjoyment. A visit from the hairdresser might also be improved by more appropriate accommodation. Some of the service areas of the home for example the laundry would benefit from a deep clean and some up-dating. Care Homes for Older People Page 17 of 25 Evidence: Staff have received training in infection control and staff handwashing facilities are available. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in the home benefit from a stable and well trained team of carers. Recruitment systems in the home meet standards of best practice and include a thorough induction. Staff receive appropriate training on a regular basis. There is an effective system of National Vocational Qualification in the home that ensures an above average level of well qualified staff. The manager is pro-active in arranging training when required. Evidence: People in the home benefit from an established team of well trained and experienced care staff. The home employs a team of support staff including cooks and domestic staff. Currently the laundry is undertaken by care staff who do all the ironing by hand. It is more usual to include the laundry work in the duties of the support staff to ensure that care staff are free to concentrate on the needs of the people who live in the home. There is an established system of recruitment that meets the requirements of the National Minimum Standards. Some staff have been employed at the home for many years. It is good practice to ask for ten years of employment history on an application form and this amendment will be made in the future. We reviewed three staff files. The file of new staff included references and Criminal Records bureau checks. The Induction programme is based on the agreed Common Care Homes for Older People Page 19 of 25 Evidence: Standards and was signed by the staff member. Currently interview notes are recorded informally and we discussed how these could be formalised and signed by the two people completing the interview. Staff training records showed that people receive up-dates on manadatory training including Moving and Handling, Fire Safety and First Aid. The home has in-house Moving and Handling Assessors and NVQ Assessors which is good practice for a home of this size. It is not surprising therefore that there is a high percentage of staff trained to National Vocational Qualification level at 2 and 3. There was evidence that staff received annual apraisals and supervision meetings. We discussed with the manager the training needs created for staff by the inceasingly complex needs of people who live in the home. One example was the care of people with diabetes. This training has been arranged however it would be good practice now to assess the skills required to care for al people in the home and decide whether there are any skill gaps or topics of knowledge that should be included in the training planned for the coming year. The manager had recently provided training in the Deprivation of Liberty legislation. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager of the home is qualified and experienced. The home is well run in the interests of the people who live there. There is a sytem of maintenance that seeks to ensure the health and safety of the people who live there. Evidence: The manager Susan Thomas has been in the home for many years and is qualified and experienced. She continues to up-date her skills and knowledge and is committed to the continuous improvement of the home. The manager spoke about the administration and maintenance staff in place to support her in the running of the home. The importance of working as a team and good communication was emphasised. The home conducts an annual quality audit which had just been completed for 2009. In addition smaller audits are undertaken around key areas such as food, care plans,activities and medications. The quality audit of 2009 showed that people felt they were treated with respect and Care Homes for Older People Page 21 of 25 Evidence: kindness. They also felt happy to make comments regarding improvements that could be made in the home. Records and finances were seen be safely managed throughout the inspection. There are systems in place to ensure maintenance is completed on timeand that appropriate health and safety checks are in place. We saw records for the maintenance of the hoists and the stair lift. A concern about a steep stair case was addressed during the inspection period. There were minutes of residents meetings and a staff meeting for this year. The manger said that there had also been other meeetings that had not been minuted. Care Homes for Older People Page 22 of 25 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 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, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Care plans should be reviewed to ensure that when a person is identified as being at risk of pressure damage through a Waterlow score appropriate directions to care staff are recorded. Care plans will also be reviewed to ensure action to be taken taken when people lose weight is clearly stated. The assisted bathroom should be up-graded and the provision of bathing facilities should be reviewed to meet peoples needs. 2 21 Care Homes for Older People Page 24 of 25 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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