CARE HOMES FOR OLDER PEOPLE
Varndean House St Leonards Nr Ringwood Hampshire BH24 2NR Lead Inspector
Catherine Churches Unannounced Inspection 13:00 10 January 2006
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Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000038431.V276430.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000038431.V276430.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Varndean House Address St Leonards Nr Ringwood Hampshire BH24 2NR Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01202 877764 varndeanhouse@freenet.co.uk Mrs Audrey Martha Watts Mr John William Watts Mr Mark Burchfield Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places DS0000038431.V276430.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25th July 2005 Brief Description of the Service: Varndean House has operated as a care home since 1983. It was purchased by Mr and Mrs Watts in June 2003 and has been managed by Mr Mark Burchfield since August 2003. Varndean House is a large detached property that has been extended over the years to provide good sized bedrooms and communal spaces for the residents. Mr and Mrs Watts have made a substantial investment in the home with regard to redecoration and refurbishment and have plans to make further improvements. The home is registered to accommodate a maximum of 18 service users in the category of OP (older people) for personal care; the home is not registered to provide nursing care. Accommodation is provided on the ground and first floor levels with a communal lounge, sun room, dining room and bedrooms on the ground floor along with kitchen, laundry communal bathing and toilet facilities. Many bedrooms have en-suite facilities. The first floor is reached by a central stairway with a chair lift if needed. There is no passenger lift. Varndean House is close to the village of St Ives, which provides local shops and post office. Ringwood, a small market town, is approximately 2 miles from the home, accessible by local bus route that stops outside the home and also serves the larger towns in the area including Bournemouth, Ferndown and Poole. DS0000038431.V276430.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place during the afternoon of 10th January 2006. The inspection took place as part of the regular, programmed inspection schedule for the home. This report should be read in conjunction with that from the inspection in July 2005 as all key inspection standards are reported on in these two reports. The purpose of this visit was to check that requirements and recommendations made during the last inspection have been acted upon, that the home continues to run in a satisfactory manner and that the people who are living in the home are properly cared for. The premises were inspected and a number of records examined. Time was also spent time observing routines within the home and talking with residents and staff. The manager was available throughout the inspection. What the service does well: What has improved since the last inspection?
Following the last inspection, a total of 4 requirements and 1 recommendation were made. All of these were reviewed. The home has made progress in working towards compliance with the requirements: 1 requirement was fully met, 1 could not be assessed, 1 was partially met and 1 was not met. Work was still required with regard to the recommendation that was made. Training in the Protection of Vulnerable Adults has been sourced and introduced. Once all staff have received training this standard will be fully met and residents will be better safeguarded from potential abuse.
DS0000038431.V276430.R01.S.doc Version 5.1 Page 6 An induction programme for new staff has been developed and implemented therefore ensuring that staff have the basic skills required to provide appropriate care to residents. There is a large programme of improvements planned for the home. Since the last inspection a new easy access shower and lavatory have been created on the ground floor together with a spacious, well-equipped laundry. The shower provides greater choice of bathing facilities for residents and the laundry area is much improved enabling staff better access and improved equipment. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000038431.V276430.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000038431.V276430.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed on this occasion as standard 3 was assessed at the last inspection and found to be met. Standard 6 is not applicable to Varndean House. EVIDENCE: DS0000038431.V276430.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 and 10 The ethos in the home is one of respect for the residents living there. This means that the residents feel settled and at home and their privacy is respected. EVIDENCE: Medication systems were briefly inspected and it became evident that the home would benefit from advice from the CSCI pharmacy inspector. A referral has been made and a separate report will be made. Those residents spoken with confirmed that they feel respected by staff and are able to maintain their privacy when receiving personal visits from professionals such as GP’s and solicitors, family and friends. It was observed that staff knock on doors before entering and that residents preferred form of address is recorded and used. DS0000038431.V276430.R01.S.doc Version 5.1 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 Residents have the opportunity to choose their own lifestyle within the home and this means that their individual preferences and routines are respected. EVIDENCE: It was noted from documentation and observation of rooms that residents are encouraged to bring their own personal items of furniture and to personalise rooms etc. Choices are also promoted with encouragement to make decisions regarding food, clothing, social activities etc. Residents confirmed in conversations that they had a choice over meals and whether to join activities etc. DS0000038431.V276430.R01.S.doc Version 5.1 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Arrangements for protecting service users from abuse were satisfactory: staff have a limited knowledge of Adult Protection issues but the manager is aware of the issues and available at all times, staff are currently receiving further training. This means that Varndean House is a safe environment that will protect residents from abuse. EVIDENCE: It was a requirement at the last inspection that staff receive training in recognising abuse and the actions they should take if they suspect it. The manager has sourced a training provider and implemented a training plan that will ensure all staff are trained appropriately. DS0000038431.V276430.R01.S.doc Version 5.1 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Neither of the key standards were assessed on this occasion as both were assessed at the last inspection and found to be met. EVIDENCE: DS0000038431.V276430.R01.S.doc Version 5.1 Page 13 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 and 30 One person has been employed since the last inspection. Appropriate checks had not been completed therefore potentially leaving residents at risk. Progress has been made in ensuring that staff are equipped with the skills necessary to meet the assessed needs of residents. EVIDENCE: Staff records were examined for the only newly appointed member of staff since the last inspection. These demonstrated some serious omissions as the person concerned had commenced their duties without a POVA (Protection of Vulnerable Adults) or CRB (Criminal Records Bureau) check. Since the introduction of POVA checks staff may only commence duties once a satisfactory POVA check has been received and while still awaiting a CRB check. Further information has been provided for the manager to clarify this. It was a requirement at the last inspection that required induction training must be provided within the prescribed timescales. This has been done and there was evidence available that the new member of staff was undertaking the required induction. A further training programme has also been developed, staff training needs have been assessed and training courses programmed in over the next 12 months. DS0000038431.V276430.R01.S.doc Version 5.1 Page 14 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 Mr Burchfield has completed the necessary training and has the relevant experience. He is a competent, approachable and committed manager and both staff and residents confirmed this. Quality monitoring systems need to be better defined and implemented in order to evidence that the home is run in the best interests of the residents. Sound practices and procedures are in place regarding residents finances. EVIDENCE: Mr Burchfield had already completed the NVQ4 qualification in care and has recently completed the Registered Managers Award. It was noted at the last inspection that further work must be undertaken with regard to quality assurance systems in the home. The Manager explained that
DS0000038431.V276430.R01.S.doc Version 5.1 Page 15 he has not yet fully addressed this standard as he has prioritised staff training etc but is aware that this must also be done. The manager confirmed that residents are encouraged to retain control of their own finances for as long as possible. Where they state that they no longer wish to or they lack the capacity to do so then the home ensures that either family or other representatives such as solicitors take on this role. The home holds petty cash for some residents. Records and balances were randomly checked for 3 residents and were found to be satisfactory. DS0000038431.V276430.R01.S.doc Version 5.1 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X X DS0000038431.V276430.R01.S.doc Version 5.1 Page 17 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Where a service user has a wound care plan from a district nurse, information must be included in the homes care plan for that service user of action necessary should dressings be dislodged, removed or damaged. Advice on these plans must be obtained from the district nursing team.10/1/06 No residents required wound care at the time of the inspection so it was not possible to assess this standard. It is therefore carried over to the next inspection. The registered person must make arrangements to train staff in the recognition and prevention of abuse and the actions they should take should they suspect that abuse has taken place. 10/1/06 Action has been taken to address this requirement but it is not yet fully met as not all staff have received training. Timescale for action 1. OP8 15 30/06/06 2. OP18 13(6) 30/06/06 DS0000038431.V276430.R01.S.doc Version 5.1 Page 18 3. OP29 19 The registered persons must ensure that all persons employed are fit to work in the home. The registered persons must obtain in respect of each person the documents listed in schedule 2 of the Care Homes Regulations 2001 and must be satisfied as to the authenticity of the references and information received. New staff must only be confirmed in post following completion of a satisfactory CRB and POVA check.10/1/06 This is the second time this requirement has been made (see 13/1/05 report). 31/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard OP33 Good Practice Recommendations Further work must be undertaken with regard to quality assurance systems in the home, by means of survey analysis and annual development plans, in order to demonstrate that the home is meeting its aims and objectives and statement of purpose. 1. DS0000038431.V276430.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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