CARE HOMES FOR OLDER PEOPLE
Varndean House St Leonards Nr Ringwood Hampshire BH24 2NR Lead Inspector
Catherine Churches Unannounced 25 July 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 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. Varndean House D55 S38431 Varndean House V229091 250705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Varndean House Address St Leonards, Nr Ringwood, Hampshire, BH24 2NR Telephone number Fax number Email 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 01202 877764 Mrs Audrey Martha Watts Mr John William Watts Mr Mark Burchfield Care Home 18 Category(ies) of OP - 18 registration, with number of places Varndean House D55 S38431 Varndean House V229091 250705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13 January 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 March 2004. Varndean House is a large detached property which 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. Accomodation 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 which stops outside the home and also serves the larger towns in the area including Bournemouth, Ferndown and Poole.
Varndean House D55 S38431 Varndean House V229091 250705 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place during the morning and early afternoon of Monday 25th July 2005. The inspection took place as part of the regular, programmed inspection schedule for the home. Prior to the visit, time was spent analysing previous reports and reviewing previous requirements and recommendations. The Registered Manager, Mr Burchfield, was present throughout the inspection. Whilst at the home the manager, a number of staff and residents were spoken with, records were inspected and a tour of the premises was undertaken. What the service does well:
Varndean House provides a homely and comfortable environment and has a relaxed atmosphere. The home is positively managed and well staffed with a staff group who were observed to be caring and respectful. Open visiting arrangements are in place and residents were settled and friendly with one another and the staff. Residents were able to confirm that the life they are able to lead is as they expected. Many remain relatively independent and prefer not to take part in organised activity. Bedrooms varied in size but all were nicely decorated and many people had taken the opportunity to personalise their rooms with their own items of furniture, furnishings, pictures and plants etc. Residents spoke positively about many things in the home and this included the food. Lunch on the day of the inspection was observed. The meal looked appetising and the dining room had a calm, unrushed atmosphere. Whilst there are no choices offered at meal times, residents confirmed that their likes and dislikes are well known by the staff and they are always offered an alternative. The Inspector was able to spend a considerable time with the residents and received a number of positive comments, a sample of which are detailed below: “I don’t want for anything here” “Mark is a real friend, there’s nothing he won’t do for you” (Mark is the registered manager). “There are lots of moaners here but they (the staff) have been fantastic to me”. “The staff here are real carers, I’m really well looked after” “They took extra special care with my best shirt and that was important to me”
Varndean House D55 S38431 Varndean House V229091 250705 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
In order to ensure that residents receive the highest degree of protection from harm and abuse, staff must receive training in recognising abuse and the actions they should take should they suspect any form of abuse has taken place. Further work must be undertaken with regard to the induction and foundation training of staff when recruited to the home. Evidence must be provided that this training meets the requirements as laid down in the TOPPS specification. The manager has started to develop a quality assurance system that will help to demonstrate that residents are consulted with and satisfied with the way the home is run. It is important to analyse the result of recent surveys and publish this was well as producing an annual development plan. Varndean House D55 S38431 Varndean House V229091 250705 Stage 4.doc Version 1.30 Page 7 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. Varndean House D55 S38431 Varndean House V229091 250705 Stage 4.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection Varndean House D55 S38431 Varndean House V229091 250705 Stage 4.doc Version 1.30 Page 9 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 standard(s) 3 Assessments of residents and their needs, prior to their admission, were satisfactory. This means that residents and their representatives can feel confident that the home is aware of all the needs of the person and is able to meet them. EVIDENCE: Pre-admission assessments for 3 residents, accommodated in the home, were examined. It was found from these records that a comprehensive system has been introduced which meets the requirements of the National Minimum Standards. A number of the residents whose documentation was examined were spoken with and they confirmed that pre-admission assessments had taken place with their involvement. Varndean House D55 S38431 Varndean House V229091 250705 Stage 4.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 8 Care Plans for residents who live at Varndean House are detailed and informative. This means that staff have sufficient information to provide a good level of care and the home can also demonstrate the care that has been provided. Reviews are carried out once a month and reflect any changes in care needs. The home ensures that resident’s healthcare needs are met through seeking appropriate input from GP’s and other healthcare professionals. EVIDENCE: Care Plans and related documentation regarding care for 3 residents were examined. Files were well laid out and risk assessments had been undertaken. Reviews were being undertaken on a monthly basis or more frequently if changes dictated this. All of the residents whose documentation was examined were spoken with. They confirmed (where they were able to) that they were happy with the care they received and that either they or their representatives are involved in reviews. They also confirmed that they are assisted appropriately to obtain help from healthcare professionals such as Doctors, District nurses, chiropodists and opticians. This was also recorded in their files.
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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 standard(s) 12,13 and 15 Varndean House provides a homely and relaxed environment. Those residents that were spoken with stated that the social and recreational activities provided for them by the home met their expectations. They confirmed that they are able to receive visitors at any time thus enabling them to maintain contact with family and friends. A nutritious and varied diet is provided for the residents. EVIDENCE: Discussions with the manager, residents and staff demonstrated that thought and consideration has gone into the activities that are organised within the home: there is a regular delivery from the library service and visiting entertainers come to the home every two weeks. The majority of residents gave the impression to the inspector that they prefer not to participate in group activities and the manager confirmed that when previous activities such as a group outing have been arranged there has been little support for this. It was clear that the manager and staff are aware of the problem of providing suitable entertainment and that they are giving thought to this: the manager had recently provided colourful window boxes for one resident and had positioned a bird table outside the window of another person. Staff were also observed to stop and spend time chatting as they went about their tasks. Varndean House D55 S38431 Varndean House V229091 250705 Stage 4.doc Version 1.30 Page 12 Residents confirmed that they are happy with the food that is provided in the home and records showed that a balanced nutritious diet is available. There was a well-stocked fruit basket in the dining room which residents may help themselves to. A small group of residents that were chatting in the lounge commented that they would prefer to have frozen rather than tinned peas and the manager agreed to address this. Varndean House D55 S38431 Varndean House V229091 250705 Stage 4.doc Version 1.30 Page 13 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 standard(s) 16 and 18 The home has a satisfactory system for making complaints. This means that residents and others involved in the home that may wish to make a complaint should feel confident that they will be listened to and matters of concern will be acted upon. The home has a satisfactory policy and procedure for the protection of residents from abuse. EVIDENCE: Residents confirmed that they felt that they could make complaints to both the manager and his wife who also works in the home and that they felt they would be listened to and treated fairly. It was evident that they were less likely to raise issues of concern with the registered provider. The manager stated that no formal complaints had been received since the last inspection but that he ensures that he spends 1-2-1 time with each resident in order to enable them to raise matters of concern – he stated that generally such matters are regarding food and heating. The manager stated that he was confident that staff were aware of policies and signs and symptoms of abuse. However, as a result of staff appraisals he has identified a training need in this area and has arranged training for all staff in the Protection of Vulnerable Adults. Varndean House D55 S38431 Varndean House V229091 250705 Stage 4.doc Version 1.30 Page 14 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 standard(s) 19 and 26 The home is nicely presented. Residents live in a safe, well-maintained environment which was clean, hygienic and free from offensive odours. EVIDENCE: A tour of the premises confirmed that the home is nicely decorated and furnished. Dorset Fire and Rescue Service have visited the home and confirmed that it complies with their requirements. The home employs two cleaners who are also responsible for domestic duties, all of the areas seen during this inspection were clean and no offensive odours were detected. Infection control was not examined on this occasion. As part of the home’s ongoing investment programme, works were commencing on the day of the inspection to provide improved laundry, staff and communal bathing facilities. Varndean House D55 S38431 Varndean House V229091 250705 Stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28 and 30 Resident’s needs are met through the provision of a good mix of experienced, qualified and unqualified staff. There is an ongoing staff-training programme and 50 of care staff have now achieved an NVQ level 2 qualification. Such training has lead to an increased level of competency among the staff. EVIDENCE: Examination of the staff rota and observation throughout the inspection demonstrated there was a sufficient number and skill mix of staff to meet the needs of residents. Staff and residents spoken with confirmed that they were satisfied with staffing levels. The staff group is stable and well established. Since the last inspection, 2 more staff have achieved NVQ level 2 and one person explained that this has motivated them to undertake level 3 in the near future. Other training in areas such as first aid, moving and handling and fire prevention has continued as required. There was no clear evidence available on the day of the inspection that the induction and foundation for staff was compliant with the Skills for Care requirements. Further information regarding this has been given to the manager. Varndean House D55 S38431 Varndean House V229091 250705 Stage 4.doc Version 1.30 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 38 The home is run in the best interests of the residents and has a good quality assurance system in the process of development to support this. The health, safety and welfare of residents and staff is protected by the systems that the home has in place for staff training, maintenance and risk assessment. EVIDENCE: The manager has reviewed the systems in the home for seeking residents and relatives views: new questionnaires have been developed and the manager stated that he had received 12 responses. Residents raised some issues and these were addressed individually. The manager was advised that, in order to fully comply with the standard an annual development plan, incorporating the survey results. Fire records, staff training records, accident books and risk assessments were examined and found to be up to date and detailed.
Varndean House D55 S38431 Varndean House V229091 250705 Stage 4.doc Version 1.30 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 x 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 x x 2 x x x x 3 Varndean House D55 S38431 Varndean House V229091 250705 Stage 4.doc Version 1.30 Page 18 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 8 Regulation 15 Requirement Timescale for action 31/10/05 2. 18 13(6) 3. 29 19 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. 25/7/05 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 30/9/05 make arrangements to to train staff in the recognition and prevention of abuse and the actions they should take should they suspect that abuse has taken place. The registered persons must 31/10/05 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 Regualtions
Version 1.30 Varndean House D55 S38431 Varndean House V229091 250705 Stage 4.doc Page 19 4. 30 18 2001 and must be satisfied as to the authenticity of the references and inforamtion received. New staff must only be confirmed in post following completion of a satisfactory CRB and POVA check. 27/7/05 this requirement was made at the last insepction and was not reviewed on this occasion. It is therefore caried over until the next inspection. The registered person is required 31/10/05 to evidence by means of recorded information that the induction and foundation training provided for staff meets the requirements of the TOPSS specification RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 33 Good Practice Recommendations Further work must be undertaken with regard to quality assurance systems in the home, by means of survey analysis and annual develpoment plans, in order to demonstrate that the home is meeting its aims and objectives and statement of purpose. Varndean House D55 S38431 Varndean House V229091 250705 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection 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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