CARE HOMES FOR OLDER PEOPLE
Varndean House St Leonards Nr Ringwood Hampshire BH24 2NR Lead Inspector
Catherine Churches Unannounced Inspection 8th February 2007 10:15 X10015.doc Version 1.40 Page 1 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 Varndean House DS0000038431.V330065.R01.S.doc Version 5.2 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. Varndean House DS0000038431.V330065.R01.S.doc Version 5.2 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 01202 874624 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 Varndean House DS0000038431.V330065.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 17th July 2006 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. Fees range from £327 - £431 Varndean House DS0000038431.V330065.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on 8th February 2007. In total four and a half hours were spent in the home undertaking the inspection. Mr Burchfield, the registered manager was present throughout the inspection. The inspection took place as part of the regular, programmed inspection schedule for the home. The last inspection took place in July 2006. The purpose of this visit was to monitor the homes compliance with National Minimum Standards and with requirements and recommendations made during the previous inspection. Also, to check that the home is 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, visitors and staff. This report refers throughout to “residents” meaning to include persons accommodated in the residential units of the home, patients in the nursing units and the overall term “service users”, which is the preferred term of the Commission. 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. Residents were able to confirm that the life they are able to lead is as they expected. They stated that they receive the assistance they require and that staff are always willing and helpful. Care planning, healthcare and medication administration is well organised and responsive to residents needs. The home is continuously looking to improve its services and faculties: there is a good range of activities and the environment is currently being upgraded. Bedrooms vary 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. Varndean House DS0000038431.V330065.R01.S.doc Version 5.2 Page 6 Residents spoke positively about many things in the home and this included the food as well as the new range of activities that are being introduced. The Inspector was able to spent time with the residents and received a number of positive comments about the management, staff and facilities in the home. What has improved since the last inspection? What they could do better:
Records of care given by Chiropodists and other care professionals that visit the home should be kept in order to demonstrate that this area of care is addressed even if it is not done by staff from the home. Where a resident’s weight varies from one month to another this should be commented on: for example if there is a weight loss care plans should reflect that this is part of a planned diet or conversely if there is weight gain this should also be commented on in the care plan. Scales should be calibrated regularly to ensure that they are providing correct information. Action must be taken to ensure that safe recruitment practices operate in the home: any identified concerns in employment history should be fully explored and documented and staff must not commence duties in the home without at least a satisfactory Protection of Vulnerable Adults list check and not be confirmed in post until receipt of a satisfactory Criminal Records Bureau check. It is of concern that this is the third time such a requirement has had to be made of the home. Further failure to meet the requirement will result in enforcement action being taken. Varndean House DS0000038431.V330065.R01.S.doc Version 5.2 Page 7 Where the home holds cash for a resident, when a transaction takes place the resident as well as a staff member should sign the record to confirm or when the resident is unable, a second staff member should sign. 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. The summary of this inspection report can be made available in other formats on request. Varndean House DS0000038431.V330065.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Varndean House DS0000038431.V330065.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments of prospective residents needs have improved since the last inspection. This means that residents can now be more certain that the home is aware of their requirements prior to their admission to the home and that the staff will therefore be able and prepared to meet these needs. EVIDENCE: Documentation for two residents was examined as part of the case tracking procedure used during this inspection. One of these residents had been newly admitted to the home since requirements regarding pre-admission assessments were made at the last inspection.
Varndean House DS0000038431.V330065.R01.S.doc Version 5.2 Page 10 The assessment was viewed: it contained good information about the person’s needs as well as information from the local funding authority. Varndean House DS0000038431.V330065.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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. The home ensures that resident’s healthcare needs are met through seeking appropriate input from GP’s and other healthcare professionals. Residents’ medication at this home is well managed, therefore promoting good health. The ethos in the home is one of respect for the residents living there. This means that the residents feel settled at the home and their privacy is respected. Varndean House DS0000038431.V330065.R01.S.doc Version 5.2 Page 12 EVIDENCE: Documentation for two residents was examined as part of the case tracking procedure used during this inspection. Both residents were also spoken with in the privacy of their rooms. The detail and content of care plans was good: information regarding each person’s daily needs and how assistance is given was recorded. It was noted that in some cases care provided by others, such as a chiropodist, was not recorded. Weights were checked monthly and daily records were up to date and detailed. It was noted that one person had lost weight but there was no record of any action taken. It later transpired that the scales may be at fault and the resident may not have lost weight as they still had a good appetite and staff had not noted any loss. Care plans were being reviewed monthly and resident’s involvement with this was recorded. Evidence was available on file and through discussion that GP’s, district nurses, specialist nurses and other health professionals are called upon whenever the need arises. Medicines in the medication cupboard were examined together with administration records. These were found to be satisfactory. Those staff responsible for medication administration have received appropriate training. It was noted that there was no pill counter available to check the quantities of medications in bottles and in one case quantities did not match with records. It was also noted that a running balance for a controlled drug was not being kept. Policies for the promotion of privacy and dignity were reviewed and satisfactory. Observation of interaction between residents and staff evidenced that residents are respected and a number of staff actions evidenced that privacy is actively promoted. Residents also confirmed during discussions that they felt their privacy was respected and their dignity promoted. Staff confirmed that they promote and maintain resident’s 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. Varndean House DS0000038431.V330065.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Varndean House provides a caring, homely and relaxed environment. Open visiting arrangements are in place enabling residents to retain contact with families and friends. Residents have the opportunity to choose their own lifestyle within the home and this means that their individual preferences and routines are respected. Dietary needs of the residents are well catered for with a balanced and varied selection of food available that meets resident’s tastes and needs. EVIDENCE: Varndean House provides occasional organised activities such as concerts from visiting musicians and singers. The home has purchased a number of games such as bingo, large sets of dominoes and connect 4 and various local interest books etc. In addition the home has a wide selection of CD’s and videos and staff confirmed that they have the time to spend with residents chatting.
Varndean House DS0000038431.V330065.R01.S.doc Version 5.2 Page 14 Residents are encouraged to maintain contact with family and friends. The visitor’s book showed that there is a constant stream of visitors to the home and discussions with staff confirmed this. Discussion with residents and staff as well as examination of records and observation during the inspection evidenced that residents are assisted to exercise choice and control over their lives. Food records and discussions with residents confirmed that a suitable and varied diet is provided in the home. Food stocks were satisfactory and plenty of fresh provisions were available. Varndean House DS0000038431.V330065.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Varndean House has a satisfactory policy and procedure for the making of complaints. This means that residents and others involved in the home that may wish to make a complaint should feel confident that they would be listened to and matters of concern will be acted upon. Arrangements for protecting service users from abuse were satisfactory. This means that Varndean House is a safe environment that will protect residents from abuse. EVIDENCE: Varndean House has a satisfactory complaints procedure that is displayed in the home as well as included in the Service Users Guide. One complaint was made to the home since the last inspection. The manager was able to provide evidence of a thorough and detailed investigation. Policies and procedures for adult protection and whistle blowing were checked and found to be satisfactory. Since the last inspection all staff have received training in the signs and symptoms of abuse and the action they should take should they suspect that abuse has taken place. Varndean House DS0000038431.V330065.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is nicely presented. Residents live in a well-maintained environment with their own possessions around them. The home is 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. Varndean House is very well maintained with good access to communal areas. It is light and airy and furnished and decorated to a good standard. The atmosphere is homely and relaxed.
Varndean House DS0000038431.V330065.R01.S.doc Version 5.2 Page 17 Since the last inspection another phase of major building works has commenced which will result in more bedrooms, a through floor passenger lift and improved communal areas. A new kitchen, hairdressing room and staff area has already been completed. Varndean House DS0000038431.V330065.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Resident’s needs are met through the provision of a mix of experienced, qualified and unqualified staff. Good progress is being made in ensuring that staff obtain minimum level qualifications. This means that residents are more likely to receive consistent care. Vetting practices for the appointment of new staff are out of date. The home has therefore potentially put residents at risk by employing staff without undertaking suitable checks. The arrangements for the induction training of staff has improved as where possible this is now being done within the required timescales. This means that staff have the necessary skills to enable them to undertake all aspects of their role competently. EVIDENCE: Examination of the staff rota and observation throughout the inspection demonstrated there was a sufficient number staff to meet the needs of
Varndean House DS0000038431.V330065.R01.S.doc Version 5.2 Page 19 residents. Staff and residents spoken with confirmed that they were satisfied with staffing levels. Four of the twelve care staff have achieved the minimum NVQ level 2 qualification in care or higher. One person is currently studying NVQ level 2. Staff records were examined for two newly appointed members of staff. Records demonstrated serious omissions as both staff had commenced their duties without updated POVA (Protection of Vulnerable Adults) or CRB (Criminal Records Bureau) checks. Also one reference had clearly stated that disciplinary action had been taken against the applicant and Mr Burchfield had not properly explored this prior to appointing the person. Induction records for two new staff demonstrated that one person had received the training within the required timescale while another was taking longer than the recommended time as they required more support to undertake the work. Varndean House DS0000038431.V330065.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,31,35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Mr Burchfield has completed the necessary training and has the relevant experience. He is a competent, committed and approachable manager and both residents and staff confirmed this. The home regularly reviews aspects of its performance through a good programme of self-review and consultations, which include seeking the views of residents, staff and relatives. Resident’s finances are safeguarded with clear policies and procedures and management guidance. 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.
Varndean House DS0000038431.V330065.R01.S.doc Version 5.2 Page 21 EVIDENCE: Mr Burchfield has completed the required care and management qualifications and has been a registered manager since 2003. Reports on the home since this time have shown a steady improvement in standards. The home has detailed policies and procedures for the promotion of quality assurance in the home. Mr Burchfield confirmed that annual surveys and analysis is due to undertaken again later in the year. Mr Burchfield 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 cash for some residents. Records and cash balances for two residents were checked and found to be satisfactory. It was noted that in most cases only one member of staff signs the transaction record. Fire records, staff training records and accident books were examined. It was noted that one accident sustained by a resident had not been recorded in the accident book. Since the last inspection a hoist has been purchased and training for staff in its use was planned for the week following the inspection. Varndean House DS0000038431.V330065.R01.S.doc Version 5.2 Page 22 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 Varndean House DS0000038431.V330065.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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 OP29 Regulation 19 Requirement 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. 8/2/2007 This is the 3rd time that this requirement has been made. Failure to comply will result in enforcement action being taken. Timescale for action 30/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Varndean House DS0000038431.V330065.R01.S.doc Version 5.2 Page 24 No. 1. Refer to Standard OP8 Good Practice Recommendations Records of visits by chiropodists as well as other care professionals should be kept in order to demonstrate that such care is provided to residents. Changes in resident’s weights should be investigated. Scales should also be regularly calibrated to ensure that they are giving a correct reading. A pill counter must be obtained to enable safe counting of tablets without risking contamination. Running balances of any controlled drugs must be kept. Residents should sign for any financial transactions. Where this is not possible a second signature should be obtained from a member of staff who must witness the transaction. 8/2/07 This is the second time this recommendation had been made. 2. 3. OP9 OP35 Varndean House DS0000038431.V330065.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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