Inspection on 19/04/06 for Old Vicarage Nursing and Residential Home

This inspection was carried out on 19th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Old Vicarage Nursing and... 29/09/05

Old Vicarage Nursing and... 05/11/04

Old Vicarage Nursing and... 09/09/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Old Vicarage Nursing and Residential Home Station Road Gobowen Oswestry Shropshire SY11 3JS Lead Inspector Keith Salmon Key Inspection 19th April 2006 12:15 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 Old Vicarage Nursing and Residential Home DS0000051235.V290279.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. Old Vicarage Nursing and Residential Home DS0000051235.V290279.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Old Vicarage Nursing and Residential Home Address Station Road Gobowen Oswestry Shropshire SY11 3JS 01691 655254 01691 658467 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) Sure Care (UK) Ltd Care Home 39 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (39), of places Physical disability (2) Old Vicarage Nursing and Residential Home DS0000051235.V290279.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. For the next 12 months Mr Bedi will undertake his monthly unannounced visits as per his obligation to comply with regulation 26 of the Care Homes Regulations 2001, accompanied by an appropriately qualified and experienced professional. This must be evidenced as per the report content necessary to be submitted to the home and NCSC following these visits. Service user categories remain as follows:- Physical disability (PD) x2, Dementia (DE) x12, Old age (N) not falling into any other category x25 Staffing: these are minimum levels required throughout the 24 hour day, including weekends. These levels include the person in charge when he/she is engaged in direct care provision and exclusive of the person in charge when he/she is carrying out management duties. They do not include ancillary staff. The home must provide, for 39 service users requiring nursing care: 08.00-14.00: 2RGN/RMSs, 6 care assistants 14.00-22.00: 2RGN/RMNs, 6 care assistants 22.00-08.00: 1 RGN/RMN, 3 care assistants There must be RMN support and supervision available for the service for people with dementia. The home can accommodate, within its overall registration, one person over 50 years of age, but under 65 years of age, with nursing needs. 29th September 2005 2. 3. 4. Date of last inspection Brief Description of the Service: Situated in the village of Gobowen, near Oswestry, The Old Vicarage is owned by Sure Care (UK) Ltd, and Registered to provide care for up to thirty-nine people, including those who may be categorised as ‘younger physically disabled’, ‘frail elderly’ and ‘elderly mentally infirm’ – fees charged range from a minimum of £286 per week up-to a maximum of £595 per week. Whilst being immediately adjacent to open fields with pleasant views, the Home is conveniently accessible to a variety of village amenities, including pubs, post office, shops, local bus route and train station. Accommodation comprises the original building, which offers double and single rooms on two floors, accessible via a shaft lift, together with a more recent extension providing accommodation for Service Users deemed ‘elderly mentally infirm.’ Old Vicarage Nursing and Residential Home DS0000051235.V290279.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Unannounced Inspection was undertaken by one Inspector, commenced at 12.15 pm and took 4.5 hours. Present were Mr. Shrini Srungaram (Joint Proprietor), and Mrs. Giby Varghese, Nurse in Charge on that day. Being the first Inspection of 2006/07 it centred on ‘Requirements’ cited at the previous Inspection, held in September 2005, plus all ‘Key’ National Minimum Standards. This Report is based on observations made during a tour of the Home, a review of care related documentation, staff duty rotas plus a range of other documents/records reflecting the general operation of the Home. The Inspector also held 1:1 discussions with Mr. Srungaram, Mrs. Varghese, 6 Residents, 4 Visitors, and several members of Staff. What the service does well: What has improved since the last inspection? At the time of the previous Inspection, held in September 2005, a vacancy existed for a Registered Manager. The former Manager, who had left to undertake other work, was acting in a consultancy capacity to the Home. Since that time the Proprietors have recruited a new Manager, Ms. Tracy Christian, whom the Inspector was informed is in the process of applying to the CSCI for approval to become Registered Manager. Old Vicarage Nursing and Residential Home DS0000051235.V290279.R01.S.doc Version 5.1 Page 6 In addition, a number of ‘Requirements,’ cited at the previous Inspection, relating to the following aspects of care have all been fully met: Medicine administration Staff recruitment practices and records Maintenance of the Home’s Complaints Log Improvements noted at the previous Inspection, i.e. assessment and care planning documentation, detailed contracts/terms and conditions documents, general cleanliness and increased provision of social activities have all been maintained or developed further. 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. Old Vicarage Nursing and Residential Home DS0000051235.V290279.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 Old Vicarage Nursing and Residential Home DS0000051235.V290279.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): 2, 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prior to taking up residency all prospective Service Users are enabled to reach an informed choice and to fully understand the service they may expect to receive. Processes to ensure appropriate and thorough care needs assessment, prior to admission, are effectively applied. EVIDENCE: At the previous Inspection it was ‘Required’ the Home ensure Residents must be provided with a written contract or statement regarding their accommodation provision, and completion of a thorough and appropriate assessment of care needs prior to admission. A review of 5 Residents’ Care Plans/Files, i.e. those relating to the two most recently admitted Residents plus 3 randomly selected, demonstrated the related Requirements have been fully met. Old Vicarage Nursing and Residential Home DS0000051235.V290279.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): 7,8,9,10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care provided by the Home is effective in meeting the Residents’ assessed care needs, and is delivered considerately and effectively. The approach of Staff in providing such care is good, with relationships between Residents and Staff being friendly and respectful. The storage, administration, and disposal of medicines are in accordance with accepted good practice. EVIDENCE: At the previous Inspection a number of ‘Requirements’ were cited under Standards covering Health and Personal Care. These being: The Home must ensure the health, personal and social care needs of recently admitted individuals are set out in appropriate Care Plans, with linked records demonstrating their assessed needs are met. Five Residents’ Care Plans/Files were reviewed (i.e. those of the two most recently admitted Residents, plus 3 randomly selected) as a component of ‘Case Tracking’. This process provided clear evidence of this Requirement being fully met. Old Vicarage Nursing and Residential Home DS0000051235.V290279.R01.S.doc Version 5.1 Page 10 Also, ‘Requirements’ relating to clinical management practices were cited. Specifically – All medications must be stored in accordance with the manufacturer’s storage requirements Oxygen cylinders are to be chained to the wall in the treatment room A thorough inspection of the medicine storage provision and medicine administration records showed these ‘Requirements’ to be fully met. The Home’s practices now meet the guidelines of the Royal Pharmaceutical Society. However, a ‘Requirement’ relating to the security of the Medicines/Treatment Room has yet to be fully addressed. Previously, the window to this Room was kept open to help maintain the room temperature at a satisfactory level, but this presented a security risk both to medicine storage and the premises in general. The Home has now installed an effective air-conditioning unit thereby obviating the need for opening of the window. Therefore, to ensure this Room remains secure it is a ‘Requirement’ that a notice is posted adjacent to the window, instructing it is to be kept locked, with the key to the window to be located within the medicines’ room. The Home is to approach Shropshire Fire Service prior to implementing this action to obtain their advice/approval of this action. Through observation and individual discussions with Residents and Relatives, it is clear they are treated in a considerate and respectful manner. Old Vicarage Nursing and Residential Home DS0000051235.V290279.R01.S.doc Version 5.1 Page 11 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): 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Leisure opportunities are provided, which are consistent with Residents’ capabilities. The Home facilitates achievement of desired lifestyle through Residents conducting the pattern of their day as they wish, including contact with family and friends, and continuation of religious practices. There is a daily choice of attractive and nutritious meals. EVIDENCE: The Home has a full and varied programme of activities, which are planned and organised jointly by Residents and Staff. Activities include local trips out with Relatives and/or Staff, regular visits to local garden centres and Chirk Castle, involvement in national commemorative events, traditional games including cards, dominoes, bingo and skittles. Minutes of Residents’ Meetings, and comments made by Residents, provided evidence of their input in determining the range and nature of activities. Residents informed the Inspector the range, quality and choice of food provided was very good and the Home caters for those Residents who have individual preferences/dislikes. Old Vicarage Nursing and Residential Home DS0000051235.V290279.R01.S.doc Version 5.1 Page 12 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): 16,18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The interests of Residents are protected through ready access to information relating to advocacy services and the Home’s Complaints Procedure. Staff are aware of their role in protecting Residents from abuse. EVIDENCE: The Inspection carried out in May 2005 ‘Required’ the Home’s Complaints Log should ensure all information relating to every complaint received is effectively indexed and sequentially recorded. Examination of this record demonstrated the Management has effectively addressed this matter and the ‘Requirement’ is fully met. The CSCI has been formally made aware of concerns held by the Home’s Staff and Management regarding the behaviour of one member of Staff towards some Residents. This person is now a former member of Staff. At the time of this Inspection action involving Adult Protection procedures had commenced and were on-going. The Inspector observed evidence the Home had implemented its abuse prevention/adult protection procedures pending possible involvement of outside Adult Protection Agencies. Old Vicarage Nursing and Residential Home DS0000051235.V290279.R01.S.doc Version 5.1 Page 13 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): 19,22,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home provides a safe, well-maintained environment with the gardens being easily accessible at all times of year. Specialist equipment, consistent with meeting the assessed care needs of Service Users and the demands of tasks carried out by Care Staff, and is appropriately serviced and maintained. The cleanliness and general state of repair in all areas of the Home is a credit to the Housekeeping and Maintenance Staff. EVIDENCE: The tour of the premises, examination of maintenance records and discussion with the Joint Proprietor, Nurse in Charge and the Home’s Maintenance Man, provided evidence of well-organised preventative maintenance practices, e.g. all bedrooms are subject to monthly application of a comprehensive checklist, including testing of water temperatures, and effective response to day-to-day maintenance issues. Specialist equipment (e.g. hoists, wheelchairs, stand-aids) were seen to be in good working order, and evidence of maintenance by qualified engineers seen. Old Vicarage Nursing and Residential Home DS0000051235.V290279.R01.S.doc Version 5.1 Page 14 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): 27,28,29,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff numbers on duty and skill-mix were sufficient to meet the assessed care needs of current Residents. Recruitment and employment practices are now consistent with the safeguarding of Residents. The commitment of the Home to provide training for Care Staff is good, and in accordance with individual Staff Members’ learning needs. EVIDENCE: The current staffing rota, and those from the immediately preceding weeks, were examined. These demonstrated Staffing numbers and skill-mix enable a service provision, which meets the care needs of the Service Users. A specific ‘Requirement’ cited at the previous Inspection was that the Home’s recruitment procedures must include obtaining two references, and a recent photograph prior to the engagement of staff. A review of employment files for 5 members of Staff, (i.e. those relating to the 2 most recently employed, plus 3 selected at random), provided evidence the Management of the Home has addressed these ‘Requirements’ and these ‘Requirements’ are now fully met with Staff Personal Files being fully compliant with the Standard and Schedule 2 of the Regulations. A review of ‘Training’ records evidenced Staff are subject to a thorough and relevant orientation/induction programme, a comprehensive ‘foundation’ training, e.g. ‘manual handling and lifting’, ‘fire safety’, ‘simple infection control’ followed by access to NVQ Training. Old Vicarage Nursing and Residential Home DS0000051235.V290279.R01.S.doc Version 5.1 Page 15 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): 31,32,33,35,36,38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Despite the post of Registered Manager being vacant for almost a year the Home is well managed by the relatively new Manager, Ms.Tracy Christian. The ambience is warm, friendly, and inclusive. Operationally, the Home now appears well organised with the central purpose being ‘the best interests of Residents’. Lines of accountability are clearly defined and observed. The views of Residents and other interested parties are sought by the Home and acted upon. Service Users are safeguarded by the financial procedures operated in the Home. All Staff are subject to effective support with regular supervision, and appeared involved and happy in their work. Health and Safety Policies/Procedures/Practices were satisfactory. EVIDENCE: Old Vicarage Nursing and Residential Home DS0000051235.V290279.R01.S.doc Version 5.1 Page 16 Mr. Srungaram, Joint Proprietor, informed the Inspector that application to the CSCI by Ms. Tracy Christian for formal Approval/Registration as Manager is imminent. Notwithstanding the situation of the Home being without a Registered Manager, observation by the Inspector, together with comments from Residents, Visitors and Staff suggest the Home is currently being well managed with clear signs of improvement in many areas of care provision from those found at previous inspections. However, despite this improvement it remains of critical importance the process of Registration of the Manager be completed forthwith. Support for the Manager is evidenced by regular attendance at the Home by either of the Proprietors and monthly submission to CSCI of Regulation 26 visits. Records reviewed demonstrated two members of Staff deal with cash held by the Home on behalf of Service Users. These monies are deposited, mainly by family members, to pay for minor items of expenditure e.g. shopping and hairdressing. Written agreement to this arrangement, signed by individuals who have cash at the Home, was observed together with records of transactions, including receipts, e.g. the hairdresser maintains a list of who has had what and this can be cross referenced to deductions in the accounts. The Home continues to address concerns voiced at previous Inspections through sustained input by the local Primary Care Trust Infection Control Nurse, which has involved application of an approved audit tool. The outcome from the most recent audit was generally praiseworthy. Quality assurance work, including questionnaires to Residents and Relatives/Visitors has continued, plus monthly meetings held with Service Users. Results of these questionnaires and notes of monthly meetings were observed and found to be relevant and suggestions implemented where possible. COSHH requirements were satisfactory, with maintenance and servicing of equipment regularly undertaken, and appropriately documented. Records are maintained for hot water supply to baths, and water tested during the Inspection was satisfactory and COSHH data sheets were up-to-date. Old Vicarage Nursing and Residential Home DS0000051235.V290279.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X X N/A 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 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 X 3 Old Vicarage Nursing and Residential Home DS0000051235.V290279.R01.S.doc Version 5.1 Page 18 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. 1. Standard OP9 Regulation 13. - (2) Requirement In the interests of security the Home is to ensure the window to the Medicines/Treatment Room is kept locked and a notice to this effect is posted adjacent to or on the window. The key to the Medicines/ Treatment Room window is to be held within the room to ensure quick access if needed. The Home must seek the advice/approval of the Shropshire Fire Service prior to implementing the above actions. The Manager must submit her application to the CSCI for approval to become Registered Manager. Timescale for action 30/06/06 2. OP9 13. - (2) 30/06/06 3. OP9 13. - (2) 30/06/06 4. OP31 8. -(1)(a) (b)(i)(iii) 9.-(1)(2) 31/05/06 Old Vicarage Nursing and Residential Home DS0000051235.V290279.R01.S.doc Version 5.1 Page 19 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 Good Practice Recommendations Old Vicarage Nursing and Residential Home DS0000051235.V290279.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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