Inspection on 29/09/05 for Old Vicarage Nursing and Residential Home

This inspection was carried out on 29th September 2005.

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... 19/04/06

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

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

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Maple Lodge

Heathlands

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Inspirations

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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 Deb Holland Unannounced Inspection 29th September 2005 09:30 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.V255445.R01.S.doc Version 5.0 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.V255445.R01.S.doc Version 5.0 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 Mrs Barbara Marie Merrick 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.V255445.R01.S.doc Version 5.0 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. 18th May 2005 2. 3. Date of last inspection Brief Description of the Service: The Old Vicarage is situated in the village of Gobowen, near Oswestry. The home has open fields on one side with pleasant views but is also conveniently close to village amenities, bus, train station, pubs, post office and shops. The Old Vicarage is registered for thirty nine people in total and is designed to meet the needs of younger physically disabled, frail elderly, and elderly mentally infirm people. Accommodation is provided on two floors with a shaft lift. The home has its original building which offers a range of double and single rooms and an extension which offers accommodation to the elderly mentally infirm service users. The provider of the home is Surecare UK Limited with Mr S Bedi being the Responsible Individual for the company registered with CSCI. The information at the beginning of this document is incorrect in that currently there is a vacancy for registered manager, but Ms Merrick, having left to do other work, has returned to act as a consultant to the home. Old Vicarage Nursing and Residential Home DS0000051235.V255445.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of this inspection was to follow up on issues raised by previous inspections of the home. The home has been through a troubled nine months with a difficult adult protection procedure relating to an ex-resident and the refusal of registration of a proposed manager. Placements at the home were suspended but the situation was reviewed in August and admissions have recommenced. Shortfalls in various aspects of the running of the home were identified in inspection visits in February 2005 and May 2005. A detailed infection control audit inspection was also conducted in June 2005. A more recent inspection visit conducted in August 2005 identified improvements. This report, in addition to reporting direct findings from 29 September 2005, will reflect on the June and August visits, the conclusions of which were communicated only by letter to the home. This unannounced inspection took place over some three hours and involved looking at records, an inspection of communal and some individual rooms, plus talking to a visiting professional, staff, a visitor and several service users. Requirements made in May relating to medication storage, complaints and management of substances hazardous to health have not been considered and will be reviewed at a future inspection. What the service does well: Assessments and care plans for those inspected were good, with a lot of information on record for staff to refer to when providing care. Efforts have been made to improve the cleanliness, safety and hygiene in the home, which now provides a safe, comfortable and homely environment for service users to live in. Staff members commented that teamwork is good, with good opportunities for training. Service users’ preferences, rights and choices are respected. Individual rooms are personalised as much as people wish. Service users’ views and those of interested parties such as visiting GPs and family members are being sought and monthly residents’ meetings are held Old Vicarage Nursing and Residential Home DS0000051235.V255445.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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.V255445.R01.S.doc Version 5.0 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.V255445.R01.S.doc Version 5.0 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 and 3 – Standard 6 does not apply to The Old Vicarage Service users are provided with a written contract or statement regarding their accommodation at the home. Assessments of need are thorough and appropriate admissions have been made EVIDENCE: The assessments, care plans and records for three people admitted to the home recently were inspected. Two of these individuals were admitted specifically for respite care, and the third was resident only for a few days as her medical condition deteriorated significantly and she was re–admitted to hospital. However, assessments complied with the requirements of the standards and were recorded clearly. The assessed needs were consistent with the service offered by the home. Contracts and statements of terms and conditions have been revised with details for payment of fees and sources of funding included clearly plus details about room occupied, period of notice, etc. Old Vicarage Nursing and Residential Home DS0000051235.V255445.R01.S.doc Version 5.0 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 The health, personal and social care needs of individuals admitted recently to the home were set out in appropriate care plans and records demonstrated that those needs were met. Requirements made earlier in the year relating to medication were not monitored on this occasion EVIDENCE: Six care plans were looked at during the inspection in August 2005 and improvements noted as well as shortfalls in plans for use of pressure relieving equipment and risk assessments. However, it was noted that a better team approach to care management was being promoted. Care plans seen in September for the three people recently accommodated at the home contained comprehensive information about how needs should be addressed. Acute care plans were in place for one lady admitted with diarrhoea, pyrexia and a urinary tract infection. Care plans for particular needs such as catheter care, pressure areas and pressure relieving equipment, manual handling were in place as were risk assessments. The records for one service user who was admitted with significant medical problems and who deteriorated showed that her condition was monitored and the GP involved appropriately, leading to a readmission to hospital. Medication records, though now discontinued, showed Old Vicarage Nursing and Residential Home DS0000051235.V255445.R01.S.doc Version 5.0 Page 10 appropriate recording practice, however the storage of medication as reported on in May 2005 was not re-inspected and will be considered at a later date. A falls risk assessment for one respite client identified as being at risk of falling was on file. The visiting “free nursing care” assessor expressed no concerns regarding care plans other than the occasional omission of dates. Requirements made in May 2005 relating to medication storage were not followed up at this inspection and will be reviewed at the next inspection visit. Old Vicarage Nursing and Residential Home DS0000051235.V255445.R01.S.doc Version 5.0 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, 14 & 15 Service users are encouraged to exercise choice and control, and social activities have increased. The home provides a varied and satisfactory diet. EVIDENCE: Some residents spoken to expressed their wishes very clearly and these have been respected by the home. A number of people described the options available to them in terms of staying in their rooms, the time at which they moved to communal areas, etc., and that these choices were respected. A visiting relative commented that the increasing dependency of their relative at the home was being managed well. Menus on display showed that a satisfactory diet was being provided, with choice available. Those residents spoken to commented favourably on the food provided. Liquidised diets were seen being prepared for lunchtime in a way which maximised appeal while accommodating the need for pureed food. It was seen from the notes from residents’ meetings that meals had been discussed and service users given the opportunity to comment and make suggestions Although this aspect was not inspected in full, the home’s noticeboard displayed photographs from the various outings which have taken place so far Old Vicarage Nursing and Residential Home DS0000051235.V255445.R01.S.doc Version 5.0 Page 12 this year and there was a plan of social activities on the board. It was identified during the visit in August 2005 that outings had included people with dementia related illness and frail individuals. It was also identified at that time that the home was employing a full time activity coordinator who had facilitated a varied activity programme valued by the service users. Old Vicarage Nursing and Residential Home DS0000051235.V255445.R01.S.doc Version 5.0 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 the following standard(s): Standards 16 & 18 were inspected in May 2005 EVIDENCE: Please see reported dated 18 May 2005 – the requirement relating to this standard will be reviewed at the home’s next inspection Old Vicarage Nursing and Residential Home DS0000051235.V255445.R01.S.doc Version 5.0 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 the following standard(s): 19, 24, 25 and 26 Improvements have been made to the infection control standards and levels of cleanliness in the home, providing a more pleasant and safe environment for service users to live in EVIDENCE: It was identified in August that the home environment had much improved, with communal areas being fresh and appealing with the provision of new furniture. Odour problems as reported from the June inspection were not in evidence. The communal area in the part of the home used for caring for people with dementia had also been improved. At this inspection, the home was clean and sweet smelling despite the time being that at which sometimes domestic and care staff have not “caught up” with the challenges of the morning activities. It was identified in August that all radiators have now been covered and that two new thermal sluice disinfectors had been installed. The laundry floor had Old Vicarage Nursing and Residential Home DS0000051235.V255445.R01.S.doc Version 5.0 Page 15 been repaired to provide a readily cleanable, safe, surface. Flooring to the lift was seen in August to have been completed renewed. The issue raised in August relating to the height of bed rails where a pressure relieving mattress is used had been addressed. However, the additional height of the rail raises problems for access to bed tables and those service users seen with rails in place without covers stated quite clearly that that was how they wanted them. Ms Varghese confirmed that these arrangements were risk assessed, documented and agreed with other interested parties. The auditing of the environment had recommenced in August and this continues. Servicing to thermostatic valves has been undertaken and hot water temperatures were assessed in bathrooms and found to be satisfactory. Old Vicarage Nursing and Residential Home DS0000051235.V255445.R01.S.doc Version 5.0 Page 16 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 The home’s recruitment procedures need to be improved to ensure that service users are safeguarded EVIDENCE: It was reported that only two of the care staff have not acquired accreditation or are actually studying at NVQ2 – most of the staff are studying for either NVQ2 or 3 with Ludlow college. However, this inspection focused on the home’s recruitment practice by examining the files for three members of staff, two of them recently appointed “overseas” staff. The file for the more longstanding senior member of staff was satisfactory, with appropriate record of PIN, CRB, references, etc. The files for the two newest members of staff were somewhat depleted, due, it was explained, by the fact that information had been sent to the Home Office relating to their work permits. It was pointed out that this is not acceptable and that copies must be maintained at the home. One member of staff had a completed CRB disclosure (but carried out by a previous employer), one had been appointed under the “POVA First” arrangement but the CRB had not yet been received. One file lacked application form, references, photograph and any indication that induction had been commenced, although manual handling training had been provided. The other also lacked any induction record, again having had manual handling training, and did not contain a photo. Old Vicarage Nursing and Residential Home DS0000051235.V255445.R01.S.doc Version 5.0 Page 17 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): 33, 35 and 38 (part) Service users’ and other interested parties’ views are obtained by the home and acted upon. Service users are safeguarded by the financial procedures in the home. Many improvements have been made to health and safety matters EVIDENCE: It was identified in August 2005 that the previous home manager, Ms M Merrick, was to employed on a consultancy basis to support the home and provide Regulation 26 reports. The arrangements in the home for dealing with managing service users’ finances have had to change, with the retirement of the member of staff who used to deal with this. Two members of staff are now dealing with the cash held by the home on behalf of service users – mainly deposited by family members to pay for minor items of expenditure, shopping and hairdressing. Agreement to this arrangements has been sought for all individuals who have Old Vicarage Nursing and Residential Home DS0000051235.V255445.R01.S.doc Version 5.0 Page 18 cash at the home and good records are maintained. The hairdresser maintains a list of who has had what and this can be cross referenced to deductions in the accounts. Other purchases are receipted. Pension books are not held and the home does not hold appointeeship for any of the service users. The inspection in June 2005 concentrated solely on infection control. Some issues relating to the cleanliness of the environment and odour control were seen to have been addressed by August 2005. The report from June 2005 formed a set of detailed guidance for the management and staff at the home to adhere to in promoting infection control within the home environment. The home’s acting manager has made efforts to improve the standards at the home, recognised by the inspection of August 2005 and the reinstatement of admissions to the home agreed at that time. In August, it was identified that all occurrences that affected a service user’s well being had been duly reported to CSCI as per Regulation 37. This practice has continued and was evidenced by the notification by the home to CSCI of a fall sustained by one of the respite clients mentioned earlier in this report. Regulation 26 reports are also being received. An infection control audit was carried out by a CSCI inspector and a Health Protection Agency Senior Nurse in June 2005. This found that arrangements at the home for hand decontamination were excellent and further information and posters for staff guidance were to be provided. Some staff at the home are undertaking a distance learning training package on infection control. At this visit, the cleanliness of some areas of the home was criticised but, as seen in August and at this inspection, the situation has improved. Although the support of a resident receiving enteral feeds was already guided by a specialist gastroenterology nurse, further guidance was to be issued following this audit. Waste disposal arrangements were considered to be satisfactory, as was the disposal of sharps, although it was identified that a written policy needed to be produced. The home was required to produce a disinfection policy and ensure that eye protection is available for staff in rooms where disinfectants are mixed. A further audit in six months time was recommended, when the designated infection control audit nurse will be in post and routinely visiting and advising care homes with nursing. Audits for health, safety and infection control purposes have been carried out internally by the home’s acting manager e.g. kitchen audit conducted in May, sharps audit in May, waste, kitchen and linen in September. These lead to the home’s improvement plan. An accident audit has been conducted covering the period 1 June 2005 to 25 July 2005. Quality assurance work has included questionnaires to service users in August and September, plus relatives where appropriate; GPs were surveyed in August and feedback seen on file. In this file the home also keeps its “thank yous” from appreciative families regarding care, usually relating to service Old Vicarage Nursing and Residential Home DS0000051235.V255445.R01.S.doc Version 5.0 Page 19 users who have died. Notes from meetings held monthly with service users were also available. Arrangements for storage and labelling of COSHH items were not inspected on this occasion and this matter will be carried forward to the next inspection. Old Vicarage Nursing and Residential Home DS0000051235.V255445.R01.S.doc Version 5.0 Page 20 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 x 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 X 18 X 3 x x x x 3 3 3 STAFFING Standard No Score 27 X 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X x Old Vicarage Nursing and Residential Home DS0000051235.V255445.R01.S.doc Version 5.0 Page 21 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 All medication must be stored in accordance with the manufacturer’s storage requirements Oxygen cylinders must be chained to the wall in the treatment room The drug room must be kept secure at all times. Any opening windows must be protected by security bars The complaints log should ensure that all information about every complaint received is effectively indexed and sequentially recorded Two references must be obtained for all staff Photographs must be obtained of all staff Timescale for action 31/12/05 2 3 OP9 OP9 13 (2) 13 (2) 31/12/05 31/12/05 4 OP16 23 (2) 31/12/05 5 6 OP29 OP29 19 (5) 19 (5) 01/11/05 01/11/05 Old Vicarage Nursing and Residential Home DS0000051235.V255445.R01.S.doc Version 5.0 Page 22 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.V255445.R01.S.doc Version 5.0 Page 23 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. Extracts may not be used or reproduced without the express permission of CSCI Old Vicarage Nursing and Residential Home DS0000051235.V255445.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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