Inspection on 02/09/05 for Old Vicarage Nursing Home

This inspection was carried out on 2nd September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 Home 06/02/08

Old Vicarage Nursing Home 20/06/06

Old Vicarage Nursing Home 07/06/05

Old Vicarage Nursing Home 09/12/04

Old Vicarage Nursing Home 11/08/04

Old Vicarage Nursing Home 12/11/03

Old Vicarage Nursing Home 18/06/03

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

CARE HOMES FOR OLDER PEOPLE Old Vicarage Nursing Home Norwich Road Ludham Norfolk NR29 5QA Lead Inspector Ann Catterick Unannounced 2 & 5 September 2005 9.00 am nd th 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. Old Vicarage Nursing Home I55 s15669 Old Vicarage v247647 UN 020905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Old Vicarage Nursing Home Address Norwich Road, Ludham, Norfolk. NR29 5QA. 01692 678346 01692 678565 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) Hewitt-Hill Limited Position vacant Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29). of places Old Vicarage Nursing Home I55 s15669 Old Vicarage v247647 UN 020905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. That appropriate care and accommodation is provided for three service users who are under 65 years of age. No further service users under the age of 65 should be admitted without agreement with CSCI. 2. Twenty-nine (29) Older People may be accommodated. Date of last inspection 7th June 2005 Brief Description of the Service: The Old Vicarage is a care home with nursing for older people, and is situated in the village of Ludham. Hewitt-Hill Limited owns the home. The majority of service users require nursing as well as personal care and the staffing ratios reflect this level of care, with a nurse on duty at all times. The 29 bedrooms are situated over two floors with access via a shaft lift. Some of the ground floor bedrooms open direct to the gardens. The communal areas consist of two lounges and one conservatory that doubles as a dining area. The grounds consist of surrounding lawns, shrubs, large trees and flowerbeds, with a small patio area and pond, all of which can be accessed by service users. There is ample car parking at the front of the premises. Old Vicarage Nursing Home I55 s15669 Old Vicarage v247647 UN 020905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Today’s inspection took place following the CSCI receiving an anonymous letter expressing several concerns about different aspects of the care home. For this reason specific standards were looked at. Those key standards not looked at within this inspection will be inspected at the time of the next inspection. The inspection took place on the 2nd and 5th of September. The inspector was able to have a tour of the building, talk to management, staff and service users as well as look at care plans and documents. The inspector found that some of the concerns identified were upheld and some were not. What the service does well: What has improved since the last inspection? The inspector could see no real improvements since the last inspection. Old Vicarage Nursing Home I55 s15669 Old Vicarage v247647 UN 020905 Stage 4.doc Version 1.40 Page 6 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 Home I55 s15669 Old Vicarage v247647 UN 020905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Old Vicarage Nursing Home I55 s15669 Old Vicarage v247647 UN 020905 Stage 4.doc Version 1.40 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 standard(s) 3 and 6 There was no clear evidence seen to suggest that all prospective service users have their needs assessed prior to admission thus ensuring that the home can meet individual needs. EVIDENCE: Some care plans were seen and there was no clear indication or evidence to suggest that comprehensive assessments were always made by the home and, when appropriate the professional placing the person. The whole area of assessment and care planning gives opportunity for further improvement. Intermediate care is not provided within this home. Old Vicarage Nursing Home I55 s15669 Old Vicarage v247647 UN 020905 Stage 4.doc Version 1.40 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 standard(s) 7 Individual care plans were seen for service users and those seen did not contain all of the information needed to ensure that health, personal and social needs of service users are met. EVIDENCE: Some care plans were seen and these tended to follow the clinical model and were limited with regard the information that they included. For example for one service user under mobility it quoted “very poor.” The inspector would suggest that this does not help staff know what particular care this person needs. There were no social histories on file, no photographs and no evidence of service users or their families being involved in the process. Some evidence was seen of care plans being reviewed. The overall quality of the care plans was not really adequate and further work needs to be done in this area. Old Vicarage Nursing Home I55 s15669 Old Vicarage v247647 UN 020905 Stage 4.doc Version 1.40 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15 The service users were seen to be content and satisfied with what the home offered, overall, but there appeared to be a general lack of recreational activities within the home. Service users receive a wholesome balanced diet but are limited on where they eat their meals. Old Vicarage Nursing Home I55 s15669 Old Vicarage v247647 UN 020905 Stage 4.doc Version 1.40 Page 11 EVIDENCE: The home benefits from having delightful grounds that are accessible to service users with several areas for service users to sit. When speaking to service users the inspector was informed that it was only the service users who had visitors who use the garden, as staff did not have the time to take them out in the grounds. Service users suggested that staff do not have enough time to sit and talk or spend very much social time with them. The home lacks usable communal space and service users appeared to stay in their room or sit in one of the lounges with meals being provided on a bed table. The disadvantage of this is that there is no communal dining. The kitchen is well organised and the service users are offered a varied and nutritious diet. Good practice was seen in the kitchen and the home was hoping to appoint further kitchen staff to compliment the present cook. All of the comments made by service users about the food were positive and the lunch on the day of inspection appeared to be appetising and well presented. At the present time all service users eat their meals in their bedrooms or on a bed table at their armchair, in the lounge. The conservatory/ dining area needs to be refurbished to offer a proper dining area for service users to sit if they choose. Old Vicarage Nursing Home I55 s15669 Old Vicarage v247647 UN 020905 Stage 4.doc Version 1.40 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 standard(s) None of the outcomes for these standards were looked at on this occasion. EVIDENCE: Old Vicarage Nursing Home I55 s15669 Old Vicarage v247647 UN 020905 Stage 4.doc Version 1.40 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 standard(s) 19,20,21 and 26 Overall the home is a safe environment but would benefit from some refurbishing and decoration. The home does not have adequate usable communal facilities. The home has sufficient bathrooms but one of these is being used as a storeroom. The home was not as clean as it could have been in all areas. Old Vicarage Nursing Home I55 s15669 Old Vicarage v247647 UN 020905 Stage 4.doc Version 1.40 Page 14 EVIDENCE: The new proprietor has a maintenance plan and had started completing some work on the outside of the property. Further work is planned. The dining area is a glass conservatory that is sometimes too cold in winter and too hot in summer and is therefore not utilised as a dining area. This area needs to be made good to enable it to be included in the communal areas. The home has very good gardens that offer additional communal space in the warmer weather. The inspector was disappointed to find that the garden is not used very much by service users, as staff do not have the opportunity to take residents out in it. One of the four bathrooms is used as a storeroom and this needs to be used as a bathroom. There was much opportunity to improve the ambience of the bathrooms. The proprietor needs to find an alternative area for storage, as this was limited throughout the home. Generally the home was clean but there were some areas of the home that would have benefited from further cleaning. For example some of the bathrooms and toilet areas were not as clean as they could be. Old Vicarage Nursing Home I55 s15669 Old Vicarage v247647 UN 020905 Stage 4.doc Version 1.40 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, 29 and 30. Evidence showed that the home does not always have the sufficient numbers and skill mix of staff on duty that is recommended to be on duty to meet the needs of service users. New staff are not always trained and competent to do their jobs at the time they initially start working in the home. The recruitment and selection process had been used correctly in relation to recent staff appointments. Old Vicarage Nursing Home I55 s15669 Old Vicarage v247647 UN 020905 Stage 4.doc Version 1.40 Page 16 EVIDENCE: The health authority has issued guidelines to all nursing homes with regard the number of nurses and care staff on duty at any one time. The staff rota was seen and did not to meet this guideline on several occasions. The home did, on most occasions have enough staff on duty but did not have sufficient nursing staff on duty. There has been a recent period that this had happened on a regular basis. This appeared to be related to the poor management of annual leave and this meant that several nurses were taking leave at the same time leaving the home very short staffed. Concern was expressed that recently, when new staff were appointed, they were not supernumerary to the rota as they should have been as part of their induction. The consequence of this was that the home was significantly short of experienced staff on some shifts This also meant that the new staff were inappropriately ‘thrown in the deep end’ without appropriate support and supervision. The induction folders that should commence at the time of appointment had only recently been completed and the inspector was concerned that the induction training given to staff was not adequate. Requirements have been made with regard staffing issues within the home. Old Vicarage Nursing Home I55 s15669 Old Vicarage v247647 UN 020905 Stage 4.doc Version 1.40 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 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) 31, 32 36and 38 The home does not have a manager at the present time. The proprietor is actively looking to appoint a new manager. There appears to have been some lack of communication between the proprietor, staff, service users and their families with regard recent changes in the home. Staff do not appear to receive regular formal supervision. Some areas of the home were looked at in relation to health and safety and this was not always promoted. Old Vicarage Nursing Home I55 s15669 Old Vicarage v247647 UN 020905 Stage 4.doc Version 1.40 Page 18 EVIDENCE: The home does not have a manager at the present time, however the proprietor is actively looking for someone to fill this post and is advertising for the vacant position. The deputy and another senior member of staff are currently managing the home, with support from the proprietor and a manager from another home owned by the company. Feedback from service users, staff and relatives suggested that the home’s proprietor has not kept them all up to date with what is going on in the home. Communication at this level appeared to be poor and there appears to be work to be done in this area. There was no evidence of formal supervision taking place and by talking to some staff it appeared that staff do not receive formal supervision. At a time when there have been lots of changes in the home this would be seen as an important management tool. This is particularly important for the new staff who need guidance and supervision. . The outcomes for standard 38 were not fully covered but some concerns were felt. The home has very little storage space and one bathroom was being used as a storeroom. Other communal areas of the home had equipment in that could be a hazard for service users and staff. The inspector was informed that it had been noted that on some occasion some of those service users who were in bed did not have access to a call bell. This needs to be addressed by the proprietor. Old Vicarage Nursing Home I55 s15669 Old Vicarage v247647 UN 020905 Stage 4.doc Version 1.40 Page 19 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 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 2 2 2 x x x x 2 STAFFING Standard No Score 27 1 28 x 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 1 1 x x x 2 x 2 Old Vicarage Nursing Home I55 s15669 Old Vicarage v247647 UN 020905 Stage 4.doc Version 1.40 Page 20 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 3 Regulation 14 1 Requirement The registered person must ensure that prior to admission the home has had a comprehensive assessment by a professional person and that the home has completed its own assessment to ensure that the service users needs can be met within the home. The registered person must ensure that the service user care plan contains all of information needed to provide the appropriate care and that this care plan is reviewed on a regular basis. The registered person must ensure that there is adequate sitting, recreational and dining space provided separately from the service users private accommodation. The registered person must ensure that there are sufficient numbers of baths and/or showers made available to service users. The registered person must ensure that at all times suitably qualified , competent and experienced persons are working Timescale for action 01/10/05 2. 7 15 01/10/05 3. 15 23 2g 01/12/05 4. 21 23 2j 01/12/05 5. 27 18 1a 01/10/05 Old Vicarage Nursing Home I55 s15669 Old Vicarage v247647 UN 020905 Stage 4.doc Version 1.40 Page 21 6. 30 18 ci 7. 36 18 2 at the care home in such numbers as are appropriate for the health and welfare of service users. The registered person must 01/10/05 ensure that all new staff receive the training they require, appropriate to the work that they perform. The registered person must 01/10/05 ensure that all staff are appropriately supervised. 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. 2. Refer to Standard 12 32 Good Practice Recommendations That it would be good practice to develop a more comprehensive activity/social plan and make the most of the outside areas within the summer months. That it would be good practice that the proprietor, in the absence of a manager, ensure that he keeps all service users, relatives and staff up to date with any changes within the home by having staff and resident/relatives meetings. That it would be good practice for the home to address the issue of lack of space and create alternate storage areas. 3. 38 Old Vicarage Nursing Home I55 s15669 Old Vicarage v247647 UN 020905 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 3rd Floor Cavell House St Crispins Road Norwich NR3 1YF 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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