Inspection on 06/02/08 for Old Vicarage Nursing Home

This inspection was carried out on 6th February 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Old Vicarage Nursing Home 20/06/06

Old Vicarage Nursing Home 02/09/05

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 Andy Green Unannounced Inspection 6th February 2008 11:30 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 Home DS0000015669.V359225.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. Old Vicarage Nursing Home DS0000015669.V359225.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Vicarage Nursing Home Address Norwich Road Ludham Norfolk NR29 5QA 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) 01692 678346 01692 678565 ashleycaregroup1@btconnect.com Hewitt-Hill Limited Sonia Baker Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Old Vicarage Nursing Home DS0000015669.V359225.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That appropriate care and accommodation can be provided for up to three (3) service users who are under 65 years of age. Twenty-nine (29) older people may be accommodated. Two (2) service users, named in the Commission’s records, who have a diagnosis of dementia may be accommodated. Maximum number not to exceed twenty-nine (29). 20th June 2006 Date of last inspection 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. There is a nurse on duty at all times in the home. The 29 bedrooms are situated over two floors with access via a shaft lift. Some of the ground floor bedrooms open directly to the gardens. The communal areas consist of two lounges and one conservatory that also double as dining areas. 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 residents. There is ample car parking at the front of the premises. The cost of a placement at the home is between £347 and £690 a week. Copies of CSCI reports can be made available to residents and their relatives upon request from the home’s office. Old Vicarage Nursing Home DS0000015669.V359225.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. CSCI carried out this unannounced key inspection on 6th February 2008. The home completed an AQAA (Annual Quality Assurance Assessment) and CSCI received a number of surveys from residents, staff and relatives giving comments about the home. A variety of procedures and policy documents were inspected including assessments, care planning, the medication policy, staff files, health and safety policies and complaints and safeguarding adults. A tour of the building was also undertaken. Discussions were also held with members of care staff and a number of residents. What the service does well: What has improved since the last inspection? What they could do better: Old Vicarage Nursing Home DS0000015669.V359225.R01.S.doc Version 5.2 Page 6 Training regarding dementia care and ‘Safeguarding Adults’ must be in place for staff to ensure safe and up to date practice. Arrangements must be in place to ensure that emergency lighting tests are carried out at regular intervals. The home would benefit from having its own transport so that day trips and outings can be arranged. 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. Old Vicarage Nursing Home DS0000015669.V359225.R01.S.doc Version 5.2 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 Home DS0000015669.V359225.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments are in place to make sure that that the care needs of new residents can be met. EVIDENCE: The home continues to receive detailed assessment information from the local authority and a copy of the care plan. The manager and senior worker carry out a needs assessment using the home’s own assessment form. There have been no significant changes to the assessment process since the last inspection. Prospective residents and their family/relatives are encouraged to visit the home as part the assessment process to ensure that the residents need’s can be fully assessed. A relative spoken to during the day confirmed this to be the case. Old Vicarage Nursing Home DS0000015669.V359225.R01.S.doc Version 5.2 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. 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. Residents receive appropriate health and personal care to meet their assessed needs. Medication administered in the home is recorded accurately. EVIDENCE: Five of the resident’s care files were seen. Detailed information and guidelines are recorded for the delivery of care and support required so that assessed needs can be safely met. Daily care notes are detailed and accurately recorded. Changes in care are clearly documented with evidence that reviews are carried out on a monthly basis. Where there have been significant changes a new sheet, with updates, is inserted to ensure that the care plan remains current and up to date. Since the last inspection the manager has implemented a quarterly review sheet which is shared with relatives and residents, where possible, to ensure greater participation in the planning of care and support. Old Vicarage Nursing Home DS0000015669.V359225.R01.S.doc Version 5.2 Page 10 A variety of healthcare professionals continue to regularly visit the as required including district nurses, nutritionist, chiropodist, CPN’s and a GP from the local surgery, and a continence advisor. All healthcare visits are recorded in individual resident’s care plans. The home continues to be committed to the prevention of pressure sores and there is a supply of appropriate aids. The manager stated that there were two residents with pressure sores and that appropriate nursing care is being given. One relative visiting the home confirmed that she felt that the care and support provided in the home was of a good standard and that she was kept informed of any changes in health or any other significant events concerning her relative. She stated that the staff were caring and friendly and always made her feel welcome. She also felt that the food, accommodation and cleanliness were always of a good standard. Medication records, including Controlled Medication, are recorded accurately. The medication is well managed and stored appropriately. One of the nurses has the delegated task of managing stock control and disposal of medication. Old Vicarage Nursing Home DS0000015669.V359225.R01.S.doc Version 5.2 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. 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. Staff provide appropriate support to ensure that residents have access to activities appropriate to their needs. EVIDENCE: The home provides a range of activities including music entertainment, coffee mornings, bingo and religious services. A hairdresser also makes weekly visits to the home. There is a notice board displaying forthcoming events for residents, and participation in activities is recorded in a separate activities book. Summer fetes are organised and birthdays are also celebrated throughout the year. The home would benefit from having its own transport so that day trips and outings can be arranged. The manager stated that she is discussing this issue with the provider for further action. There is a varied range of nutritious meals provided throughout and residents are offered choices to the planned menu. Snacks and drinks are also available at all times during the day. Residents and a relative met during the inspection confirmed the food provided in the home was of good quality and that choices are offered. Old Vicarage Nursing Home DS0000015669.V359225.R01.S.doc Version 5.2 Page 12 Residents were complimentary about the services they received and felt appropriately supported by a friendly and caring staff team. Feedback from surveys received by CSCI from residents and their relatives was given to the manager. Comments received were positive about the care and support provided in the home. One relative met during the inspection was complimentary about the service and felt that their relative lived in a safe and comfortable home and that she was kept informed of any changes or significant events. The home has a calm and cheerful atmosphere and residents were seen socialising with each other, and their relatives. A newsletter is also sent to all relatives regarding changes/events in the home. Old Vicarage Nursing Home DS0000015669.V359225.R01.S.doc Version 5.2 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. 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 home has a clear complaints procedure to make sure that residents have their complaints or concerns listened to and acted upon properly. EVIDENCE: The home has a clear complaints procedure to ensure that any concerns are dealt with and actioned appropriately. The home has not received any complaints since the last inspection. CSCI has also not received any complaints regarding the home. A relative confirmed that she was aware of the complaints procedure and would not hesitate in contacting the manager or senior staff if she had any concerns. The home has a policy statement regarding safeguarding adults. Conversations with members of staff clearly evidenced that they would have no hesitation in reporting any incidents of abuse or neglect to the manager or senior staff member on shift. It was noted during the inspection that care staff spoke to residents in a friendly, social and respectful manner. Old Vicarage Nursing Home DS0000015669.V359225.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides appropriate premises and accommodation to meet the resident’s needs. EVIDENCE: The home is well presented and free from unpleasant odours. An ongoing programme of maintenance ensures that the home remains in a good decorative condition and repairs are carried out in a timely manner. Residents and relatives confirmed that the accommodation provided was comfortable, homely and met their individual needs. Residents are encouraged to personalise their bedrooms with additional furniture, televisions, photographs and personal possessions. This was evidenced in bedrooms viewed during a tour of the premises. The manager stated that plans have been submitted to the County Council to extend the property to provide further communal and bathroom space. The outcome is still awaited. Old Vicarage Nursing Home DS0000015669.V359225.R01.S.doc Version 5.2 Page 15 Since the last inspection blinds have been fitted to the conservatory along with radiators to improve heating and make the room more comfortable for residents. The manager stated that water temperatures are now kept at recommended levels following the last inspection of the home. Temperatures were not inspected on this occasion. No further changes have been made to the communal areas of the home. Old Vicarage Nursing Home DS0000015669.V359225.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s recruitment and training processes ensure that residents are protected from harm. However improvements to POVA and dementia training need to be made. EVIDENCE: There was six staff on the morning shift (one nurse and five carers) four staff on the afternoon shift (one nurse and three carers) and three staff at night (one nurse and two carers). All staff are issued with contracts, detailed job descriptions and clear details of their areas of responsibility. Four members of staff’s files were seen and they contained appropriate information including their application form, references and evidence of a satisfactory POVA/CRB checks. Evidence of individual training was including dates for refreshers/updates to ensure continuing safe practice. Three members of care staff were interviewed and they confirmed that they received training throughout the year. Examples of training included; moving & handling, fire safety, first aid, Safeguarding Adults, nutrition and health & safety. Old Vicarage Nursing Home DS0000015669.V359225.R01.S.doc Version 5.2 Page 17 However it was noted that training regarding dementia awareness needs to be organised to ensure that staff can provide appropriate care and support for residents with dementia care needs. Safeguarding Adults training also needs to be reviewed, as information contained in the home’s training manual was not up to date/correct. Old Vicarage Nursing Home DS0000015669.V359225.R01.S.doc Version 5.2 Page 18 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): 31,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed to ensure that residents receive a good and safe standard of care. EVIDENCE: The manager is experienced and skilled and provides a clear and supportive style of management. Staff members spoken to confirmed that they were well supported by the manager and senior care staff in the home and that they were able to freely raise any concerns or issues. Residents and relatives also confirmed that they found the management in the home to be responsive to any issues or queries that they have raised. The personal monies and records, held in the office, for four residents were inspected and they were accurately administered. Old Vicarage Nursing Home DS0000015669.V359225.R01.S.doc Version 5.2 Page 19 Formal recorded supervision is in place and staff confirmed that they received regular sessions to ensure that the their practice and development needs are monitored. Evidence of supervision were seen in a sample of staff files. There are also staff meetings held regularly throughout the year. The fire alarm records were satisfactory but it was noted that the monthly emergency lighting testing must be improved. Contracts for the servicing of the lift, hoists and fire safety appliances are in place and evidence of up to date checks were seen. PAT tests and electrical wiring tests are also carried out. Old Vicarage Nursing Home DS0000015669.V359225.R01.S.doc Version 5.2 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 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 3 X X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Old Vicarage Nursing Home DS0000015669.V359225.R01.S.doc Version 5.2 Page 21 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 OP30 Regulation 18(1)(c) (i) Timescale for action Training regarding dementia care 30/04/08 and ‘Safeguarding Adults’ must be in place for staff to ensure safe and up to date practice. Arrangements must be in place to ensure that emergency lighting tests are carried out at regular intervals. 29/02/08 Requirement 2 OP38 23(4)(c) (v) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations The home would benefit from having its own transport so that day trips and outings can be arranged. Old Vicarage Nursing Home DS0000015669.V359225.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 © 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 Home DS0000015669.V359225.R01.S.doc Version 5.2 Page 23 - 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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