CARE HOMES FOR OLDER PEOPLE
Old Vicarage, The 26 Cottage Road Wooler Northumberland NE71 6AD Lead Inspector
Hilary Stewart Unannounced Inspection 11:00 13 and 29 November 2007
th th 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, The DS0000064203.V346586.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, The DS0000064203.V346586.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Old Vicarage, The Address 26 Cottage Road Wooler Northumberland NE71 6AD 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) 01668 281662 01668 281662 oldvicwooler@btconnect.com A & P Ltd Mrs Janet Cresswell Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Old Vicarage, The DS0000064203.V346586.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To service uses of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP, maximum number of places: 17 The maximum number of service users who can be accommodated is: 17 25th October 2006 2. Date of last inspection Brief Description of the Service: The old Vicarage is a stone built detached house on the outskirts of Wooler. This former vicarage has been extended and converted to provide residential accommodation for up to seventeen older people. Day care is also provided for up to five older people. The public rooms, which are comfortable and spacious are on the ground floor. There is a shaft lift fitted for access to the first floor. The home stands in its own grounds, which are accessible and well maintained. Car parking is available to the front and rear of the house. Public transport is available in the centre of Wooler a short walk from the home. The home has an estate care that is used to transport residents. Fees range from £379 to £437.00p. Old Vicarage, The DS0000064203.V346586.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. How the inspection was carried out Before the visit: We looked at: • Information we have received since the last visit on 25th October 2006. • How the service dealt with any complaints & concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service and the staff. The Visit: An unannounced visit was made on 13th and 29th November 2007. During the visit we: • • • • • • Talked with people who use the service, staff and the manager. Looked at information about the people who use the service & how well their needs are met, Looked at other records which must be kept, Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, Looked around the building to make sure it was clean, safe & comfortable, Checked what improvements had been made since the last visit. We told the manager what we found. What the service does well:
The needs of the people who live at the home are assessed before and after they move into the home. This means that their care needs can be planned and properly met. Accurate and up to date information is kept in the care plans so staff know how to meet their needs. Information about the home is available to help people decide if it is the right home for them to move in to. Healthcare needs are well met by using a multi-agency approach. This helps the people who live at the home to stay healthy.
Old Vicarage, The DS0000064203.V346586.R01.S.doc Version 5.2 Page 6 The home has medication systems for the staff to follow to make sure that the people who live at the home are not put at risk. The people have opportunities to take part in a variety of leisure pursuits and interests, which help them maintain links with the local community and help them keep their social skills. The staff team at the home value the differing needs of the people who live there and make sure that they are aware of each person’s preferences. They treat the people who live at the home as individuals and support them to live the life they choose as much as possible so they know they are valued. The staff team make sure that the home is warm and pleasantly furnished so the people who live at the home have a comfortable place to live. There are procedures in place at the home that make sure that the people who live there are protected and kept safe from abuse. The staff are supervised and trained so they know how to provide the people with good care. The manager is qualified and experienced. They are approachable and clearly present in the home to give direction and support to staff and make sure that the service is centred on the people whom live at the home. What has improved since the last inspection? What they could do better:
If the bathroom floor was replaced or repaired this would make it less likely that of the people who live at the home or a member of staff may injure themselves by tripping on it. . If all of the care plans had sufficient detail and all parts of the plan were completed, staff would know that the information in them was up to date and
Old Vicarage, The DS0000064203.V346586.R01.S.doc Version 5.2 Page 7 correct. This would mean that they would be sure they were providing the people at the home with the support and care they need. If staff recruitment records showed that all of the staff have been properly vetted this would demonstrate that the organisation have made sure that they only employ suitable people to work at the home and therefore safeguard the people who use the service. If the manager reciveded individual supervision at regular intervals this would support them to run the home and make sure that the people who live there are well cared for. If the staff at the home all had up to date training in adult protection procedures this would make them more skilled at safeguarding the people at the home. If the home’s quality assurance system was fully implemented so that their was an annual development plan, this would build on the existing ways in which the people who live at the home; their families, friends and relevant people in the local community are consulted about the quality of care provided at the home and how it should be developed. 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, The DS0000064203.V346586.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Old Vicarage, The DS0000064203.V346586.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have their needs assessed before they are offered a place at the home. This makes sure that only people whose needs can be met at the home are offered a place. The home does not provide intermediate care. EVIDENCE: People have an assessment by their care manager before they move into the home. The manager looks at this assessment to see if the home can meet the person’s needs. They also carry out an additional pre admission assessment prior to the person moving in. People can visit the home before they make a decision. Old Vicarage, The DS0000064203.V346586.R01.S.doc Version 5.2 Page 10 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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All of the people who live at the home have individual care plans, through which staff monitor and promote the health of the people at the home to maintain their well-being. This helps the people stay healthy. Furthermore the manager and staff respect the privacy and dignity of the people who live at the home. This is so the people know that they are valued as individuals. EVIDENCE: The manager said and records showed that each person who lives at the home has an individual care plan, which is based on their assessment of need. Plans are reviewed and updated regularly. Most records showed that each person’s changing needs are clearly recorded although some needed more detail about how to meet their health care needs. There are risk assessments and moving and handling plans for each individual. Nutritional needs, pressure areas and continence are regularly reviewed for individuals.
Old Vicarage, The DS0000064203.V346586.R01.S.doc Version 5.2 Page 11 There are procedures for staff to follow when they deal with medication. The manager said that all staff have received training in how to safely administer medication. Staff said and records showed that any changes of medication or medication procedures are recorded and followed in the home. The manager said that people are supported to manage their own medication if, following a risk assessment it was found to be safe enough. The medication records were up to date. Records showed that the people’s health care needs are met at the home. Details of visits by the district nurse; visits to their GP and hospital appointments are recorded in the individual files. The manager said that the health and welfare of the people who live at the home is monitored all of the time. They had recent difficulty getting a visit from a chiropodist for one of the people at the home so the manager arranged this themselves. One person had been visited by their GP the previous day. The people who live at the home looked comfortable. One person said, “ This is a nice place to live” on relative said, “ they have looked after my parent really well” and “ the staff are nice to them”. Old Vicarage, The DS0000064203.V346586.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live at the home are able to follow their own daily routines, which satisfy their social, cultural and religious needs. They can see their family and friends at any reasonable time. This helps to prevent them from feeling and becoming isolated. Meals at the home are varied and nutritious which promote the people’s health and well-being. EVIDENCE: The manager and staff said that they arrange a variety of outings for the people who live at the home. One persons said they had been out for coffee another person said, “ You can go out when you want”. Records showed that people are asked to suggest what they would like to do. An Easter party had been suggested in a residents meeting, this had been arranged. The manager said that the people go out in the car and a bus was being booked for a group of people to go on a trip. There are also activities in the home such as talks about the local area, visits by a choir, some people attend church and there
Old Vicarage, The DS0000064203.V346586.R01.S.doc Version 5.2 Page 13 had been a Robert Burns lunch. One person said about their relatives care “the staff are very kind ” and “I don’t have any concerns about the standard of care”. The manager, staff and the people who live at the home said that relatives and visitors are welcome and encouraged to visit at any reasonable time throughout the day and evening. Visitors were observed during the visit, one relative said, “ we can visit at any time”. The manager said that the people who live at the home had been asked their opinions on the food provided. They had a positive response and the menus are based on the likes and dislikes of the people who live there. The cook said that there are choices at meal times and if people want something different they will make it for them. Special diets can be catered for. Hot drinks and snacks are always available throughout the day and evening. The kitchen was well stocked and there were fresh fruit and vegetables. One person said, “the food is fine” and “ we can have what we like” two people stated in the surveys they returned that the home did not provide enough choice at meal times. Staff were observed sitting with people at meals times and talking with and supporting them. Old Vicarage, The DS0000064203.V346586.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a procedure for dealing with complaints. Complaints are dealt with so any problems are taken care of quickly which helps good relationships to be maintained. Staff know about and most have had training in how to protect people from harm, so the people who live at the home are kept safe. EVIDENCE: Copies of the homes complaints procedure are in the information about the home. The manager and staff said that the people who live at the home and their relatives know how to make a complaint. Records showed that there had not been any complaints made since the last inspection. One of the people said, “ I would say if I wanted to complain”. Another person said that they were not quite sure how to make a complaint. The manager said that the home had not had any complaints since the last inspection. The manager said that most of the staff team have received training in Protection of Vulnerable Adults (POVA). They have planned that all of the staff will receive this training in the near future. There is a copy of the Local Authority procedures and the home has copies of their own POVA procedures for staff to access. Staff said that they have had the training and they could describe what they needed to do if someone disclosed abuse to them.
Old Vicarage, The DS0000064203.V346586.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a safe, comfortable and clean home, although some repairs are necessary. EVIDENCE: The home is comfortable, clean and free from any offensive odours. There are enough bathrooms and showers for the people who live at the home. One of the bathrooms had some flooring missing exposing the floors boards and in parts was lifting from the floor. Each person has their own bedroom and they looked comfortable and clean. They were all personalised and made very individual.
Old Vicarage, The DS0000064203.V346586.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 and 30 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 recruitment procedure to vet staff, so only suitable people work at the home and the people are kept safe. Staff get regular training and supervision which ensures that they have the necessary skills to provide the people who live at the home with good care. EVIDENCE: The manager said that 43 of the staff have vocational qualifications. Records showed and staff said that they have mandatory training regularly, such as first aid and food hygiene. Sufficient staff were on duty during the visit and the manager and staff said that enough staff work at the home. However at times the home would benefit from having more so they could spend more time with the people individually. The rota showed that on other days enough staff had been on duty. One person said, “ There always seem to be enough staff about”. Old Vicarage, The DS0000064203.V346586.R01.S.doc Version 5.2 Page 17 The manager said that all staff have been CRB (Criminal Records Bureau) checked at an enhanced level to make sure they are suitable people to work at the home. Records showed that checks had been carried out before staff started to work at the home. Some of the records could not confirm that checks on people’s previous employment and one person’s reference check had been carried out however the manager confirmed that this had taken place. Staff said and the manager and records confirmed that they have individual supervision and staff meetings to support them to carry out their work. Old Vicarage, The DS0000064203.V346586.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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered person is qualified and experienced and runs the home in the best interests of the people who live there. The home has procedures in place that make sure the people who live there are protected as much as possible. EVIDENCE: The manager said and records showed that they are qualified and experienced to run the home effectively. It was observed that there was a pleasant rapport
Old Vicarage, The DS0000064203.V346586.R01.S.doc Version 5.2 Page 19 between the people who live at the home the manager and staff. The staff said that the manager is approachable and supportive. One person said “ the manager is great” and that they are “teaching them a lot”. Staff said that they liked working at the home. The manager said that they get a lot of support from the staff. The home has procedures for staff when they deal with the people’s money so it is kept safe. Records showed that staff sign records when any of the resident’s money is used and the manager checks them regularly. Records showed that fire drills and staff instruction have taken place when they should. The home had had a recent visit from the local fire authority. Electrical equipment through the home had been safety checked. The home has recently had a new boiler installed. The manager said that the home does have a quality assurance system where the people who live at the home are consulted. As a result of one consultation the people had said that they thought a lot of the furniture was old fashioned so most of it had now been replaced. The manager said that the annual development plan for the home is still being worked on. Old Vicarage, The DS0000064203.V346586.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 2 8 3 9 3 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 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Old Vicarage, The DS0000064203.V346586.R01.S.doc Version 5.2 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 OP7 Regulation 15 Requirement The content of care plans must be regularly monitored to ensure that they fully reflect the needs of individual residents. (Timescale of the 31/12/06 not met) Timescale for action 31/01/08 2. OP18 13 All staff must receive training in 31/01/08 dealing with allegations of abuse. (Timescale of the 31/01/07 not met) An annual development plan must be drawn up. (Timescale of the 28/02/07 not met) 28/02/08 3. OP33 24 4. 5. OP19 OP29 23 19 The bathroom flooring must be 28/02/08 replaced or repaired. The registered manager must 28/02/08 make sure that records show that reference checks have been carried out and gaps in work history explored in the case of all staff. Old Vicarage, The DS0000064203.V346586.R01.S.doc Version 5.2 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. 1. Refer to Standard OP31 Good Practice Recommendations Consideration should be given to providing the manager with appropriate professional supervision. Old Vicarage, The DS0000064203.V346586.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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