Inspection on 23/09/09 for Old Vicarage, The

This inspection was carried out on 23rd September 2009.

CQC found this care home to be providing an Adequate service.

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, The 24/09/08

Old Vicarage, The 03/09/07

Old Vicarage, The 25/07/06

Old Vicarage, The 04/01/06

Old Vicarage, The 04/05/05

Old Vicarage, The 11/01/05

Old Vicarage, The 02/07/04

Similar services:

22 Sandown Road

The Highlands

Turret Villa Retirement Home

Dilston College Of Further Education

West View House

Moor House

Prince Bishop Court

Park View (15)

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Old Vicarage, The 2 Waterville Road North Shields Tyne & Wear NE29 6SL Lead Inspector Carole McKay Key Unannounced Inspection 09:00 23rd and 30 September 2009 th DS0000000374.V378011.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Vicarage, The Address 2 Waterville Road North Shields Tyne & Wear NE29 6SL 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) 0191 2570937 sdewan@tiscali.co.uk Dr Sandeep Dewan Alwin Joan Fidler Care Home 25 Category(ies) of Dementia - over 65 years of age (6), Learning registration, with number disability (2), Old age, not falling within any of places other category (17) Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Two learning disability beds are currently occupied by named residents. If any of these residents vacate the beds CSCI must be notified and action will be taken to revert those places to the category of OP. 24th September 2008 Date of last inspection Brief Description of the Service: The Old Vicarage is a privately owned care home that is situated in a residential area of North Shields, close to the town centre. The home provides personal care for up to 25 older people of both sexes. The accommodation is provided over two floors. The original building was extended and en-suite facilities are provided in the new part of the home only. Residents living in the home include people who require care due to old age and physical frailty, people with memory loss including dementia type illnesses, and some with physical disabilities. Weekly fees range from £396.39 to £412.10. A guide to the home’s services and inspection reports are available at the home. Old Vicarage, The DS0000000374.V378011.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 one star adequate. This means the people who use this service experience adequate quality outcomes. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. How the inspection was carried out: Before the visit: We looked at: • • • • Information we have received since the last key inspection visit on the 24 September 2008, including details of action taken by the provider. How the service dealt with any complaints and concerns since the last visit; Any changes to how the home is run; The manager’s view of how well they care for people. The views of relatives, staff and people using the service. The Visit: An unannounced visit was made on the 23 and 30 September 2009. During the inspection we: • Carried out a Short Observational Framework Inspection (SOFI). A SOFI is carried out where people who live in a care home find it difficult to communicate with an inspector. This tool, developed with the University of Bradford, helps us to find out what people think of the care they receive; Talked with the manager; Looked at information about the people who use the service and how well their needs are met; Looked at other records which must be kept; Checked that staff have the knowledge, skills and training to meet the needs of the people they care for; DS0000000374.V378011.R01.S.doc Version 5.2 Page 6 • • • • Old Vicarage, The • • Looked around the building to make sure it was clean, safe and comfortable; Checked what improvements had been made since the last visit. We told the manager what we found. What the service does well: The home has a friendly atmosphere. This was commented on during contact with service users and in the surveys. The SOFI showed that staff generally interact with people in a warm, reassuring and positive manner. Staff are polite, respect people’s dignity and treat them in an age appropriate manner. A range of care plans have been devised for each person. Those looked at addressed people’s needs in a range of areas such as mobility, nutrition and personal care and are usually reviewed monthly. A range of preventative healthcare risk assessments have been completed. This will help to ensure that people receive the healthcare support they require. What has improved since the last inspection? The service user plans have been further developed since the last inspection and are well ordered and indexed. The home has improved the information available to staff regarding the care they are expected to deliver to service users. More organised social activity is being offered to service users. The premises have improved. The access to the front door is safer. The home is kept clean and fresh. The bathing, heating, sluicing and hand-washing facilities have been improved. Some of the communal and private rooms have been redecorated. A weekly audit of the building has been introduced. Staff recruitment procedures are better and staff training has been developed and brought up to date for mandatory subjects. Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.2 Page 7 Care staff are now receiving regular supervision. The home now has a manager who is registered with the Care Quality Commission. What they could do better: The capacity of service users to consent to treatment and make decisions should be considered during the assessment process. Steps must be taken to carry out a falls risk assessment for each service user. These must be reviewed regularly and following any slip, trip or fall. Where people are identified as at risk, management plans for these must be devised. This will help prevent falls. Steps must be taken to carry out a falls risk assessment for each service user. These must be reviewed regularly and following any slip, trip or fall. Where people are identified as at risk, management plans for these must be devised. This will help prevent falls. Safe storage temperatures for medications must be monitored daily. The competency of staff to follow the home’s medication procedures should be periodically assessed. The process of administration of medications should be routinely audited to pick up any errors or omissions. Arrangements must be in place to consider the social care needs of each individual service user and provide a plan of intervention for each person, with particular reference to people who have a dementia and / or communication difficulty. The provider must visit the home, unannounced, at least monthly and prepare a written report on the conduct of the home. The visit must include inspecting the premises, record of events and complaints and interviewing (with consent) service users and their representatives, people working at the home. A copy of this report must be sent to the Care Quality Commission. A full environment audit must be carried out and action plan submitted to CSCI with timescales for completion. This must include the electrical wiring and installation. The Care Quality Commission must be informed of the action taken in response to the report from the lift engineer. Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.2 Page 8 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.3 Page 9 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 DS0000000374.V378011.R01.S.doc Version 5.3 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users have information to help them make informed choices and their needs are appropriately assessed before moving into the home. The home des not provide intermediate care. EVIDENCE: Three service users who completed surveys said that they had received the information they needed before moving into the home, so they could decide if it was suitable for them. Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.3 Page 11 Information about the home and its routines is openly available in the entrance hall. Service users we asked about this said that they, or their relatives, had received this information. The sample of records that we examined showed that service users have their needs fully assessed before moving into the home. The home obtains a copy of the assessment carried out by the person’s care manager. And a thorough assessment is completed by the home. Copies of these were included in the records we examined. The home’s assessment process is comprehensive. It includes aspects of personal, physical and mental health care needs, as well as social and leisure interests. Part of the assessment is called “Getting to Know You”. This part concentrates on the person’s preferences to do with how they like to be addressed, their routines, belongings, use of keys, and any special needs. This is person centred and the manager said that she encourages the service user’s keyworker (on the staff team) to be part of the assessment process. In surveys staff responded that they always (8) or usually (2) receive the information they need to provide the correct level of care to service users. In a survey returned by a visiting professional the respondent indicated that the service usually ensures that accurate information is gathered and that the right service is planned for people. The assessments describe the things that service users can do for themselves, as well as the things people need support with. Signed copies of the Terms and Conditions of residence are held on file for each person. Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.3 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 10 and 11. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health care needs of service user are broadly addressed. More preventative care planning and better auditing of medication arrangements will ensure service users’ safety and well being. EVIDENCE: Each service user has a plan of care. These are well organised and clearly indexed. In response to recommendation made at the last inspection, the service has developed these to a more consistent standard. Each plan has a section for the medical history of the service user. The plans include the comprehensive assessment as well as assessments that specifically focus on areas of health and dependency. For example; falls risk assessments, pressure sore risk assessments and general dependency assessments have been introduced. But these are used where an identified need becomes apparent, rather than for each service user as a matter of routine. For example, although Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.3 Page 13 a service user had recently had a fall the assessment for falls had not been completed or reviewed. Dental health, sensory impairment and continence assessments are carried out and the support that service users require is recorded. The files show that regular visits to dentists and opticians are arranged, as well as to any other health specialists. The district nursing services regularly visit the home. There is evidence in one file that the home will call on them for support and advice between planned visits. Visits are recorded and signed off. In a survey returned to us by a visiting professional they indicated that the service usually ensures that people’s health care needs are properly monitored, reviewed and met by the care service. And that the service always seeks advice and acts on it to meet service users needs and improve their well being. And the following comments were added in respect of what the service does well; “Information sharing and advice seeking from professionals. Quick response to areas of difficulty, concerning roles, relatives’ views and expectations of quality, service provision.” A second professional survey was returned. To the question – ‘are people’s social and health care needs properly monitored, reviewed and met?’ the respondent answered ‘usually’. To the question –‘does the care service seek advice and act on it to meet people’s social and health care needs and improve their well being?’ the respondent answered- ‘usually’. The following comment was added under the heading what the service does well- ‘consider people as individuals without making judgement or discrimination.’ The home does not have a nutritional screening tool as yet. However the records show that the home is vigilant in monitoring the weight of service users on admission, and thereafter on a regular basis. The home has the benefit of sit on scales for this purpose. And there is evidence that special needs to do with nutrition are recorded in the service user plan. For example one person has special needs with the consistency of food and fluids. This is described in the service user plan. During the SOFI observation it was noticed that a service user required prompting to drink and was reluctant, or was forgetting to do so. No effective plan for managing this and monitoring the person’s fluid intake was in place. Moving and handling assessments are carried out and the support people require is described, as well as the things people can do for themselves. The manager said that promoting independence is part of the home’s philosophy. None of the current service users have complex needs in this area. Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.3 Page 14 Where risks to health are identified, there is not in every case a management plan for this. For example, where a service user is identified as at risk of falling this has not been translated into a plan as to how this will be managed. The service user plans include daily recording regarding the well being of service users. These are consistently well maintained and body maps are used to describe their observations. Keyworkers for each service user are expected to complete a weekly report. Both the daily logs and the weekly reports were up to date in the records we sampled. On the day of the initial visit a service user was quite poorly, unsettled and had fallen. Staff were monitoring the person very closely to avoid further harm whilst awaiting the GP visit to assess the person’s needs. By the end of the inspection this person had responded positively to anti-biotic treatment. The home has written policies and procedures for the safe administration of medication. The home has slightly altered its arrangements for the administration of medication since the last inspection. A different system is being used by the dispensing pharmacist for the supply of medication. The deputy manager said that this was working well. The room that the medication is stored in has no ventilation and is quite warm. The temperature is not actually monitored. The refrigerated storage is monitored for safe storage temperatures. The storage is secured and organised so that internal medications are separate from external medications. A small number of controlled drugs are kept and there are additional arrangements for their secure storage. The records of medication were examined. These were largely in order. But the following omissions were noted; in the medication administration record (MAR) for one person the staff had handwritten the instructions for the medication on to the MAR. The instruction had not been countersigned as accurate. In the controlled drug (CD) register, two staff had signed and countersigned the amount given and the balance remaining, but had entered the wrong balance. This had arisen as the staff had given the correct dose but not taken account of a change of dose in the balance column. Had the tablets been counted this would have highlighted the error. When asked about this the deputy manager said that it was the home’s procedure for staff to count the number of tablets remaining of controlled drugs. There is evidence that staff in the home have undertaken external and accredited training in the safe administration of medication. Most staff have received this training within the past twelve months. The home does not have its own system for ongoing assessment of competence to administer medications in line with the home’s internal procedures. This was suggested as good practice. Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.3 Page 15 One service user manages their medication in part but this is not clearly described in the MAR and there is no supporting risk assessment for this to occur. There is no evidence that the capacity of each service user to consent to treatment has been considered as part of the assessment process. The manager said that senior staff from the home are due to attend training in this matter. The wishes of individuals about terminal care and arrangements after death are not always recorded. The home has policies and procedures for addressing the rights, privacy and dignity of service users. Some staff have attended training in equality and diversity, dementia awareness, oral health, management of incontinence, falls awareness and responding to conflict and challenge. In surveys service users responded that staff ‘usually’ or ‘always’ listen to them and that they always receive the medical care they need. Service users spoken to on the day of the inspection said that they are well cared for. Two relatives returned surveys. Both responded that the service meets the needs of their relative- ‘always’ and responds to the different needs of people- ‘always’. No bedrooms are currently shared and service user said that they can hold keys to their doors if they want to. Service users’ preferences regarding how they are addressed and likes and dislikes are clearly recorded in the service user plans. Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.3 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service meets most of the diverse needs of the service users well. Some of the social needs of a small group of people who have dementia should be addressed more closely. EVIDENCE: The people who live at the home have diverse needs and abilities. There is a small group of service users who are able to go out independently using taxis. The service user plan for a person who was recently admitted included an assessment of the person’s social and leisure interests. No plan of intervention had been described. Since the last inspection the manager has devised a weekly and monthly plan of activity and has introduced an activity log. A timetable of events was posted up in the entrance hall and service users participated in board games in the afternoon of the initial visit. These included armchair exercise. Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.3 Page 17 The service has a strong commitment to enabling service users to maintain their skills. Two service users went out independently on the day of the initial visit and one person was planning to go to a local community centre. This person said that they did this regularly, as they had done when they lived at home. Another person said that they went out each day for a walk and another said they carried on attending the bingo with a relative. In a survey returned by a visiting professional the following comment was included; “The Old Vicarage has provided excellent care and support to … (details removed to protect identity). Being an older man with different needs they have enabled him to live a purposeful and content life. I am very impressed by their dedication to meet these very complex needs.” Service users have a choice of communal areas, and an additional smoking lounge. The non smoking lounges each have a TV and on the day of the inspection both TV sets were switched on. This meant that there was no quiet area for service users to read or listen to music, other than the smoker’s lounge. Although both televisions were switched to the same channel the sound was not synchronised and this would be distracting to a person following the TV programme. There was no evidence that consideration had been given to how people with dementia may be encouraged to engage with activity and exercise in the home on an individual basis. Though when staff did engage with these people they did so in a gentle and sympathetic way that enhanced their apparent well being. Much of the time of the observation period two of these three people appeared withdrawn. The person who was not withdrawn was engaged with when communicating distress. The manager said that organised outings had been offered since the last inspection. The first had not been successful as the venue was not as suitable as first anticipated, and none of the service users wanted to attend the second outing. Small group activity and one to one activity was discussed. The home has an open visiting policy and visitors are welcomed at any time. Visits can take place in resident bedrooms or in communal areas. Visitors can also stay for a meal if this is requested in advance. The home has links with a local church for seasonal events. One resident goes out to church. There is evidence that service user are encouraged to personalise their rooms. Some rooms have small items of furniture, pictures, ornaments and soft furnishing that service user have brought with them from home. The home has a four weekly menu. Service users are offered a choice of cooked breakfast one person said they particularly liked the porridge, or would Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.3 Page 18 sometimes have bacon. Each day a choice of two meals is offered at lunchtime. The cook said that she asks the staff to take the menu around each morning at about 10am so that service user can choose each day. The menus are varied but have not been audited in any way for balance. The home has plentiful food stocks and there is a clear system of stock rotation. The service user we spoke to said that they enjoyed the food. In surveys all three people who responded confirmed that they always liked the meals. The evening meal was a convivial occasion. Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The well being of service users is protected through the home’s procedures and staff training. EVIDENCE: The complaints policy is displayed and included in the guide to the home’s services. All residents and relatives who completed surveys and spoke with the inspector said they would know how to make a complaint. Records of complaints are maintained along with how these matters are investigated. The home has policies and procedures on recognising and preventing abuse, and ‘whistle blowing’ (informing on bad practice). These have been revised and updated recently. Since the last inspection the manager has organised training for staff in safeguarding service users. Staff have received external ‘awareness raising’ training. Other training that is more in depth has also been provided for some of the staff. And more training is planned. In surveys all staff said that knew how to respond to concerns. Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.3 Page 20 And in ‘visiting professionals’ surveys three confirmed that the service always or usually (1) responds appropriately if a person using the service or another person have raised concerns. Since the last key inspection there has been one anonymous concern raised with The Care Quality Commission (CQC) and this was referred to the manager of the home to investigate. No evidence was found to substantiate this matter. One safeguarding matter has been raised since the last inspection. This followed a notification received from the home by CQC. Notifications of this sort are a legal requirement. The matter was referred to the Local Authority and no further action was taken by them. The home took action to avoid a recurrence. The home has policies and procedures to do with service users’ monies and financial affairs that ensure the safekeeping of these. Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.3 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Infection control practices are not up to date but the home is clean and well presented offering a comfortable environment for service users. EVIDENCE: Since the last inspection significant improvements have been made to various parts of the environment. The ramp at the main entrance has been resurfaced and is safe to use. Where required, bedrooms have been redecorated. The smoking room has been repainted and a damaged bath has been replaced. The lounges and entrance hall have been re decorated. A sluice has been provided on the ground floor. This is not a specialist facility and there is no evidence that the advice of an infection control advisor has been taken into account during the fitting of this. Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.3 Page 22 The home has not carried out an infection control risk assessment. Where required radiator valves have been replaced and the doors that are required to be held open, to allow service users ease of access, now have automatic release door guards fitted. The laundry room was tidy and clean on the day of the visit. There were no odours present. Two cleaning staff were on duty with a designated staff member in the laundry covering for the laundry assistant. This person was additional to the care staff cover. The cleaning and laundry staff said that the time they have allocated to them is sufficient for the amount of cleaning they need to carry out. And they said that if more time is required they are able to work overtime to ensure all cleaning tasks are carried out before they go off duty. The home employs cleaning staff to cover 7 days per week. Some of the service users’ rooms are much personalised. And include small items of furniture, ornaments, pictures and soft furnishings that individuals have brought from home. The home has two non-smoking lounges and a lounge where people who smoke can sit. The manager keeps a log of ongoing maintenance and regular checks of the building are carried out by the deputy manager to pick up faults. These are logged and remedial work is arranged through tradesmen under contact with the provider. The manager said that this arrangement usually works well for the home and urgent matters are attended to promptly. At the last inspection the provider was required to submit an action plan showing planned improvements to the fabric of the home. This was not received; however the work required has been carried out. The service users we spoke to said that they liked their rooms and found the home comfortable. Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28,29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service recruits, trains and deploys staff in sufficient numbers to continue to meet the needs of service users safely. EVIDENCE: The manager said that home provides for staff cover of four care staff on duty from 8am to 4pm and three care staff from 4 pm to 8 pm, with two care staff from 8pm to 10pm with two waking staff on night duty. Weekend cover is the Deputy Manager and two carers from 8am to 4pm with one senior and two care staff from 4pm to 8pm and two care staff from 8pm to 10 pm ( one of these a Senior carer). The manager is usually additional to the four staff on duty through the week. In line with advice from the Care Quality Commission the service has retained three staff on duty from 4pm up to 8pm in light of a slight drop in occupancy. Staff turnover is low. Though there is a vacancy for a laundry assistant. The majority of staff are employed on a part time basis. Existing staff provide cover for absences and agency staff are not used. There are sufficient weekly catering, domestic, and laundry hours. The vacant post of laundry assistant Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.3 Page 24 was being covered at the time of the inspection by off duty care staff. They confirmed that they were being paid additional hours to their care hours. In surveys three service users responded that the service always has staff available when they need them and staff always listen to them and act on what they say. Relatives/carers/advocates of service users returned surveys (2). In these one person said that the care workers ‘always’ have the right skills and experience to look after people properly, and one person said that they ‘usually’ have this. All seniors and carers have either achieved, or are studying for National Vocational Qualifications (NVQ) in care. The home therefore exceeds the standard for at least 50 of carers to have NVQ qualifications or equivalent. A sample of recruitment files was examined, for staff employed in the past year. Photograph and proof of identification is kept on file. Application forms are completed, with details of employment history. References are obtained from the person’s last employer. Records of interviews are made. A declaration statement that the employee is physically and mentally fit to do the work has been introduced. Staff are employed subject to Criminal Records Bureau (CRB) checks. Where gaps are evident in the staff employment history, there is no evidence that this is followed through at interview. Staff who spoke with the inspector demonstrated caring attitudes and a keenness to improve skills through further training. New staff undertake induction training to Common Induction Standards. A plan is now in place to give an overview of the training completed or planned for the staff team. The staff have received, or are planned in to receive; training in safe handling of medicines, protection of vulnerable adults, mental capacity act, infection control, dementia awareness, equality and diversity, care planning, food hygiene, diabetes, and further NVQ training. In surveys staff commented that on-going training was one of the things that the home does well. Good team work was also mentioned. Staff confirmed in their responses that there is enough staff ‘usually’ (4) or ‘always’ (6) to meet the individual needs of the people using the service. All staff confirmed that they have the support, experience and knowledge to meet the needs of the people who live at the home. And that the training is relevant, helps them to understand and meet individual needs, keeps them up to date and provides enough knowledge about health care and medication. Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.3 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The day to day management of the home is good. Quality assurance and audit arrangements are not fully developed. EVIDENCE: The home now has a registered manager, Mrs Joan Fidler. Mrs Fidler holds qualifications in care and management. The home’s owner, Dr Dewan visits the home regularly. However reports on the conduct of the service by the provider have not been produced on a monthly basis, as required at the last inspection. Nor has the provider Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.3 Page 26 submitted a full environment audit and action plan as required at the last and previous inspection. Some of the work required at the last inspection has been addressed. But we need to be assured that regular audits are being carried out and that matters related to the safety and well being of service users are being addressed in a timely fashion. The audit must address the safety of the electrical installations at the home and the recommendations of the lift engineer in his report form July 2009 Residents spoken with during the inspection, and those who completed surveys, indicated they were generally satisfied with the service. Some residents commented on what they feel the home does well. One person said, “I feel well looked after and get on well with staff as they are friendly. I am happy and content”. Another person said- “A homely atmosphere and staff are very friendly. I also enjoy the meals her at the Old Vicarage. Staff always explain everything to me i.e. any appointments. It’s well run.” Resident personal finance records were not examined at this inspection but the written procedures that staff are required to follow are appropriate. At the last inspection the home was required to improve individual supervision to ensure staff have supervision six times a year and those records are maintained. The manager and deputy take responsibility for providing supervision sessions and a recording format is available. A sample of staff files was checked and staff had received regular supervision. The home has a health and safety policy and a range of associated procedures. Since the last inspection the manager has made a concerted effort to bring staff training up to date. Staff have received training in the following since the last inspection (or have training dates planned) in; infection control, safe food handling, health and safety, fire awareness and first aid and moving and handling. Fire safety records showed regular fire instructions being given to staff. Checks and tests of fire alarms, emergency lighting and fire fighting equipment were being carried out at the correct intervals. Accident reporting is generally well documented, including checking people for injuries and any treatment or follow up action. The safety of services and equipment are ensured through regular servicing of lifting equipment, gas installations and portable appliance testing. The most recent report from servicing of the lift indicated that the control panel requires replacement; this report was dated July 2009. No certificate was available for the electrical installations and wiring. Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.3 Page 27 Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.3 Page 28 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 3 x 3 x x n/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 2 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 3 x 2 Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.3 Page 29 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 OP8 Regulation 15 Requirement Each of the service user plans must include: A falls risk assessment and management plan for those at risk. Nutritional screening using an accredited tool such as the ‘MUST’ tool. Clear care plans for monitoring and ensuring fluid and food intake where people are at risk. These steps will promote good health and well being of the people who live at the home. 2. OP9 13(2) Steps must be taken to: Ensure that accurate records of medication received into the home are kept. Ensure that the temperature of the medication room is monitored and maintained at a safe level for the storage of Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.3 Page 30 Timescale for action 31/12/09 31/12/09 medication. Carry out a risk assessment for those service users who are self medicating and keep the risk assessment under regular review. Ensure that handwritten entries in the medication administration record are signed by the person making the entry, and that a second person checks this for accuracy and countersigns the record. These steps will ensure that people’s health and welfare is promoted. A full environment audit must be 31/12/09 carried out and action plan submitted to CSCI with timescales for completion. (Requirement outstanding from inspection of 19.9.07 and 24.09.08) This must include action to rectify the building issues from this inspection concerning bathing and sluicing facilities, heating, ventilation and door guards. (A Warning Letter has been issued to achieve compliance with this outstanding requirement) The Registered Person, or their representative must visit the home at least monthly and prepare reports on the conduct of the service.( Requirement outstanding from inspection of 24.09.08) (A Warning Letter has been Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.3 Page 31 3. OP19 23(2)(b) (d) 4. OP33 26 31/12/09 issued to achieve compliance with this outstanding requirement) 5. OP38 13(4) Steps must be taken to: Provide a valid certificate for the electrical wiring and installations at the home. Produce a written plan for responding to the recommendation of the lift engineer in the engineer’s report dated July 2009. This will ensure the safety of people living in the home. 31/12/09 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 OP7 Good Practice Recommendations Care plans should be further developed to achieve a consistently good standard and demonstrate specifically the care/support each person requires to meet their needs by including: Information regarding a person’s capacity to consent to treatment and to make decisions. Clear information regarding service users’ wishes regarding and of life care and arrangements after death. This will support the rights and best interests of people using the service. 2. OP9 Steps must be taken to: Introduce a system for regular audit of medication systems in the home. Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.3 Page 32 Introduce a process for regularly assessing the competency of the staff who administer medication to carry on doing so in line with the home’s polices and procedures. This will ensure the safety and well being of the people who use the service. The social, emotional and spiritual needs of the people who have dementia should be specifically assessed and the care plans should describe how staff should interact with and support these people. To achieve this: • • • A person centred activity plan should be devised for each individual with dementia care needs; Staff should receive training in how to provide specialist activity sessions for people with dementia; Staff should have access to specialist activity materials and equipment that will help them to deliver suitable activities for people with dementia. 3. OP12 This will promote the social well being of a group of people who are least able to promote this for themselves. 4. OP26 An infection control risk assessment should be carried out for the home using the ‘essential steps’ model. This will help identify good practice and any areas for improvement in ensuring the wellbeing of people living at the home. Any gaps in individual’s employment records should be explored at interview and recorded. This will help to ensure that people using the service are protected from harm. 5. OP29 Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.3 Page 33 Care Quality Commission North Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.northeastern@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Old Vicarage, The DS0000000374.V378011.R01.S.doc Version 5.3 Page 34 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!