CARE HOMES FOR OLDER PEOPLE
The Old Vicarage 2 Waterville Road North Shields Tyne & Wear NE29 6SL Lead Inspector
Aileen Beatty Unannounced 04 May 2005 09:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Old Vicarage B53-B03 S374 Old VicarageNT V220942 040505 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service The Old Vicarage Address 2 Waterville Road North Shields Tyne & Wear NE29 6SL 0191 2570934 N/A N/A Dr Sandeep Dewan Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Vacant CRH 25 Category(ies) of DE Dementia (6) registration, with number LD Learning disability (2) of places OP Old age (17) The Old Vicarage B53-B03 S374 Old VicarageNT V220942 040505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11/01/05 Brief Description of the Service: The Old Vicarage is a privately owned residential home situated in a residential area of North shields, close to the town centre. The home provides personal care (no nursing care) for up to twenty-five elderly 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. The Old Vicarage B53-B03 S374 Old VicarageNT V220942 040505 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The home was inspected on the 4th May 2005 at 09.30.a.m. The inspection consisted of discussions with residents visitors and staff, and a tour of the premises. Records were also examined. A manager has been appointed since the last inspection, which has brought an improvement to paperwork and additional support for staff. The home overall standard of care in the home is good. What the service does well: What has improved since the last inspection?
A manager has been appointed since the last inspection, which has resulted in an overall improvement, mainly in record keeping. The new manager has reviewed care records. The overall standard of paperwork has improved. Some social assessments have now been completed. A number of areas have been redecorated since the last inspection. Bath and shower rooms now have blinds and shower curtains and walls have been painted which looks much more inviting. Most requirements relating to the environment set at the last inspection have been met. This includes painting, decorating and new carpets. Laundry is no longer done at night as this was disturbing a resident. The assisted bath and kitchen extractor fan were broken at the last inspection and have now been repaired. The Old Vicarage B53-B03 S374 Old VicarageNT V220942 040505 Stage 4.doc Version 1.20 Page 6 The home has exceeded the target of having a minimum of 50 of staff qualified in NVQ level 2 or above by the end of 2005. Schoolchildren have visited the home as part of a communication project they are doing with BT. Residents have visited the school and it is hoped a long term relationship will be forged as it is enjoyable for the residents and the children. The medication system has been updated to improve safety. Refresher training in the administration of medication has been arranged. The proprietor has purchased a car for use by the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Old Vicarage B53-B03 S374 Old VicarageNT V220942 040505 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Old Vicarage B53-B03 S374 Old VicarageNT V220942 040505 Stage 4.doc Version 1.20 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2, and 3 were assessed, 6 is not applicable. Assessment information has not always been available in the past prior to admission, and this has now improved. Information is provided to service users regarding terms and conditions of occupancy although this information needs to be updated. EVIDENCE: The manager is aware of the assessment information required prior to admitting service users, and of the information that should be provided to them. At the last inspection, it was identified that there was very little background information relating to a new resident in their notes. This has now been added. A copy of terms and conditions is available ion the file of a newly admitted resident but there are blank spaces where fees and other information liable to change should be written. The admission documentation and service user guide must be reviewed by the manager and updated. The Old Vicarage B53-B03 S374 Old VicarageNT V220942 040505 Stage 4.doc Version 1.20 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 and 11. The standard of physical care and emotional support is good. Health needs are met. Medication procedures are appropriate. The written documentation relating to care is not of a satisfactory standard and this could compromise the standard of care provided. Service users are treated with dignity and respect at all times. there are satiosfactory procedures in place relating to the care of the dying. EVIDENCE: Residents say that they feel well looked after and relatives are pleased with the standard of care provided. Medication procedures have been improved and refresher training arranged. There is no fridge in the treatment room and medication requiring refrigeration, would be stored in the kitchen fridge which is not acceptable. Care records are still out of date. The manager is going through every file and prioritising those requiring urgent attention. There is evidence of improvement in this area but they are not yet maintained to a satisfactory standard. The manager is, however, aware of this and is dealing with this in a systematic way.
The Old Vicarage B53-B03 S374 Old VicarageNT V220942 040505 Stage 4.doc Version 1.20 Page 10 One resident was very ill in bed at the time of the inspection. A care plan was in place and policies and procedures relating to the care of the dying are in place. Staff were being supported by district nursing services who was also giving advice re pressure relief. Staff preserve the dignity of residents by ensuring they are assisted with personal care and remain clean and tidy and appropriately dressed. They knock on bedroom doors and offer assistance discreetly and sensitively. The Old Vicarage B53-B03 S374 Old VicarageNT V220942 040505 Stage 4.doc Version 1.20 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15. Service users have access to a range of activities and are supported to maintain links with the local community. They receive a balanced and appealing diet. EVIDENCE: Residents have access to a number pf activities either arranged by staff or on their own such as dominoes. Children have visited the home from St Joseph’s school, and residents are visiting the school for presentations. It is hoped that an ongoing relationship will be formed between the school and the home as residents very much enjoyed the company of the children. Residents may visit church or go shopping. Activities in the home include carpet bowls, bingo and chair exercises. Friends and families were observed being made welcome by staff who are always quick to offer refreshments. Social assessments and social care plans are inadequate but are being reviewed along with other documentation. A car has been purchased for the home, which would be useful for transporting resident on outings. It must be confirmed that appropriate insurance is in place. The Old Vicarage B53-B03 S374 Old VicarageNT V220942 040505 Stage 4.doc Version 1.20 Page 12 The menu has been changed and a varied choice in food available. The dining area is nicely decorated and a pleasant environment to eat in. Residents said they were enjoying the meal provided. The very noisy extractor fan identified at the last inspection has been repaired. The fly screen in the kitchen recommended by the environmental health officer still needs to be provided. The kitchen is clean and well organised. It is recommended that menus are available in large print. The Old Vicarage B53-B03 S374 Old VicarageNT V220942 040505 Stage 4.doc Version 1.20 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. There is a satisfactory complaints procedure prominently displayed in the home. Procedures are in place to protect service users from abuse. EVIDENCE: A satisfactory complaints procedure is in place. It is prominently displayed in the home and easy to read. There have been no complaints since the last inspection. Recruitment and selection procedures ensure that staff are thoroughly vetted before being appointed. Staff files examined confirms that criminal records checks have been carried out. A “no secrets” and whistle blowing policy is in place. Training relating to the protection of vulnerable adults is provided. There have been no allegations of abuse or neglect. The Old Vicarage B53-B03 S374 Old VicarageNT V220942 040505 Stage 4.doc Version 1.20 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,23,24 and 26. The home is clean tidy and homely. The indoor and outdoor facilities are safe and confortable. Lavatories and toilet facilities are suitable. Bedrooms are nicely personalised and well equipped. There are ongoing maintenance and repair issues but there have been a number of improvements in the environment. EVIDENCE: A number of areas have been redecorated since the last inspection. Carpets have been replaced in some bedrooms, and there are no serious odour problems. When an odour problem persists, carpets are replaced. The bathrooms have been made much less clinical with the addition of some colour to walls, blinds or voiles and shower curtains. Most requirements set at the last inspection relating to the environment have been met. The safety of the concrete ramp has not been established, and it very uneven in places. The Old Vicarage B53-B03 S374 Old VicarageNT V220942 040505 Stage 4.doc Version 1.20 Page 15 The home is generally clean and tidy. Some oddments of furniture have appeared since the last inspection and the general appearance of the lounges is cluttered and a bit shabby. Chairs need to be replaced, as does the nest of tables which is badly marked and worn. Furniture must not be brought into the home without the permission of the manager. Residents are encouraged to bring items in from home although these would normally be placed in their own room. The manager will ensure that risk assessments take place in relation to furniture (e.g. glass cabinets, clutter etc.) and will also ensure that the home looks presentable. A number of residents are choosing to have breakfast in bed. It was noticed that bed tables are not provided. These should be made available to enable the safe serving of breakfast in bed. Beds that enable access of a hoist must be provided. The Old Vicarage B53-B03 S374 Old VicarageNT V220942 040505 Stage 4.doc Version 1.20 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30. The staff in the home are competent to care for the residents and are suitably trained and supervised. Recruitement procedures are satisfactory. EVIDENCE: Over 50 of care staff are qualified to NVQ level 2 or above (13 out of 15). Ongoing training is provided and the manager also holds a teaching certificate so plans to provide some in house training. A training plan has been devised with the Tyne and Wear Care Alliance. Staff files examined demonstrates that recruitment procedures are being followed. Photographs of staff need to be added to their files. The Old Vicarage B53-B03 S374 Old VicarageNT V220942 040505 Stage 4.doc Version 1.20 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 35, 36 and 38. A manager has been appointed. There has been no manager for a long time and this has brought greater stability and improvements in some areas. Staff supervision is not yet satisfactorily organised. Financial procedures are appropriate. The manager is well qualified and the safety and welfare of service users and staff is protected. EVIDENCE: A new manager has been appointed since the last inspection. She has NVQ assessor and is working towards verifier qualifications, a teaching certificate, and has completed the registered managers award (RMA). She has a great deal of experience in care and demonstrates a good understanding of the role of a registered manager. The long-term absence of a manager has made the introduction to the role a difficult one. Many records were out of date and the new manager has begun the process of systematically reviewing all paperwork. She is prioritising urgent care records and progress made to date is evident. Fortunately the standard of care delivered has remained good due to a
The Old Vicarage B53-B03 S374 Old VicarageNT V220942 040505 Stage 4.doc Version 1.20 Page 18 very caring and consistent staff team. It is essential that the records required by law are now brought up to date and maintained to a satisfactory standard. Financial procedures are satisfactory. The administrator responsible for dealing with personal allowances is now based on site at the Old Vicarage. The manager and administrator plan to audit finances monthly. A new system of formal staff supervision is being devised and must be implemented in the home. The manager is reviewing all policies and procedures. Safety procedures will be prioritised for updating, although all safety checks have previously been in place. The handy man has recently left and a new job description is being prepared. As he used to carry out the checks on fire equipment, emergency lighting, water temperature etc. It must be confirmed that these checks continue and by whom. The home is generally safe, it is, however, recommended again that the safety of the ramp be reviewed by a relevant expert. It is also recommended that staff have access to staff room facilities to enable them to have their breaks away from residents. It is recommended that they have a separate area to smoke. The Old Vicarage B53-B03 S374 Old VicarageNT V220942 040505 Stage 4.doc Version 1.20 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 2
COMPLAINTS AND PROTECTION 2 2 3 x 2 3 2 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 3 x 3 2 x 2 The Old Vicarage B53-B03 S374 Old VicarageNT V220942 040505 Stage 4.doc Version 1.20 Page 20 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 OP2 Regulation 5 (1)(b) Requirement Service user guide and statement of purpose must be updated and be fully completed before issuing to service users. Care plans and assessments of health status must be brought up to date. New chairs must be purchased for lounges. The nest of tables in small non smoking lounge must be replaced. Bed tables must be provided. furniture must not be brought into the home without the approval of the manager. Photographs must be added to staff files. A system of formal staff supervision must be implemented. Timescale for action 01/07/04 2. 3. OP7 OP8 OP19, OP20,OP23 15 (1) (2) 23 (2) 01/07/05 01/09/05 4. 5. OP29 OP36 Schedule 2 (1) 18 (2) 01/07/05 01/07/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP15 OP38 Good Practice Recommendations Menus should be available in large print. A relevant expert should be consulted regarding the safety
B53-B03 S374 Old VicarageNT V220942 040505 Stage 4.doc Version 1.20 Page 21 The Old Vicarage of the ramp. Staff welfare facilities should be provided such as staff room. The Old Vicarage B53-B03 S374 Old VicarageNT V220942 040505 Stage 4.doc Version 1.20 Page 22 Commission for Social Care Inspection Northumbria House Manor Walks, Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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