Inspection on 30/01/09 for The Noel

This inspection was carried out on 30th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Noel 04/06/09

The Noel 28/04/09

The Noel 17/03/08

The Noel 24/01/07

The Noel 01/02/06

The Noel 27/07/05

The Noel 07/10/04

The Noel 07/04/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Noel St Boniface Road Ventnor Isle Of Wight PO38 1PN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Annie Kentfield     Date: 3 0 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: The Noel St Boniface Road Ventnor Isle Of Wight PO38 1PN 01983852292 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Miss Sandra Vivienne Phillips Name of registered manager (if applicable) Miss Sandra Vivienne Phillips Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 12 The registered person may provide the following category of service only: Care home only (PC) to service users 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 (OP) Date of last inspection Brief description of the care home The Noel is a residential care home providing care and accommodation for up to 12 older people. The home is owned and managed by Miss Sandra Phillips. The home is a period three-storey (including basement) detached house in Ventnor, near to the town centre, with its shops and amenities. Accommodation for the residents is arranged over the ground and first floors and a stair lift assists with access to rooms on the first floor. Rooms at the front enjoy fine sea views and those at the rear face St Boniface Down. The home is registered to accommodate 12 older people, but the manager Care Homes for Older People Page 4 of 28 care home 12 Over 65 12 0 Brief description of the care home prefers to provide single room accommodation and therefore limits the occupancy to 8. Double rooms are used only if residents choose to share. There is off road parking to the front of the building. A stair lift is available to assist those with mobility difficulties to negotiate the steps up to the front door. Daily fees range from fifty three pounds 81 pence to sixty five pounds 93 pence depending on the level of care. Additional fees for chiropody etc are listed in the service user guide. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We made an unannounced visit to the home on 30 January 2009. This was with one inspector (Annie Kentfield) and the visit lasted for four hours. During the visit we spoke to the manager and all of the residents (in the privacy of their own rooms). We looked at some of the homes records including care plans, medication records, health and safety records, staff recruitment records and policies and procedures. Before the visit we received the Annual Quality Assurance Assessment (AQAA). This is a self-assessment about what the home does well and where improvements are planned. We sent surveys to residents, staff and health and social care professionals. We received completed surveys from 3 residents, 3 staff and one social care professional who visits the home. All of the feedback about the home is positive. Care Homes for Older People Page 6 of 28 Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. New residents do not move into the home until an assessment of their care needs has been completed and the manager is confident that the home can meet assessed care and support needs. Evidence: The home had three residents at the time of our visit. The manager has told us in the past that she does not use the larger double rooms for two people, unless people actively choose to share a room. This means that the home usually has 8 residents in single bedrooms. We discussed the current vacancies with the manager who told us that a number of potential new residents had been assessed but the manager was clear that the home could not meet their needs. The manager has a policy that residents are free to go out if they wish to and this means that the home could not meet the needs of people who Care Homes for Older People Page 10 of 28 Evidence: may not be safe to do this. The home also has a fire exit door on the first floor that leads into the garden and the manager wants to be confident about residents ability to be safe in the home. Potential new residents are assessed by the manager who is clear about the level of care that the home can provide. We looked at the records of assessment for a resident who has moved into the home since the last inspection and this demonstrates that the assessment process is clear and new residents do not move into the home unless the manager is confident that the home can provide the care and support needed. We looked at information about the home. The manager has produced a comprehensive guide to the home and what residents can expect when they move into the home. The guide is given to prospective residents and/or their representatives. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have their health care needs met promptly, and with regard for privacy and dignity. The administration records of medication prescribed for the residents are not always kept up to date and this puts residents at risk of not receiving their medication as prescribed, at all times. Evidence: We looked at all of the care records and spoke to the residents in the home. There is sufficient information in the care plans to guide care staff on the way that care needs are to be met. Individual care plans include a brief history, relevant information about next of kin and GP, dietary likes and dislikes, preferences for getting up and going to bed, plan of care to meet health care needs, manual handling risk assessments, daily recording of care provided and night care logs. We spoke to all of the residents who confirmed that staff are kind and efficient and always respect privacy by seeking permission before entering bedrooms or bathrooms. One resident told us that staff are very prompt to call a GP when needed and all of the Care Homes for Older People Page 12 of 28 Evidence: residents told us that they always receive their medication at the right time. The manager told us that the care philosophy of the home is to provide care until the end of life, if that is what residents choose for themselves. Previous evidence demonstrates that the manager has good working relationships with community health and social care providers and has always worked in consultation with specialist health care providers to meet residents care needs if and when they change. One health care professional told us that the home is good at supporting people to live their lives as they wish. This person also told us that the manager and staff are pro-active in responding appropriately and promptly if they have any concerns about the health or well being of any of the residents. The manager has met a previous requirement with regard to the storage of controlled drugs. A new cupboard has been purchased and installed and meets current regulatory requirements. The controlled drugs register was up to date and unused medication had been returned to the pharmacy and signed for. The home uses a measured dosage system for medication, however, one new resident had their medication in the original packets and this was not yet recorded on the medication administration records. When we spoke to the resident they confirmed that they receive their medication at the right time. There were some gaps in the recording on the medication administatration record sheets, this means that the records did not confirm whether medication had been given or not. This was discussed with the manager who told us that she knew the medication had been given and staff had forgotten to record this on the administration record. One resident is prescribed an iron tablet to be taken at night. The resident prefers to take the tablet just before going to sleep and has asked that staff do not disturb them late at night. However, staff are leaving the tablet in the room with confirming that it has been taken or not. This means that there is not a clear and accurate record of medication dispensed. Some of the medication had not been recorded on the medication administration record as received and amounts checked and signed for. The manager told us that she had checked the medication herself but had forgotten to sign the record. Paracetamol that has been prescribed to be given as and when required had been taken out of the original packaging. This means that staff were dispensing the paracetamol but did not have the dosage instructions that were on the original box. This means that residents may be at risk of not receiving their medication, as prescribed, at all times. We looked at the homes policy and procedures for the safe administration of Care Homes for Older People Page 13 of 28 Evidence: medication. This is out of date and needs reviewing and updating to ensure that staff have access to current guidance and good practice information. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 lifestyle of the home is suitable for the abilities, needs and preferences of the residents. Emphasis is placed on offering fresh and nutritious meals for the residents. Evidence: We spoke to all of the residents who expressed their satisfaction with the daily routines in the home. Two of the residents told us that they prefer their own company and like to stay in their rooms and read, listen to music, or watch favourite programmes or films. One resident told us that they are always invited to join in with any activities or events that take place in the sitting room from time to time. Another resident told us that if there is anything that I can do or want to do, staff will arrange it for me. One resident enjoys being in the sitting room, this room has a sunny aspect with sea views. The home provides a selection of newspapers for residents to read. Staff will read aloud, or play games if residents would like to do this. Visitors are always welcome. The manager told us that she always checks with residents that they are happy to receive visitors, otherwise there is no restriction on Care Homes for Older People Page 15 of 28 Evidence: people visiting. Relatives and friends are always made welcome and often stay for meals in the home. All of the residents told us that the meals are good with generous portions provided. Residents told us that there is always a menu alternative if they do not want the meal being prepared. Residents are offered drinks and snacks throughout the day. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents living in the home are protected from the risk of harm or abuse. The information about the formal complaints procedure has not been updated. Evidence: Residents felt confident about taking any comments/concerns they may have to the manager. Concerns or comments are usually dealt with informally as the manager has daily contact with residents, visitors and visiting professionals. The manager and staff are aware of the homes formal complaints procedure and would use this if and when complaints are received. The information about the complaints procedure needs to be updated with the new address and phone number for the Commission, in the event that people wish to contact the Commission. Formal training in safeguarding policy and procedures has not been arranged for staff in the home, however, information and awareness training is provided by the manager. The home has a copy of the Isle of Wight safeguarding policy and procedures, however, this has been updated and the manager told us that she would request a copy of the most updated document. The manager and staff demonstrated an understanding of their responsibilities for what action they must take to report any concerns about the safety or well being of residents in the home. Care Homes for Older People Page 17 of 28 Evidence: Since the last inspection there has been one safeguarding referral and these concerns were investigated by the local authority Social Services department. The manager worked with Social Services to investigate the complaint. No further action was taken from the investigation. The manager is aware of the new Mental Capacity Act but staff have not yet received training in the new legislation, to inform their practice. The home does not have a copy of the Mental Capacity Act, Code of Practice. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 home provides an environment that meets the specific needs of the people who live there in a comfortable and homely way. Evidence: When we spoke to the residents, they told us that the home provides everything they need and they were very happy with the room they had and could not think of anything else that they would change. Some of the residents use the sitting room but some of the residents prefer to use their bedrooms as a bed-sitting room. Most of the bedrooms are large enough to accommodate easy chairs and tables. There is a bathroom with an assisted bath and toilet on each floor, with additional separate toilets for residents to use. The home does not have a separate dining room, however, there is a dining area in the sitting room, but the residents we spoke to preferred to have their meals in their room, or with an individual table in the sitting room. The home does not have a passenger lift and the layout of the building means that this is not a practical option. However, residents are aware of this before they move into the home. There is a stair lift to provide access to the upper first floor and from the road to the front door, for residents who are not independently mobile. The manager Care Homes for Older People Page 19 of 28 Evidence: told us that the building access is always taken into consideration when assessing the suitability of the home for new residents. The home is clean and warmly heated and furnished in a comfortable and homely way. As bedrooms become vacant, these are being decorated and new carpeting installed, if needed. Residents told us that their rooms are cleaned every day. The home has an infection control policy and procedures and the manager seeks advice from external specialists when required, as part of the homes action to reduce the risk of infection or cross infection. We observed that staff have access to gloves and aprons as needed as part of the homes infection control procedures. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 care and support needs of the residents are met by sufficient numbers of competent staff. However, staff have not received training updates in those areas of mandatory training in safe working practice. Evidence: The home has not employed any new staff in the last twelve months. The manager and staff work closely together as a team and practice issues are discussed and agreed informally. The manager told us that the staff team is stable and values the fact that staff have been prepared to reduce their working hours for a temporary period, due to current vacancies in the home. Supervision is informal and ongoing because the manager works in the home with the staff and is always available during the day, and is on call at night. Comments from residents and visitors, and observation of practice in the home, confirms that residents receive a high level of care and support. The home has not kept up to date with staff training and development and records show that staff have not updated their training in a number of areas, including moving and handling; this was last updated in 2007. If training in moving and handling is not regularly updated there is a risk to residents and staff from practice not being safe. Care Homes for Older People Page 21 of 28 Evidence: The home employs nine staff and 3 people have achieved an NVQ (National Vocational Qualification) in care, level 2, one person at level 3, and two people are currently enrolled to achieve NVQ level 2 in care. The manager is aware that record keeping is not her strong point and that the size of the home means that it is not practical to employ an administrator to organise record keeping. There are also limited resources to organise a planned programme of training and development. This means that although the service is able to recognise when additional training is needed, they are not always in a position to deliver the training needed. There is evidence that staff are clear about what is expected from them and residents report that staff working with them know what they are meant to do and that they meet their individual needs in a way that they are happy with. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home that is run in the best interests of the people using the service. The views of the residents are listened to and taken seriously. The health, safety and welfare of the residents and staff are promoted but this is sometimes compromised by a lack of organisation and poor record keeping. Evidence: We received the annual quality assurance assessment from the manager. Although the information provided was brief, the AQAA provided a picture of the service and the care philosophy of the home. The AQAA stated that the privacy and dignity of the residents is paramount. In practice this means that the daily routines of the home are based on what residents choose to do and how they choose to have their care and support provided, and staff respect this. Comments from residents and a health care professional confirm that the manager and staff always have a professional approach to providing a service that is flexible and adaptable to the needs of the residents. One person also commented that the manager and staff are also very good at supporting Care Homes for Older People Page 23 of 28 Evidence: residents families when relevant. The AQAA told us that the homes approach to equality and diversity in practice is to treat everyone with the same respect, affection and care. The manager has owned and managed the home since 1984. The manager has considerable expertise based on experience, but does not have formal qualifications in management. The home does not have a formal quality assurance system but with the size of the home and the type of service that the home offers, the manager is in daily contact with the residents and visitors to discuss any queries or feedback as part of the monitoring of the service. However, there are no systems in place to monitor that the home is meeting regulatory requirements in some aspects of practice in the home such as the safe administration of medication and safe practice in moving and handling. We looked at records in the home for the servicing and checking of safety equipment. These were up to date for the fire alarm and emergency lighting, the alarm call system, and fire fighting equipment. The home has a fire safety risk assessment and was inspected for fire safety in March 2008. One requirement from this inspection has been addressed. The manager said that the home does not have fire drills, staff have fire practices but these have not been recorded. This means that the home cannot demonstrate that staff know what to do in the event of a fire. The manager has not updated staff training in safe moving and handling. This means that the residents and staff may be at risk from unsafe practice. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person must have safe systems in place for the storage, administration, dispensing, and disposal, of all medicines received into the home. Residents must receive their medication, as prescribed, at all times. 31/03/2009 2 30 13 The registered person must 30/04/2009 make suitable arrangements to provide a safe system for moving and handling residents in the home. Residents and staff must be protected from the risk of unsafe practice in moving and handling. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 28 Care Homes for Older People Page 27 of 28 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - 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. 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