Inspection on 20/02/07 for The Old Parsonage

This inspection was carried out on 20th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

The Old Parsonage 28/01/09

The Old Parsonage 13/02/08

The Old Parsonage 22/05/06

The Old Parsonage 31/01/06

The Old Parsonage 15/07/05

The Old Parsonage 27/01/05

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Old Parsonage (The) The Street Broughton Gifford Melksham Wiltshire SN12 8PR Lead Inspector Karen Mandle Unannounced Inspection 20th February 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Old Parsonage (The) DS0000061474.V316105.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Old Parsonage (The) DS0000061474.V316105.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Parsonage (The) Address The Street Broughton Gifford Melksham Wiltshire SN12 8PR 01225 782167 01225 783245 christine.rch@googlemail.com 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) Roseville Care Homes (Melksham) Limited Mrs Christine Ann Jones Care Home 20 Category(ies) of Dementia - over 65 years of age (20), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (20) Old Parsonage (The) DS0000061474.V316105.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The staffing levels set out in the Notice of Decision dated 23 December 2004 must be met at all times 22nd May 2006 Date of last inspection Brief Description of the Service: The Old Parsonage is a 19th century listed building that has been converted for use as a care home and is situated on the edge of Broughton Gifford village in the north west of the Wiltshire countryside. The home is registered to provide nursing and care for 20 people with dementia and/or mental disorder who are aged 65 or over. On the day of the inspection, there were 20 persons resident in the home. Accommodation is provided on 2 floors of the home and consists of 14 single rooms and 3 double rooms. There is an accessible paved courtyard area to the rear of the building. Parking space is available. The home was purchased by Roseville Care Homes Ltd on 24th December 2004. The responsible individual is Mrs Edith Parkin. The registered manager is Mrs Christine Jones, who is a registered mental health nurse; she leads a team of nursing, care and ancillary staff. Broughton Gifford is about 10 minutes away from Melksham to the north and Bradford on Avon to the south. Both towns have railway stations. The M4 is about 30 minutes drive away. Old Parsonage (The) DS0000061474.V316105.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This second key inspection commenced 20th February 2007. The inspector returned to complete the inspection when the manager, Mrs Christine Jones was available on the 20th March 2007. During the first visit, the inspector visited with many of the service users. However due to the complex mental health care needs of the service users group, communication was very limited, therefore the inspector was not able to gain their views. Much of the inspection was done through observation of service users and the interaction the staff had with them. Five care plans were reviewed and the inspector observed the lunch time meal. An agency person spoke with the inspector and whilst it was her first time at the home she provided positive comments to the care she had seen such as, “They are well looked after here, I like it”. A visitor also spoke with the inspector who said, “ I am very pleased with the home, and the staff are helpful”. During the second visit the inspector discussed any outstanding requirements with the manager and assessed the medications. Health and safety records were reviewed and a tour of the building took place. Six requirements were made following this inspection and one recommendation with two recommendations outstanding from the previous inspection. The judgments contained in this report have been made from evidence gathered during the inspection, which included two visits to the service. What the service does well: What has improved since the last inspection? The care plans are comprehensive and now contain nutritional risk assessments and are reviewed monthly. The staffing levels had been increased providing another carer from 8am to 2pm ensuring the social and care needs of the service users can be met. Manual handling procedure and equipment have both improved with further training and hoists provided. Pressure Old Parsonage (The) DS0000061474.V316105.R01.S.doc Version 5.2 Page 6 relieving equipment is now in use for service users spending time out of bed. All chemicals are securely locked away. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Old Parsonage (The) DS0000061474.V316105.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Old Parsonage (The) DS0000061474.V316105.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All service users are fully assessed by the manager prior to admission. EVIDENCE: Standard 3 was fully met at the previous key inspection conducted in May 2006 therefore this standard was not assessed on this occasion. Standard 6: The home is not registered for intermediate care. Old Parsonage (The) DS0000061474.V316105.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plans are now of a good standard and reviewed monthly. The home is providing a good standard of care and any changes to health care needs are promptly addressed. Service users are respected and personal care needs well supported. The medication procedure was safe. EVIDENCE: The manager has continued to improve the standards of the care plans with fall risk assessments in place and care plans being reviewed monthly. Mental health needs are clearly addressed, instructing staff how to support service users who many of whom have complex mental health needs. Physical care needs are identified and care plans are in place, which are also supported by appropriate risk assessments, pressure damage risk assessments, manual handling assessments and nutritional risk assessments. The manager had implemented a 24-hour care chart to support the care needs of the higher dependency service users. The charts were seen fully maintained. Old Parsonage (The) DS0000061474.V316105.R01.S.doc Version 5.2 Page 10 The Old Parsonage is registered to provide nursing care, which is of a good standard. Evidence was seen of prompt action taken when the health care needs of the service user changed. All service users are registered with a local GP who visits on request. Good pressure relieving equipment is in place, such as air mattress for those service users assessed at high risk of pressure damage. Pressure relieving cushions are now provided for service users at risk whilst out of bed. The home has been successful with healing pressure wounds, which have usually occurred prior to admission. The wound documentation seen was detailed with frequent wound evaluations taking place. Due to limited verbal communications of the service users, it was not possible to gain their views of the service provided relating to their own health care needs. The medication administration procedure was observed during the first visit of this inspection, which was safe. Medication storage was assessed on the second visit. Medication was stored correctly, as was the controlled medications. The controlled register was correct. The disposal of medications was in line with current legislation. The medication administration records were signed and up to date. Hand written medications orders should be, signed by two nurses to ensure the accuracy of the order. Service users would not be able to self medicate. The appearance of service users was good, providing evidence of personal care being well supported. The service users clothes were nicely laundered. Whilst touring the building it was evident that all care was being given behind closed doors and staff were heard addressing service users in a respectful manner. Due to complex mental health needs, service users need supervision and support whilst in the communal rooms, this is now being accomplished as staffing levels have been increased since the last key inspection. Old Parsonage (The) DS0000061474.V316105.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each service user had a social care plan in place in-line with their mental health care needs. Service users are encouraged to engage in activities. Service users are supported by the home to retain links with family and friends. Nutritional needs are well monitored and a nutritional, varied diet is provided. EVIDENCE: A flexible activities programme is in place, as some days service users may join in and other days they won’t due to behavioural issues. However the care staff provides activities appropriate to the moods of the service users such as walks to the village, reading the newspapers with service users and sitting quietly talking with service users about the past. Service users were observed walking freely around the home, others spending time in their rooms who do not wish to go the to communal lounges. A smoking room is provided on the ground floor, which two service users like to use. Old Parsonage (The) DS0000061474.V316105.R01.S.doc Version 5.2 Page 12 Service users are supported by the home to retain links with family and friends. A visitor spoke with the inspector who was very complimentary of the care provided saying, “We are very pleased with the home and the standard of care provided”. Several service users do not have any family. The manager works hard to support those service users by ensuring they are provided with new clothes and personal items and furnishings for their bedroom. The nutritional needs of the service users are closely monitored with nutritional risk assessments in place and weights monitored monthly. Food supplements are given to those service users assessed at risk. The main hot meal of the day, which is served at lunchtime, was observed. The majority of service users were seen having their meal in the dining room. Service users were supported by the care staff on a one to one basis. The meal was nicely presented and well cooked. Service users appeared to enjoy the meal with a service user saying, “I like the food and there is lots of it”. Service users at risk of not drinking enough fluids were closely monitored and encouraged by the staff to drink adequate amounts of fluids. Old Parsonage (The) DS0000061474.V316105.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A complaints procedure is in place. The registered manager is fully informed of the local vulnerable adults procedure. Service users are protected by robust recruitment procedures and the training provided to staff. EVIDENCE: A complaints procedure is in place, which is openly displayed. The registered manager maintains a complaints and concerns log. The home has not received any formal complaints since the previous inspection. The CSCI have not received, any formal complaints since the last inspection. A concern has been raised about the homes’ financial arrangements. The manager is fully informed of the local vulnerable adults procedure and how to implement the procedure if any allegation of abuse was reported or suspected. The staff had received training in abuse awareness. The recruitment procedures are robust and protect the service users from abuse as far as possible. Old Parsonage (The) DS0000061474.V316105.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable standard of accommodation. The home is not providing adequate bathing facilities. The home was clean to a good standard. The home is generally well maintained, however repairs to broken equipment are often delayed. EVIDENCE: The current providers have refurbished the home to a good standard. New flooring has been laid through out. Homely furnishings are in place in the bedrooms and communal rooms creating a much-improved homely environment for service users to live in. Old Parsonage (The) DS0000061474.V316105.R01.S.doc Version 5.2 Page 15 However the assisted bathroom on the ground floor was not in use as the hoist did not work and water was leaking onto the floor. Water was not available in the hand basin. Therefore the home cannot fully comply with Standard 21.4. The home was clean to a good standard with no unpleasant odours. Domestic staff are employed to carry out cleaning duties. The laundry was seen on both visits, which found that one of the two tumble driers was not in working order but had been reported to the provider, creating a slower process in which to get service users laundry washed and returned to them. Infection control measures were in place and clinical waste dealt with appropriately. The home is generally well maintained, however delays do occur in repairing equipment. Old Parsonage (The) DS0000061474.V316105.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staffing levels had been increased to support the care and social needs of the service user. Employment procedures are robust and protect the service users. The staff had not been provided with all mandatory training. EVIDENCE: The staffing levels during the morning shift from 8am to 2pm have now been increased by providing an additional carer ensuring that the needs of the service users are being met at all times. A qualified nurse is on duty at all times. However administration support is not provided for the manager. Mrs Jones reported that with additional staff in place, administration tasks were more manageable. It should be considered by the providers to employ an administrative person to assist with employment issues and the financial side of the business and other general administration tasks. The care team are supported by, domestic staff, a handy man and a cook. The inspector reviewed two employment files. The files contained two references, employment contract and appropriate police checks. The files had photographs of the employee as proof of identification. The manager remains responsible for all issues relating to the employment of staff. Old Parsonage (The) DS0000061474.V316105.R01.S.doc Version 5.2 Page 17 The manager supports the staff with NVQ training and encourages staff to attend local training events such as tissue viability. However not all mandatory training had been provided such as fire training due to lack of funding by the providers for trainers. This may put the staff and service users at risk in the event of a fire. Night staff should be provided with fire training four times a year, as it considers the risk is greater at night due to the reduction of staffing levels during this period. Old Parsonage (The) DS0000061474.V316105.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 34 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The financial procedures of the home are not satisfactory. Health and safety issues are addressed apart from staff not receiving fire training, putting service users at risk and the staff. EVIDENCE: Standard 31 and 33 were met at the previous inspection and therefore not assessed on this occasion. Standard 35 was almost met which has now been addressed apart from the financial arrangements of 1 service user. The manager was advised to contact the care manager of the service user with this matter. Old Parsonage (The) DS0000061474.V316105.R01.S.doc Version 5.2 Page 19 The providers managed all the financial procedures of the home. The procedures in place remain unsatisfactory with equipment not being repaired promptly such as the bathroom on the ground floor and the tumble drier. The manager is not being provided with funding or budgets to ensure that all mandatory training is provided. The home is generally well maintained and provides a safe environment for service users to live in. However the lack of fire training will need to be addressed, as this is putting both service users and staff at risk. The manual handling and equipment in use is now much improved and procedures are safe. All chemicals are now safely stored in a locked cupboard. A record is kept of all accidents and audited by the manager. Old Parsonage (The) DS0000061474.V316105.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X 2 2 X X 2 Old Parsonage (The) DS0000061474.V316105.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP21 Regulation Requirement 12(1)(a) 13(3) The bathroom on the ground floor must be fit for purpose. The providers will ensure that procedures are in place to repair equipment in a reasonable amount of time. The providers will ensure that the manager is provided with appropriate funding to provide all mandatory training. The registered person will ensure correct procedures are in place to safeguards the service users personal money. The providers will ensure that financial procedures are put in place to ensure that the home is able to meet its aims and objectives. All staff will be provided with mandatory fire training and the night staff will be provided with training four times a year. 01/05/07 Timescale for action 01/05/07 2. OP19 23(2c) 3. OP30 18(c1) 01/05/07 4. OP35 16(2L) 01/05/07 5. OP34 25 (4) 01/06/07 6. OP38 23(4d) 01/05/07 Old Parsonage (The) DS0000061474.V316105.R01.S.doc Version 5.2 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP21 Good Practice Recommendations Bathrooms and WCs should be easily identifiable by door labelling or other means. 2. OP23 Service users’ room doors should have door knobs or push-plates. 3 OP27 Consideration should be given to employing an administration person who can support the manager and deal with the financial business of the home. Old Parsonage (The) DS0000061474.V316105.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Old Parsonage (The) DS0000061474.V316105.R01.S.doc Version 5.2 Page 24 - 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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