Inspection on 24/05/07 for The Old Rectory

This inspection was carried out on 24th May 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Old Rectory 14/06/06

The Old Rectory 07/10/05

The Old Rectory 07/07/05

The Old Rectory 18/11/04

The Old Rectory 12/08/04

The Old Rectory 09/02/04

The Old Rectory 11/12/03

The Old Rectory 30/10/02

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

CARE HOMES FOR OLDER PEOPLE The Old Rectory Main Road Stickney Lincs PE22 8AY Lead Inspector David Bacon Unannounced Inspection 24th May 2007 08:30 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 The Old Rectory DS0000002460.V341217.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. The Old Rectory DS0000002460.V341217.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Rectory Address Main Road Stickney Lincs PE22 8AY 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) 01205 480511 Mr Richard Atterby Mrs Christine A Atterby Mr Richard Atterby Care Home 44 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (1), Old age, not falling within any of places other category (44), Physical disability (16) The Old Rectory DS0000002460.V341217.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Service users within the category of Physical Disability (PD) between the ages of 25 and 64 years can be accommodated. Service Users within the category of PD may be accommodated in rooms 2, 3, 4, 5, 7, 8, 9, 14, 21, 22 and 23 only on the ground floor. Service Users within the category of PD may be accommodated in rooms 3, 4, 5, 6, 21, 24, 25, 26 and 27 on the first floor. The total number of service users accommodated in the home will not exceed 44. 14th June 2006 Date of last inspection Brief Description of the Service: The Old Rectory is a large, 18th century country house with three additional purpose-built wings set in it own grounds in the village of Stickney, which is approximately 8 miles from the market town of Boston. The home is situated next to the village church and a short walk from the pub and shop. There are landscaped gardens to the front of the house with a car park to the front and the side of the building. The home is privately owned by Mr. and Mrs. Atterby and managed by Mr. Atterby. It is registered to provide personal care for up to 44 residents, older people, one having a defined mental health disorder and up to sixteen having a defined physical disability between the ages of 25 years and 65 years. The home does not provide any nursing care. The owner makes inspection reports available to service users and members of the public upon request. The care fees range from £335 to £ 432 per week. Hairdressing and private chiropody treatments are not included within the home fees. The Old Rectory DS0000002460.V341217.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection took place during May 2007 and the visit to the home was undertaken over approximately 4 hours. Outcomes from the previous inspection are also identified within this report. The care received by three service users was looked at in detail. This process is called “case tracking” and individual service users care records and general home records were looked at as part of this along with discussions with service users about their experience of life within the home. The inspector spoke with five service users, one service users representative, the registered manager/proprietor and three staff members. Feedback was also received prior to the visit from seven satisfaction surveys completed by or on behalf of service users. Notifications received along with a pre-inspection questionnaire, completed by the manager were also viewed as part of the overall information gathering regarding the service. A partial tour of the premises was conducted including areas relating to the service users who were case tracked. Service users care records and staff records were inspected along with policies/procedures and administrative systems. What the service does well: What has improved since the last inspection? Some improvements have been made regarding care recording systems. For example, new care records are being completed for all service users although further adjustments are required to fully identify service users care needs and any related risks. It had been identified previously that linoleum flooring had been laid in several bedrooms and one of these floors has been replaced with cushioned flooring. The Old Rectory DS0000002460.V341217.R01.S.doc Version 5.2 Page 6 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. The Old Rectory DS0000002460.V341217.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 The Old Rectory DS0000002460.V341217.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): 3, 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems are in place for the introduction of service users to the home although the overall assessment of service users care needs is too brief, which could have a detrimental effect on the care provided. EVIDENCE: The records viewed demonstrated that an assessment of each service users care needs had been undertaken although some of the information within these was brief, including identifying potential risks, which could restrict staff members awareness of service users care needs. Records provided staff with a brief history of each service user including some basic likes and dislikes but this information was limited overall. Senior staff took some action to address this matter during the visit. The service users spoken with were satisfied with admission procedures but were not aware of being involved in the care planning process. The Old Rectory DS0000002460.V341217.R01.S.doc Version 5.2 Page 9 The care staff spoken with were clearly aware of individual service users assessed care needs and how these were met. Intermediate care services are not provided at the home. The Old Rectory DS0000002460.V341217.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users feel that care staff treat them respectfully and they are satisfied with the care provided although care records overall only provide staff with limited information about service users care needs. Procedures for the administration of medication are not fully adequate. EVIDENCE: The service users spoken with said that staff met their individual care needs, that care staff were respectful and promoted their privacy and dignity. Comments included: “I am very satisfied with the way I am looked after”. “The home successfully nursed my mother back to her former fullness”. “I have always been happy”. “I seem to be alright here, they look after you and you get well fed”. “I’m looked after and I don’t want to move again”. Comments received in satisfaction surveys completed by service users indicated that service users/representatives were satisfied overall that they received the care and support they needed. The Old Rectory DS0000002460.V341217.R01.S.doc Version 5.2 Page 11 Staff were observed to carry out personal support in private, and they spoke with service users in a friendly and respectful manner. Some recent improvements have been made regarding care plan information, which now detail any specific known needs of service users during each part of the day. However, the records of one service did not provide staff with sufficient information regarding their care needs. Senior staff took action regarding this during the visit. Service users or their representatives (where appropriate) had not all been consulted with or involved in the devising of their individual plan. Care records identified any specific health needs of service users, how these were met by supporting health agencies and any action taken by the home. For example, one service user assessed as having care needs regarding weight management and tissues viability had continuous monitoring regarding these and records clearly instructed staff regarding any instructions from district nurses. Some minor improvements had recently been made regarding the homes medication systems, which now generally document the strength of medicines although the number of tablets received was not recorded, which was identified during the previous visit. It is acknowledged that the home manager is seeking to upgrade the medication recording system. Staff whom administer medicines have recently received updated awareness training regarding this subject matter. The Old Rectory DS0000002460.V341217.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to choose how they spend their time and to maintain and develop community links as they prefer. Service users enjoy the meals provided overall although their views regarding meals are not fully sought. EVIDENCE: A part time activity co-ordinator works during the week and occasional weekends. The service users spoken with were satisfied with the homes provision of activities of which records are maintained. Comments received regarding activities included: “My loved one has always been able to do as they please”. “There’s things going on but I’m not interested”. “They come and talk with you to see if you want to do anything”. “Yes, I like the things they do, yes, quite happy”. A record of any activities undertaken is maintained for each service user. Service users said that they were able spend their time as they liked, that there were no restrictions regarding this and that their visitors were made welcome, which was further confirmed by the representative spoken with and the homes policies and procedures. The Old Rectory DS0000002460.V341217.R01.S.doc Version 5.2 Page 13 A four-week rolling menu is in place and a record of all meals provided is maintained along with meal and equipment temperature records. The service users said that their views regarding meals were not sought. It is recommended that the cook regularly talks with service users to ascertain their views when planning the menu. The manager and cook agreed to address this during the visit. Service users comments included: “Excellent”. “Well they vary, alright sometimes, not so good at other times”. “Very good meals are served each day”. “It could be better but you get enough”. No suggestions were made. The Old Rectory DS0000002460.V341217.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users feel able to comment or complain about the care they receive and staff are made aware of the systems in place to protect service users from abuse. EVIDENCE: Records show that there have been no complaints or safeguarding adult’s referrals since the last inspection visit. The pre inspection information received identified that policies and procedures were in place to safeguard service users, which included: comments and complaints, whistle blowing and risk assessing. Information regarding these is displayed in the home and provided to service users. The service users spoken with said that they felt able to express their views regarding the care provided and that any comments would be appropriately acted upon, which was further confirmed in the quality satisfaction surveys seen. Comments included: “I’ve not got any complaints but I would go to the staff”. “I’d go straight to the top and they would sort it but you can speak with most of them”. “If I complained then I think they would treat me properly”. The staff members spoken with explained the correct action to be taken in the event of an issue of abuse being suspected and confirmed that they were The Old Rectory DS0000002460.V341217.R01.S.doc Version 5.2 Page 15 aware of policies and procedures and had attended training regarding this subject matter. The Old Rectory DS0000002460.V341217.R01.S.doc Version 5.2 Page 16 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, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of cleanliness is satisfactory and the environment is considered clean, comfortable and homely by service users although the manager should seek advice regarding risk of infection policies and procedures. Fire safety systems are adequately maintained. EVIDENCE: The home was clean and tidy throughout all the areas seen and the service users personal accommodation had been personalised. The service users spoken with were satisfied with the cleanliness of the home and comments received in completed satisfaction questionnaires further confirmed this. Comments included: “I have a lovely room which is always nice and clean”. “Excellent”. “I have not noticed any smells”. “It’s generally kept clean enough”. “Yes, it seems alright, clean and tidy”. “They regularly clean my room”. The Old Rectory DS0000002460.V341217.R01.S.doc Version 5.2 Page 17 Fire safety systems were being maintained as per fire safety regulations. For example, records of emergency lighting and fire system tests. Also, the home recently received a visit from the fire safety officer, of which the report was satisfactory. Cleaning materials were safely stored and the staff spoken with were satisfied with the awareness training and equipment provided to enable them to undertake their roles, of which policies and procedures are in place. There were no obstructions in corridors or other communal areas that could limit mobility although two bedrooms seen had linoleum flooring, which created increased risks to service users falling in their bedrooms. The proprietor said was due to be replaced. Some infection control policies and procedures were in place although these provided only limited information to staff and it is recommended that the manager seeks advice from NHS infection control staff regarding these to further safeguard service users. The Old Rectory DS0000002460.V341217.R01.S.doc Version 5.2 Page 18 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, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is being staffed to meet the current needs of residents and appropriate recruitment procedures are in place. Staff attend awareness training to meet service users care needs. EVIDENCE: The staff records viewed evidenced that appropriate recruitment checks had been undertaken prior to staff commencing work at the home. The checks included criminal record bureau checks, obtaining professional references and staff completing application forms. Records detailed where all newly appointed staff had received a basic formal induction, which was further confirmed by the staff members spoken with who said they received adequate training to undertake their roles. A rolling programme of nationally recognised training is in place and the staff members spoken with that they received regular training specific to the needs of service users. The service users spoken with confirmed that there were adequate numbers of staff, which was further evidenced during the visit. The Old Rectory DS0000002460.V341217.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are satisfied with the management of the home although quality satisfaction, health and safety and some finance management systems are not fully adequate. EVIDENCE: The service users and staff members spoken with were satisfied with the manager’s approach to the role, which was further confirmed in the completed satisfaction surveys seen. Comments included: “I just go to the owner but you can speak with all the staff”. “It’s friendly and you can approach any of them”. “I wouldn’t have a problem going to anyone”. However, there are no formal quality satisfaction systems in place. For example, questionnaires are not sent to service users and service users meetings are not held. It is recommended that satisfaction questionnaires are openly promoted and The Old Rectory DS0000002460.V341217.R01.S.doc Version 5.2 Page 20 displayed to further afford service users and their representative opportunities to express their views regarding life within the home. This should include meal provision, which is identified earlier within this report. Policies and procedures are in place to protect service users where the home staff have any involvement in their finances. However, monies are not kept separate and receipts although records of transactions and totals are maintained. Service users sign for any transactions, where this is possible. The staff members spoken with were satisfied with the homes management of health and safety. A risk assessment of the premises has recently been undertaken although this was not comprehensive to adequately identify risks to service users or document the action taken to minimise these. For example, the overall security of the premises was inadequate for service users prone to wandering and potential risks to service users were not assessed although senior staff took action regarding this during the visit. Safety tests had not been undertaken regarding legionellosis and there had been no risk assessment undertaken regarding this although the manager said that this would be addressed. Water temperatures were not regularly checked although the manager said that temperature restrictive valves are in place. However, regular checks regarding this were not undertaken to minimise risks to service users. The Old Rectory DS0000002460.V341217.R01.S.doc Version 5.2 Page 21 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 2 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 2 The Old Rectory DS0000002460.V341217.R01.S.doc Version 5.2 Page 22 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 OP3 Regulation 14 (1) Requirement An assessment of each service users care needs must be undertaken to ensure service users care needs can be adequately met. A robust quality assurance system must be established (previous timescale of August 12th 2004 not met). A comprehensive care plan must be completed for each service user, which clearly identifies each care need met. Service users must be involved in the plan, where possible (previous timescale of April 30th 2007 not met). Systems must be in place to fully account for all medicines received into the home (previous timescale of April 30th 2007 not met). The flooring in service users bedrooms must be safe to minimise any risk to service users (previous timescale July 31st 2007 not yet elapsed). Systems must be in place to minimise spread of infection DS0000002460.V341217.R01.S.doc Timescale for action 31/07/07 2. OP33 24 (1) 31/07/07 3. OP7 13 (4) c and 14 (2) and 15 (1) (2) 31/07/07 4. OP9 13 (2) 31/07/07 5. OP19 13 (4) (a) 31/07/07 6. OP38 13 (4) 31/07/07 The Old Rectory Version 5.2 Page 23 7. OP38 13 4 (a) (c) from water outlets. An environmental audit of the premises must be undertaken to minimise risks to service users including service users who may wander. 31/07/07 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 OP26 Good Practice Recommendations It is recommended that the manager seeks advice from NHS infection control staff regarding infection control policies and procedures these to further safeguard service users. It is recommended that service users monies are kept separately as per the individual records maintained for each service user. 2 OP35 The Old Rectory DS0000002460.V341217.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 The Old Rectory DS0000002460.V341217.R01.S.doc Version 5.2 Page 25 - 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. 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