Inspection on 24/11/06 for The Old Rectory

This inspection was carried out on 24th November 2006.

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 Rectory 08/07/08

The Old Rectory 20/12/07

The Old Rectory 24/09/07

The Old Rectory 30/01/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Old Rectory (The) Langton Matravers Swanage Dorset BH19 3HB Lead Inspector Catherine Churches Key Unannounced Inspection 10:45 24th November 2006 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 DS0000064826.V321580.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. DS0000064826.V321580.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Rectory (The) Address Langton Matravers Swanage Dorset BH19 3HB 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) 01929 425383 F/P01929 425383 JLH Healthcare Ltd Mrs Sonia Joy Adams Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places DS0000064826.V321580.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of six service users in the category DE(E) may be accommodated. 30th January 2006 Date of last inspection Brief Description of the Service: The Old Rectory is situated in the centre of Langton Matravers, a rural village on the outskirts of Swanage. The village has a Post Office, newsagents, bakery, public house and church. There is a bus stop outside the home. The home is registered to accommodate a maximum of 19 people in the category of Old Age. There were 12 people living in the home on the day of the inspection. Accommodation is arranged on the ground and first floor levels in thirteen single rooms and 3 double rooms. All except one of the rooms have ensuite facilities. There is a passenger lift to the first floor. The home is a very old building and in some areas there are additional small flights of stairs to some bedrooms and the dining room. There is a well kept garden and plenty of off road parking for visitors. Fees at the time of the inspection were £500 per week. DS0000064826.V321580.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key, unannounced inspection undertaken on 24th November 2006. The inspection took place as part of the regular, programmed inspection schedule for the home. The last inspection was January 2006. The purpose of this visit was to monitor the homes compliance with National Minimum Standards and compliance with recommendations made during the previous inspection. Also, to check that the home is run in a satisfactory manner and that the people who are living in the home are properly cared for. The premises were inspected and a number of records examined. Time was also spent time observing routines within the home and talking with residents, visitors and staff. Prior to the inspection survey/comment cards were sent out to residents, relatives, GP’s, healthcare professionals and care managers. Sixteen responses were received in total: 7 from residents, 6 from relatives, one from a GP and 2 from care managers for local authorities. Analysis is included within the relevant sections of this report. This report refers throughout to “residents” meaning to include persons accommodated in the residential units of the home, patients in the nursing units and the overall term “service users”, which is the preferred term of the Commission. What the service does well: The Old Rectory provides a homely and comfortable environment and has a relaxed atmosphere. The home is positively managed and well staffed with a staff group who were observed to be caring and respectful. Residents were able to confirm that the life they are able to lead is as they expected. Bedrooms vary in size and standard of décor, as many have not been refurbished for a considerable period of time. Many people had taken the opportunity to personalise their rooms with their own items of furniture, furnishings, pictures and plants etc. Residents spoke positively about many things in the home and this included the food, their relationship with the manager and the programme of activities. Care planning and the related documentation as well as pre-admission assessments continue to be done well. DS0000064826.V321580.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. DS0000064826.V321580.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 DS0000064826.V321580.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments of prospective residents needs continue to be satisfactory. This means that residents can be certain that the home is aware of their requirements prior to their admission to the home and that the staff will therefore be able and prepared to meet these needs. EVIDENCE: Documentation for three residents was examined as part of the case tracking procedure used during this inspection. All of these residents had been newly admitted to the home since the last inspection. All assessments were viewed. They contained good information about each persons needs and a letter was also available on file to confirm, that having carried out the assessment, the home could meet the persons needs. DS0000064826.V321580.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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care Plans for residents who live at The Old Rectory are detailed and informative. This means that staff have sufficient information to provide a good level of care and the home can also demonstrate the care that has been provided. The home ensures that resident’s healthcare needs are met through seeking appropriate input from GP’s and other healthcare professionals. The ethos in the home is one of respect for the residents living there. This means that the residents feel settled at the home and their privacy is respected. DS0000064826.V321580.R01.S.doc Version 5.2 Page 10 EVIDENCE: Care Plans and related documentation regarding care for 3 residents were examined. Files were well laid out and risk assessments had been undertaken. Reviews were being undertaken on a monthly basis or more frequently if changes dictated this. Evidence was available on file and through discussion that GP’s, district nurses, specialist nurses and other health professionals are called upon whenever the need arises. During conversations with a number of residents, they confirmed (where they were able to) that they were happy with the care they received and that either they or their representatives are involved in reviews. They also confirmed that they feel respected by staff and are able to maintain their privacy when receiving personal care or visits from professionals such as GP’s and solicitors, family and friends. It was observed that staff knock on doors before entering and that residents preferred form of address is recorded and used. The home has a good policy for the promotion of privacy and dignity but not all staff and had signed to confirm that they had read this DS0000064826.V321580.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): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social, cultural and recreational activities are dependent on individual preferences and the resident’s capacity for involvement. Open visiting arrangements are in place enabling residents to retain contact with families and friends. Residents have the opportunity to choose their own lifestyle within the home and this means that their individual preferences and routines are respected. Dietary needs of the residents are well catered for with a balanced and varied selection of food available that meets resident’s tastes and needs. DS0000064826.V321580.R01.S.doc Version 5.2 Page 12 EVIDENCE: Residents are encouraged to continue any interests that they followed prior to moving to the home. They are assisted to get to a community tea once a fortnight, there is a weekly communion service in the home, visiting entertainers, 2 residents attend a local camera club, reminiscence therapy, visiting library service and various videos, music etc is available in the lounge. Question 7 of the resident’s questionnaire sent out prior to the inspection asked “Are there activities arranged by the home that you can take part in?” 0 people responded “Always” 3 people responded “Usually” 1 person responded “sometimes” 2 people responded “never” 1 was left blank The manager confirmed that she was aware that activities needed to be improved and hopes that once the extension of the home is complete, an activities organiser will be employed. The visitor’s book showed that there is a constant stream of visitors to the home and discussions with staff confirmed this as well as the fact that many residents are taken out by visitors. Discussion with residents and staff as well as examination of records evidenced that residents are assisted appropriately to exercise choice and control over their lives. Residents confirmed that a suitable and varied diet is provided in the home. The Old Rectory has not previously offered a choice of main meal but has provided alternatives if residents are known not to like a particular item. Mrs Adams showed the inspector plans to introduce choices at each meal together with a new menu plan that provides and even greater variety of foods that has been offered up to now. Question 8 of the resident’s questionnaire sent out prior to the inspection asked “Do you like the meals at the home?” 5 people responded “Always” 2 people responded “Usually” 0 people responded “sometimes” 0 people responded “never” DS0000064826.V321580.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 adequate. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory system for making complaints. This means that residents and others involved in the home that may wish to make a complaint should feel confident that they would be taken seriously and that matters of concern will be acted upon. EVIDENCE: The complaints procedure was displayed in the main hallway of the home and included in the Service Users Guide/Terms and conditions of residence that is given to all residents/representatives. No complaints have been made to CSCI since the last inspection. One complaint had been made to the home and fully investigated. However, the manager had failed to actually record this as a complaint. Question 9 of the resident’s questionnaire sent out prior to the inspection asked “Do you know who to speak to if you are not happy?” 6 people responded “Always” 1 person responded “Usually” 0 people responded “sometimes” DS0000064826.V321580.R01.S.doc Version 5.2 Page 14 Question 10 of the resident’s questionnaire sent out prior to the inspection asked “Do you know how to make a complaint?” 6 people responded “Always” 1 person responded “Usually” 1 was left blank Policies and procedures for adult protection and whistle blowing were checked and found to be satisfactory. Staff have all had copies of the homes policy and procedure for recognising and preventing abuse as well as informal training from the manager. Recognised training courses are also being planned for staff either through NVQ training or external short courses. DS0000064826.V321580.R01.S.doc Version 5.2 Page 15 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): 19,22,24, 25 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 is nicely presented. Residents live in a well-maintained environment with their own possessions around them. The home is clean, hygienic and free from offensive odours. A number of issues such as the unreliable lift, poor door locks and problems with provision of hot water mean that staff are not always able to support and promote residents privacy, dignity and independence. DS0000064826.V321580.R01.S.doc Version 5.2 Page 16 EVIDENCE: A tour of the premises confirmed that the home is nicely decorated and furnished. Dorset Fire and Rescue Service have visited the home and confirmed that it complies with their requirements. During discussions it became evident that the lift is unreliable and consequently a number of residents choose not to use it. The manager stated that no one is isolated upstairs because of this as staff are on hand to give assistance to those that require it. However, this does mean that residents are restricted, as they have to rely on staff whereas with suitable equipment they may be able to remain independent. It is recognised that a new lift will be installed in the extension but this will mean long distances to walk for some whose rooms remain in the older part of the home. All residents have keys to their rooms but the locking system used is not acceptable as it could be abused. The supply of hot water to resident’s rooms, ensuite facilities and bathrooms can be unreliable and the manager was unable to confirm that the temperature of hot water accessed by residents is regulated to a maximum of 43° C. Staff had a good understanding of infection control procedures and the relevant protective clothing was available. There was a detailed infection control policy in the home that covered all of the required areas. Training records were available to demonstrate that most staff have undertaken appropriate training and a plan was in place for those still requiring training. Question 11 of the resident’s questionnaire sent out prior to the inspection asked “Is the home clean and fresh?” 5 people responded “Always” 2 people responded “Usually” DS0000064826.V321580.R01.S.doc Version 5.2 Page 17 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 home was well staffed ensuring that residents receive the care and attention they need in an unrushed manner. Staff clearly enjoyed working in the home, there was a positive atmosphere and residents had a happy, relaxed relationship with the manager and staff. It was noted that the staffing structure means there is very little availability for cover in the manager’s absence. Staff have experience in caring for the elderly and a number are undertaking training to further develop their abilities and competencies. Recruitment procedures are satisfactory and this gives further protection to residents. Plans are being developed for the induction of new staff which will ensure that staff have a clear understanding of their roles and expectations of them as well as providing evidence that they are competent. DS0000064826.V321580.R01.S.doc Version 5.2 Page 18 EVIDENCE: Examination of the staff rota and observation throughout the inspection demonstrated there was a sufficient number and skill mix of staff to meet the needs of residents. Staff and residents spoken with confirmed that they were satisfied with staffing levels. However, it was noted that the Manager has no deputy, very little admin support and is even responsible for doing the weekly food shopping. All this therefore gives less time for the day-to-day management of the home. The majority of staff worked for the previous owners of the home and some have completed NVQ training. Mrs Adams is aware that the home does not meet the minimum level of 50 of all care staff trained to NVQ level 2 and is planning to enrol staff on courses in the near future. She reported that staff are keen to undertake training. Since the last inspection staff changes mean that there are now 5 out of the 15 carers who have NVQ2 or 3, 4 staff are awaiting funding to start their training and one person is hoping to become an NVQ Assessor to enable assessments to take place in the home. Staff records were examined for three members of staff. These demonstrated that appropriate recruitment practices are in place: application forms were completed; interviews documented and appropriate evidence of identity and qualifications had been obtained. References, Criminal Records Bureau and POVA checks had also been completed as required. Mrs Adams confirmed that new staff receive an induction and was able to provide evidence of this. This did not comply with the requirements of the Skills for Care induction programme but she confirmed that she was aware of this and will be ensuring that future inductions do comply. DS0000064826.V321580.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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management arrangements for the home support good care practices for the residents. Mrs Adams has demonstrated that she is a competent manager both through training and experience as well as the improvements that have been made since the last inspection. Systems for quality assurance and resident consultation are being developed with the aim of ensuring that the home is run in the best interests of the residents and that performance issues are identified and addressed. Sound practices and procedures are in place regarding residents’ finances. Residents, staff and visitors to the home are potentially being put at risk due to poor practice in relation to some areas of fire prevention DS0000064826.V321580.R01.S.doc Version 5.2 Page 20 EVIDENCE: Mrs Adams has a number of years experience in a management capacity of other care homes. All staff and residents spoken with spoke positively about her and were comfortable with approaching her if they needed to. Work has already been started on the introduction of a quality assurance system for the home. Further advice was given on further items to be addressed in order to achieve full compliance. One survey of resident’s views of the services and facilities in the home has been undertaken but has not been analysed or reported on. The home holds small amount of cash for a few residents. Records and balances for 3 residents were checked and found to be satisfactory. Accident books and risk assessments were examined and found to be up to date and detailed. Weekly and monthly checks of the fire alarm system, emergency lights and extinguishers were out of date. DS0000064826.V321580.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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 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 2 17 X 18 3 3 X X 1 X 2 1 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 1 DS0000064826.V321580.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement The Registered person must ensure that Service Users have access to all parts of service users communal and private space through the provision of lifts where required to achieve this. The registered person must ensure that service users are protected from the risk of scalding from hot water by the fitting of fail-safe devices which provide water close to 43°C The registered person must ensure that safe working practices are operated in the home including the regular testing and checking of the fire warning system and emergency lights. Timescale for action 1. OP22 16 & 23 31/05/07 2. OP25 13 &23 31/03/07 3. OP38 23 30/01/07 DS0000064826.V321580.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP16 OP24 OP27 Good Practice Recommendations A record must be kept of all complaints made and this must include details of the investigation and any action taken. Doors to service users private accommodation must be fitted with locks suited to service users capabilities and which are accessible to staff in emergencies. A review of the staffing structure should be undertaken to ensure that the manager has back up and support to enable the management of the home to be undertaken. A plan must be developed and implemented to ensure that the minimum requirement of 50 of staff trained to NVQ 2 is achieved as soon as possible. 24/11/06 This repeated for a second time but progress has been made. An induction programme which meets the National Training Organisation workforce training targets (Skills for Care) must be developed and implemented to ensure that staff can meet the needs of residents. 24/11/06 This repeated for a second time Further work must be undertaken with regard to quality assurance systems in the home in order to demonstrate that the home is meetings its aims and objectives and is run in the best interests of the residents. 24/11/06 This repeated for a second time 4 OP28 5 OP30 6 OP33 DS0000064826.V321580.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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. 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