CARE HOMES FOR OLDER PEOPLE
Old Rectory, The The Old Rectory Care Home 70 Risley Lane Breaston Derby DERBYSHIRE Lead Inspector
Vanessa Davies Key Unannounced Inspection 09:00 3rd May 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 Old Rectory, The DS0000033891.V291105.R01.S.doc Version 5.1 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 Rectory, The DS0000033891.V291105.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Old Rectory, The Address The Old Rectory Care Home 70 Risley Lane Breaston Derby DERBYSHIRE 01332 874342 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) Mr Allen William Heath Ms Jacinta Barker Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Old Rectory, The DS0000033891.V291105.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 30th June 2005 Brief Description of the Service: The Old Rectory is a detached property situated in the village of Breaston. It is situated 300/400 yards from the village centre and from a main bus route. The Home is registered to provide care for 21 older people within eleven single rooms and five double rooms on the ground and first floors. The first floor rooms can be accessed by both a shaft lift and stair lift.The Home was registered to a new provider in October 2002. The home has recently had an extension of 8 single bedrooms with en-suite facilities, the work is not completed as the provider intends to make changes to the main building, the extra bedrooms are awaiting registration. Old Rectory, The DS0000033891.V291105.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report is written following a visit to the home, speaking with residents, staff and the proprietor and reading through records kept at the home and information held at CSCI. Since the previous inspection the Registered Manager has resigned therefore the managers position is currently vacant. The Provider was unable to access his office therefore previous requirements were not discussed and some have reappeared in this report. What the service does well: What has improved since the last inspection?
Details of past interests are now documented. Care files have more information documented relating to the service users in order to ensure that all of their needs and wishes are met. The provider consults with the service users and or relatives, when preparing assessments of need and care plans. The provider keeps a clear record of all training completed by staff and ensures that their training is kept up to date. Old Rectory, The DS0000033891.V291105.R01.S.doc Version 5.1 Page 6 The provider has clearly worked hard to address issues highlighted at previous inspections. 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. Old Rectory, The DS0000033891.V291105.R01.S.doc Version 5.1 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 Rectory, The DS0000033891.V291105.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome area is good. Detailed assessments of need and other relevant assessments, ensures that staff are able to meet the changing needs of the residents. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: Four residents files were examined during the visit. The files are much improved. Each of the files have an assessment of need, which had recently been updated. All information documented within the national minimum standards 3, is now included within the files. Each of the files had a completed and reviewed nutritional assessment, a falls assessment and an assessment of skin condition. The home does not offer intermediate care.
Old Rectory, The DS0000033891.V291105.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. Detailed information on residents and input from other professionals ensures that needs and expectations are met. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: Each of the files had a plan of care in place and it was evident that residents or their relatives had been involved. One resident spoken with confirmed that she had been involved with the preparation of her care plan and could access it when she wanted to. There was some information in all files examined relating to the residents history, however the provider does intend to improve the information gathered and have staff members involved with gathering the information. It was evident that other professionals are involved with the residents as necessary, this was confirmed when speaking with residents. As stated
Old Rectory, The DS0000033891.V291105.R01.S.doc Version 5.1 Page 10 previously each file had a nutritional assessment and an assessment on skin condition. Medication records were examined, all records were signed following administration of medication, however the home does not keep a record of medication received and two of the records had hand written prescriptions with no signature from the person writing and no signature from the GP. Residents spoken with confirmed that staff always treat them with respect, they always knock on doors prior to entering and ensure that bathrooms doors are closed when in use. Old Rectory, The DS0000033891.V291105.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. A range of activities offered and a welcome to all relatives and visitors ensures that residents expectations of the home are met. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: The provider evidenced a record of activities kept by the home, this included indoor garden games, bingo and quiz games. One resident spoken with stated that she had lived at the home for a long time and enjoyed gardening, the provider stated that he was supporting the residents wishes to commence with her gardening hobby again and was considering purchasing a greenhouse. She stated that although it will never be home, she was happy there and felt well supported and looked after. It was evident on the day of the visit that relatives are made to feel welcome. The inspector spoke with a lady leaving after a short stay of respite. She was happy at the home and used it often, her relatives collecting her clearly had a positive relationship with the home.
Old Rectory, The DS0000033891.V291105.R01.S.doc Version 5.1 Page 12 The home offers a varied and healthy menu and residents have a choice of food, any changes to the menu are documented. Old Rectory, The DS0000033891.V291105.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Appropriate responses to complaints and adult protection allegations ensures the safety of the residents. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: The provider has a clear policy and procedure for complaints and adult protection. He keeps a record of complaints made and his responses. All staff are aware of how to respond to any allegations of abuse and appropriate training is provided. Old Rectory, The DS0000033891.V291105.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is average. Areas of improvement should be addressed in order to prevent any risk of injury to residents. This outcome has been made from evidence gathered before and during the visit to the service EVIDENCE: The home does need to be improved in areas and the provider is aware of these areas and stated that he does have an improvement plan in place. Areas highlighted during the visit need to be addressed as they pose a safety risk to residents. The home is always kept clean with no malodour present. Old Rectory, The DS0000033891.V291105.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is average. Lack of domestic staff potentially prevents care staff from fulfilling their role of meeting residents needs. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: The residents spoken with felt that there were enough staff on duty to meet their needs, on the day of inspection there was no cook on duty, therefore care staff were having to prepare meals, taking them away from their role of caring. The provider stated that all staff had received training up dates and additional training was in the process of being arranged. He also stated that all staff had received a POVAFirst check and all CRBs had been applied for, however he was unable to evidence staff files as they were locked in the office and he had not got the keys. Old Rectory, The DS0000033891.V291105.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,38 Quality in this outcome area is good. Appropriate safety tests ensure that residents live in a safe environment. This outcome has been made from evidence gathered before and during the visit to the service EVIDENCE: The position of manager is currently vacant, however the provider has clearly worked very hard to address issues raised at previous inspections. The provider evidenced regular fire safety training, tests and inspection of equipment. Appropriate action is taken to prevent legionella. The landlords safety check has been completed. The provider has implemented detailed risk assessments for residents and the environment.
Old Rectory, The DS0000033891.V291105.R01.S.doc Version 5.1 Page 17 Old Rectory, The DS0000033891.V291105.R01.S.doc Version 5.1 Page 18 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X X X 3 Old Rectory, The DS0000033891.V291105.R01.S.doc Version 5.1 Page 19 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 OP37 Regulation 4.1c, 7, 9, 19, Requirement The Registered Person must maintain records detailed within Schedule 1 & Schedule 2. (previous timescale 30.09.05) The Registered Person must ensure that the premises are kept in a good state of repair externally and internally. Timescale for action 30/06/06 2. OP19 23.4 30/07/06 3. OP29 19 Sch 2 (6,7) All staff employed must have two 30/06/06 written references, a criminal record certificate on file and available for inspection. (previous timescale 30.08.05) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP17 Good Practice Recommendations The registered person should make herself and staff aware of the local ‘Age Concern Advocacy Scheme’.
DS0000033891.V291105.R01.S.doc Version 5.1 Page 20 Old Rectory, The 2. OP19 A written programme of routine maintenance and renewal of the fabric and decoration of the premises should be developed. Staff should be expected to confirm that they have read and understood all the Home’s policies and procedures by means of a recorded signature and date. Staff should receive training on bereavement The registered person should ensure that medication is documented accurately and signed by the GP and a record of medication received in the home is kept. Carpets and decorating highlighted at previous inspections should be replaced. The provider should ensure that catering and domestic staff are on duty enabling care staff to care. A registered manager should be appointed as soon as possible. 3. OP33 4. 5. OP11 OP9 6. 7 8 OP19 OP27 OP31 Old Rectory, The DS0000033891.V291105.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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