Inspection on 30/01/06 for The Old Rectory

This inspection was carried out on 30th January 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 24/11/06

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 Unannounced Inspection 10:45 30 January 2006 th 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.V260948.R01.S.doc Version 5.0 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.V260948.R01.S.doc Version 5.0 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 01929 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.V260948.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 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. DS0000064826.V260948.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on 30th January 2006. This was the first inspection undertaken since the change of ownership and management that took place in September 2005. The new owners were aware prior to the purchase that this home did not meet a number of standards and that a great deal of work was required both to the building and with regard to policies, procedures, documentation and staff development. The purpose of this visit was to assess the progress that has been made so far and agree how further improvements will be implemented. The inspection also assessed that the people who are living in the home continue to be 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 and staff. The manager was available throughout the inspection. The change of ownership responds to needs in community with plans to change registration to admit dementia and improve building with extension and refurbishment existing. Lots of paperwork, policies, procedures are out of date and in need of review or replacement which is being addressed gradually. Lot of standards don’t meet full compliance but it is recognised that there is lots of work to do and this is being done whilst trying to maintain the usual level of care the residents have come to expect. 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. The new owners have already refurbished many areas of the home including some bedrooms and a high standard of décor and furnishings has been achieved. 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 new programme of activities that is gradually being introduced. DS0000064826.V260948.R01.S.doc Version 5.0 Page 6 The Inspector spent time with the residents and received a number of positive comments about the management, staff and facilities in the home. A number of comments such as, “I couldn’t ask for a better place”, “I’m waited on hand and foot” and “they’re all excellent” were made. Three residents also raised minor issues that did bother them and were very confident for these to be fed back to the manager. This is a positive thing as it demonstrates that they feel comfortable and confident that they can raise issues and receive appropriate responses. What has improved since the last inspection? What they could do better: As stated previously in this report there has been a great deal of work required at The Old Rectory to achieve full compliance. This inspection has shown that progress has been made in a number of areas and the manager is clear about the work still required and how this will be done. Twenty of the twenty-one key standards were assessed on this occasion. Medication was not assessed, as the CSCI pharmacy inspector will visit the home to undertake a review of this standard. Mrs Adams has clearly prioritised her work so far and undertaken the improvements whilst ensuring that residents continue to receive a good standard of care. Areas that still require improvement are as follows: • Policies and procedures with regard to the protection of residents from abuse must be reviewed and amended. Staff must receive training in the recognition of abuse and the actions they should take. • Currently only 30 of staff have achieved the minimum NVQ level 2 qualification in care and the requirement is that 50 of staff must be trained. • Recruitment and vetting procedures must be reviewed to ensure that they comply with the requirements placed upon the home with regard to checks with the Protection of Vulnerable Adults list and the Criminal Records Bureau. All staff, including existing staff should have a Criminal Records Bureau check. DS0000064826.V260948.R01.S.doc Version 5.0 Page 7 • • • • • Development of staff induction programmes must be completed and then training implemented to ensure, and demonstrate, that staff have the required competencies. Quality assurance systems must be fully developed and implemented to demonstrate that the home is run in the best interests of the residents. Policies and procedures for the handling of resident’s pocket money should be reviewed to provide greater protection for both residents and staff. Staff should be aware of all relevant policies and procedure and the manager must be able to demonstrate that they are aware. Training of staff in fire prevention and the actions to take in the event of a fire must take place at the required intervals and drills must also be undertaken to ensure that residents are also aware, where possible, of the procedure to be followed in an emergency. 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. DS0000064826.V260948.R01.S.doc Version 5.0 Page 8 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.V260948.R01.S.doc Version 5.0 Page 9 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 and 5 Assessments of residents and their needs, prior to their admission, were satisfactory. This means that residents and their representatives should feel confident that the home is aware of all the needs of the person and is able to meet them. Procedures for emergency admissions are satisfactory therefore ensuring that a residents’ needs will quickly be identified and responded to. EVIDENCE: Pre-admission assessments for 3 residents, accommodated in the home, were examined. It was found from these records that a comprehensive system has been introduced which meets the requirements of the National Minimum Standards. One recent admission had been on an emergency basis. Documentation evidenced that required procedures and records were made within the prescribed 48 hours. DS0000064826.V260948.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 and 10 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 and at home and their privacy is respected. 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. DS0000064826.V260948.R01.S.doc Version 5.0 Page 11 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.V260948.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Recent improvements in the range of activities available in the home mean that residents expectations have been met and surpassed and have also given them a greater range of interests. Relatives and visitors are welcome in the home at any time with no restrictions. 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. EVIDENCE: Since taking over the management of the home, Mrs Adams has reviewed the activities and entertainments available to residents and is gradually introducing a wider range of activities. Residents reported that they have enjoyed a number of things over the past few months including a Christmas party with visiting carol singers and a brownie pack. 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 DS0000064826.V260948.R01.S.doc Version 5.0 Page 13 available in the lounge. The manager advised that they hope to have a vehicle in the future to enable them to take people on trips out. 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. It was noted that the record of meals provided, which is used to evidence dietary intake, had not been completed for some time. DS0000064826.V260948.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 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 can feel confident that they would be listened to and matters of concern will be acted upon. Whilst, in practice, staff knowledge and skills should protect residents from abuse, staff training and policies and procedures need to be reviewed and updated. EVIDENCE: The home has a satisfactory complaints procedure that is included in the Service Users Guide. Those spoken to said that they would feel comfortable in making a complaint. No complaints have been made either to the home or the Commission since the change of ownership. It was suggested that the complaints procedure also be displayed prominently in the home to ensure that visitors to the home are also aware of the procedure should they have any concerns. Mrs Adams confirmed that she is developing a training plan for staff and this includes training in recognising and preventing abuse. The abuse policy was examined. It provides basic information but did not have enough detail about the types of abuse and actions staff at various levels should take. Contact details of the local CSCI office were also not included. DS0000064826.V260948.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The new owners have already made considerable investment in the interior décor and furnishing of the home creating a better and more comfortable environment for those living there and visiting. Further works are planned which will make even greater improvements to the environment and facilities for residents. The home maintains a good standard of hygiene and all areas seen were clean and free from offensive odours. EVIDENCE: Since taking over the ownership of the home in September 2005, JLH Healthcare Ltd have redecorated and refurnished a number of bedrooms and also the entrance hall. New carpets have also been provided in a number of areas. One room was identified as having a very poor quality bed and curtains that did not meet. The manager agreed to provide new curtains and see if the resident concerned would like a new bed. A new shower room and new call bell system have also been provided. DS0000064826.V260948.R01.S.doc Version 5.0 Page 16 All areas of the home were found to be clean and tidy and free from offensive odours. Staff are currently undertaking training in infection control and the relevant protective clothing was available. DS0000064826.V260948.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28, 29 and 30 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. Staff have experience in caring for the elderly and a number are undertaking training to further develop their abilities and competencies. Vetting and recruitment practices for the appointment of new staff are out of date. The home has therefore potentially put residents at risk. 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. 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. 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 DS0000064826.V260948.R01.S.doc Version 5.0 Page 18 planning to enrol staff on courses in the near future. She reported that staff are keen to undertake training. Staff records were examined for two newly appointed members of staff. These demonstrated serious omissions as both staff had commenced their duties without a POVA (Protection of Vulnerable Adults) or CRB (Criminal Records Bureau) check. It was also noted that a number of the existing staff did not have references, CRB checks and proof of identity. 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.V260948.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 The management arrangements for the home support good care practices for the residents. The manager also has a good understanding of the areas of weakness in the home and was able to demonstrate that strategies for addressing these issues are either in place or being developed. 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. Procedures for the management of resident’s pocket money must be reviewed and improved in order to safeguard the rights and best interests of the residents. 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.V260948.R01.S.doc Version 5.0 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. 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 minor anomalies were found. Accident books and risk assessments were examined and found to be up to date and detailed. Staff training in fire prevention and the action to take in the event of a fire was out of date as were the fire drills/evacuations. DS0000064826.V260948.R01.S.doc Version 5.0 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 3 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 3 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 1 X 2 1 DS0000064826.V260948.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? 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 are safeguarded from all forms of abuse. Policies and procedures must reflect current guidance and include reference to the DoH guidance No Secrets as well as the local interagency interpretationof this document. CSCi contact details must be ncluded. Staff must be trained in the recognitionof abuse and the actions they should take should they suspect abuse. The registered persons must ensure that all persons employed are fit to work in the home. The registered persons must obtain in respect of each person the documents listed in schedule 2 of the Care Homes Regulations 2001 and must be satisfied as to the authenticity of the references and information received. New staff must only be confirmed in post following completion of a satisfactory CRB and POVA check. All existing staff must have CRB checks. Detailed policies and procedures for the handling of all money or DS0000064826.V260948.R01.S.doc Timescale for action 1 OP18 12 & 13 31/03/06 2 OP29 19 31/03/06 3 OP35 9 28/02/06 Page 23 Version 5.0 4 OP38 23 other valuables deposited with the home by a resident must be developed. Clear records must be kept and residents should sign for any transactions. Where this is not possible a second signature should be obtained from a member of staff who must witness the transaction. Staff must receive training, at the required intervals, in fire prevention and the actions to take in the event of a fire. Fire drills must be carried out at the required intervals to ensure that persons working at the home and, so far as practicable, residents, are aware of the procedure to be followed in the case of fire, including the procedure for saving life. 10/02/06 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 Refer to Standard OP28 OP30 Good Practice Recommendations 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. 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. 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. Staff should be aware of the homes policies and procedures in order that they work in accordance with these. 3 OP33 4 OP37 DS0000064826.V260948.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 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 DS0000064826.V260948.R01.S.doc Version 5.0 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. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!