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Inspection on 30/06/05 for The Old Rectory

Also see our care home review for The Old Rectory for more information

This inspection was carried out on 30th June 2005.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has a detailed Statement of Purpose in place to ensure that potential service users have enough information to assist with a decision about moving. Prospective service users are invited to visit prior to any move to the home. The home has regular input from the GP and District Nurse, to address specific medical needs as necessary. All staff administering medication have received appropriate training from the pharmacist supplying the medication. Service users spoken with stated that the staff were lovely and felt that they were treated with respect. The manager ensures that information relating to service users wishes in the event of terminal illness and death are detailed on their care file. Friends and relatives are always made to feel welcome and can visit without restriction. Details of the complaints procedure are made available to service users. The home was clean.

What has improved since the last inspection?

The manager has started to provide more planned activities, enabling service users to become involved with the local community. A clothing party had also been arranged since the previous inspection. Of the 11 care staff employed by the home 1 has achieved NVQ 2, 4 are completing and 2 are completing NVQ 3. The Registered manager has completed registration with the Commission and is currently completing NVQ 4.

What the care home could do better:

Care files need to have more information documented relating to the service users in order to ensure that all of their needs and wishes are met. The manager needs to consult with the service users and or relatives, when preparing assessments of need and care plans. The terms and conditions of residence should be completed and signed. Medication records need to be documented more clearly and the GP should sign any hand written prescriptions. Medical needs of service users need to have a care plan in place to address these needs. Medical input from specialists should be sought, when specific health needs are highlighted. A number of areas were highlighted on the day of inspection for redecoration, new carpeting, new bedroom furniture and radiator/pipe covers. Wardrobes were light and could easily be pulled over, therefore need to be fixed to the wall to prevent injury. Staff files need to be kept up to date, staff should not be appointed without 2 written references and a completed Criminal Records Bureau check. The manager should keep a clear record of all training completed by staff and ensure that their training is kept up to date.

CARE HOMES FOR OLDER PEOPLE The Old Rectory 70 Risley Lane Breaston Derbyshire Lead Inspector Vanessa Davies Unannounced 30 June 2005 10.00am 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 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 C52 C02 S33891 The Old Rectory V239646 300605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Old Rectory Address 70 Risley Lane Breaston Derbyshire Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01332 874342 01332 874826 asheathuk@yahoo.co.uk Mr Allen William Heath Ms Jacinta Barker Care Home with Personal Care 21 places Category(ies) of 21 Older People registration, with number of places The Old Rectory C52 C02 S33891 The Old Rectory V239646 300605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 12.01.05 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 Old Rectory C52 C02 S33891 The Old Rectory V239646 300605 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced. In order to gather information for this report the inspector spoke with the proprietor, the registered manager and a number of service users. Care records, health and safety records, the complaints record and medication records and storage were examined. The inspector had a tour of the building. What the service does well: The home has a detailed Statement of Purpose in place to ensure that potential service users have enough information to assist with a decision about moving. Prospective service users are invited to visit prior to any move to the home. The home has regular input from the GP and District Nurse, to address specific medical needs as necessary. All staff administering medication have received appropriate training from the pharmacist supplying the medication. Service users spoken with stated that the staff were lovely and felt that they were treated with respect. The manager ensures that information relating to service users wishes in the event of terminal illness and death are detailed on their care file. Friends and relatives are always made to feel welcome and can visit without restriction. Details of the complaints procedure are made available to service users. The home was clean. The Old Rectory C52 C02 S33891 The Old Rectory V239646 300605 Stage 4.doc Version 1.40 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 Old Rectory C52 C02 S33891 The Old Rectory V239646 300605 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Old Rectory C52 C02 S33891 The Old Rectory V239646 300605 Stage 4.doc Version 1.40 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 standard(s) 1,2,3,5 There is sufficient information available to enable prospective service users to make an informed choice about the home. However limited information in the assessment of need means that service users needs are not fully met. EVIDENCE: The proprietor is currently having an extension to the home and has subsequently developed a new Statement of Purpose. This currently contains all of the information a prospective service user would need to know prior to any move to the home. Three care files were examined. Each of the files had limited information and areas with no information at all. Documentation to provide staff with detailed information is available, however it is not completed; eg. Hobbies & Social Activities was not completed in any file examined. There were no photographs of service users in their files, however there were photographs in the medication file. There was no evidence of any consultation with the family or the service user. There were no terms and conditions of residence completed and signed. The Old Rectory C52 C02 S33891 The Old Rectory V239646 300605 Stage 4.doc Version 1.40 Page 9 The manager stated that all prospective service users or their relatives are invited to visit the home prior to any move. On the day of inspection there were relatives looking around the home. The Old Rectory C52 C02 S33891 The Old Rectory V239646 300605 Stage 4.doc Version 1.40 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 standard(s) 7,8,9,10,11 Limited information and poor medication records prevent service users needs being met and potentially place them at risk EVIDENCE: As stated earlier in this report there was limited information on file relating to the needs of the service users. Care plans documented the needs but not how to address them. One file examined, the service user had epilepsy, however there was no care plan in place to manage this. Medication detailed in a file indicated heart problems, however again information was so limited that this was not highlighted and no care plan in place. In one file daily records detailed antibiotics prescribed to heal a kidney infection, however there was nothing documented to indicate that the service user had a kidney infection. There was evidence of input from the district nurse and the GP. There was no specific input from an epilepsy specialist nurse and staff had not received up to date training on managing epilepsy. All staff administering medication have received training from the chemist who supplies the medication. On one medication chart there was a hand written prescription for an antibiotic, this had not been signed by the GP and was not administered as per the prescription. The Old Rectory C52 C02 S33891 The Old Rectory V239646 300605 Stage 4.doc Version 1.40 Page 11 One care file examined stated that the service user had been prescribed Digoxin MGs (Milligrams), however the medication chart documented MCGs (Micrograms). Service users spoken with felt they were treated with respect and privacy was always maintained. The manager has details of service users wishes in the event of terminal illness or death, in the files examined. The Old Rectory C52 C02 S33891 The Old Rectory V239646 300605 Stage 4.doc Version 1.40 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 standard(s) 13 Families are made to feel welcome ensuring service users maintain contact with their community. EVIDENCE: Service users spoken with stated that family and friends visited without restriction and were always made to feel welcome. Relatives were visiting on the day of inspection. The Old Rectory C52 C02 S33891 The Old Rectory V239646 300605 Stage 4.doc Version 1.40 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 standard(s) 16 Complaints are dealt with appropriately and in a timely way ensuring service users feel listened to. EVIDENCE: The home has a complaints procedure on display and service users spoken with were confident that any complaint they needed to make would be dealt with promptly and appropriately. The manager stated that she keeps a record of all complaints made although this was not examined on the day of inspection. The Old Rectory C52 C02 S33891 The Old Rectory V239646 300605 Stage 4.doc Version 1.40 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 standard(s) 19,20,21,22,23,24,25,26 The home provides a clean environment, however a number of areas need to be addressed in order to ensure the needs, expectations and safety of service users are met. EVIDENCE: At the time of inspection the Old Rectory was having an extension built on the side, to provide additional bedrooms. In addition to the extension the provider has plans to make changes within the existing building. Areas in need of updating were highlighted. A small lounge area needs to have the carpet refitted as at present it is a safety hazard for service users unsteady on their feet. The stairs carpet needs to be replaced as it is threadbare. There is a bathroom on the ground floor with an assisted bath. On the first floor there is a bathroom with a bath not currently used, as part of the updating programme the provider intends to change this to a shower room. Rooms were identified by the inspector as needing new furniture, lockable storage, redecorating and wardrobes fixing to the wall or risk assessing as they were very light and easy to pull over. Radiators identified need to be covered or risk assessed. There The Old Rectory C52 C02 S33891 The Old Rectory V239646 300605 Stage 4.doc Version 1.40 Page 15 are sufficient toilets in the home. Some specialist equipment was evident and the provider stated that he intended to change an unused bath to a shower. Service users bedrooms were personalised and individual. The home was clean and free from any malodours. The Old Rectory C52 C02 S33891 The Old Rectory V239646 300605 Stage 4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Recruitment procedures at the home are not followed appropriately, therefore leaving service users potentially at risk. EVIDENCE: There are 3 staff on duty in the morning and 2 staff in the afternoon, the cook works Monday to Friday. The provider stated that either he or his wife worked in the kitchen at the weekend, however this was not reflected on the duty rota. The home employs 11 care staff, 1 has NVQ 2 Care, 4 are currently completing and 2 are doing NVQ 3. The inspector examined 4 staff files; 2 had all of the relevant information, however the other 2 files had information missing, in 1 there was no documented work history and only 1 reference and in the other there was only 1 written reference and no Criminal Records Bureau check. The training records were difficult to examine as certificates are kept in staff files. 3 staff need to complete fire training, the provider stated that some staff had completed Food Hygiene although certificates had not been received. The Old Rectory C52 C02 S33891 The Old Rectory V239646 300605 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,38 The home is generally well-managed, however there are a number of areas within this report to be addressed by the manager and provider to ensure the safety and well-being of the service users. EVIDENCE: The manager has recently successfully completed the Registration process with the Commission and manages the home well. She has a good positive relationship with staff and service users and works closely with the providers. The manager is completing NVQ 4 Equipment service records were seen and were up to date. Portable appliances had been tested in August 2004. An inspection by the Fire Authority had been undertaken in January 2005. The home’s electrical system received a five-year test in January 2002. Induction training had commenced for new staff. The Old Rectory C52 C02 S33891 The Old Rectory V239646 300605 Stage 4.doc Version 1.40 Page 18 The Old Rectory C52 C02 S33891 The Old Rectory V239646 300605 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 1 2 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 x COMPLAINTS AND PROTECTION 2 2 2 2 3 2 2 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 x x x x x 3 The Old Rectory C52 C02 S33891 The Old Rectory V239646 300605 Stage 4.doc Version 1.40 Page 20 YES 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. 1. Standard 7 Regulation 13 Requirement The Registered Person must ensure that any activities in which service users participate are so far as reasonably practicable free from hazards to safety. (previous timescale 01.07.04) The Registered Person must make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. (previous timescale 01.06.04) The Registered Person must maintain records detailed within Schedule 1 & Schedule 2. The Registered Person must ensure that unnecessary risks to the health and safety of service users are identified and eliminated.(previous timescale 01.05.04) The registered person must ensure that all staff are appropriately supervised. (previous timescale 01.08.04) The registered person must maintain all records detailed in Schedules 3 - 4.(previous Timescale for action 30.09.05 2. 10 12.4 a 30.09.05 3. 37 4. 25 4.1 c, 7,9,19 Sch 1, Sch 2 13.4 c 30.09.05 30.11.05 5. 36 18 30.09.05 6. 37 17 30.09.05 The Old Rectory C52 C02 S33891 The Old Rectory V239646 300605 Stage 4.doc Version 1.40 Page 21 timescale 01.07.04) 7. 38 13.4 a The Registered Person must ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. (previous timescale 01.09.04) The responsible individual must ensure that the recommendations made on the fire risk assessment are carried out.(previous timescale 01.03.05) The Registered Person must ensure that all parts of the home are reasonably decorated.(previous timescale 01.05.05) The Registered Person must ensure that the premises are kept in a good state of repair externally and internally.(previous timescale 01.05.05) The Registered Person must ensure that service users bedrooms have adequate furniture to meet their needs..(previous timescale 01.05.05) The needs of the service users must be assessed by a suitably qualified person and a copy of the assessment is kept on file. The registered person must ensure that there has been appropriate consultation regarding the assessment with the service user or representative. The registered person must ensure that proper provision is made to promote the health and welfare of the service users. Service users health needs must be fully met and where 31.08.05 8. 19 23.4 31.10.05 9. 19 23.2 d 31.10.05 10. 20 23.2 b 31.10.05 11. 24 16.2 c, 23.2 b 31.10.05 12. 3 14.1 30.09.05 13. 3 14.1 c 30.09.05 14. 7 12.1a 30.09.05 15. 8 13.1 b 30.11.05 Page 22 The Old Rectory C52 C02 S33891 The Old Rectory V239646 300605 Stage 4.doc Version 1.40 16. 9 13.2 17. 9 17.1a Sch 3 (3)(m) 18. 27 17.2 Sch 4 (7) 19 Sch 2 (6,7) 18.1 c i 19. 29 20. 30 necessary advice and other services from a health professional gained. The registered person must make arrangements for the recording, handling, safe keeping, safe administration and disposal of medicines received into the care home. The registered person must keep a record of details of any plan relating to the service user in respect of medication, specialist health care. The duty roster of persons working at the home and whether the roster was worked, must be kept. All staff employed must have two written references, a criminal record certificate on file and available for inspection. All staff must receive training appropriate to the job they perform. 30.09.05 30.09.05 30.09.05 31.08.05 31.11.05 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. 2. 3. 4. 5. Refer to Standard 7 7 17 19 27 Good Practice Recommendations Daily notes on residents’ behaviour and experiences should be recorded on individual sheets to facilitate the review of care plans. Where intervals between entries on daily record sheets are longer than one week it is recommended that a summary entry is made for the week. The registered person should make herself and staff aware of the local ‘Age Concern Advocacy Scheme’. A written programme of routine maintenance and renewal of the fabric and decoration of the premises should be developed. The registered person should ensure, by means of a communication system, that the waking member of night C52 C02 S33891 The Old Rectory V239646 300605 Stage 4.doc Version 1.40 Page 23 The Old Rectory 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 30 30 33 33 37 8 24 11 3 2 9 19 21 30 staff can quickly communicate with the sleeping-in member of night staff. A record of mandatory and additional training undertaken by staff should be developed. A suitable model was discussed with the Manager. Staff should be provided with training on dementia. The registers persons should provide an annual development plan for the Home. 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. The Manager should regularly monitor the standard of residents’ records and show evidence of this by entering her initials on these records, or by some other means. The Manager should undertake a refresher course of training in the management of continence. The Registered Provider should make an assessment of all bedrooms in respect of standard 24, paragraph 2. Staff should receive training on bereavement The registered person should ensure that relevant documentation relating to the needs of service users is completed. The registered person should ensure that the terms and conditions of residence are signed by the service users or representative. The registered person should ensure that medication is documented accurately and signed by the GP. Carpets and decorating highlighted on the day of inspection should be replaced. The registered person should ensure that bathrooms are accessible to service users. The registered person should ensure that staff receive training in Fire safety, food hygiene, adult protection. The Old Rectory C52 C02 S33891 The Old Rectory V239646 300605 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection South Point Cardinal Square Nottingham Road Derby DE1 3QT 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 The Old Rectory C52 C02 S33891 The Old Rectory V239646 300605 Stage 4.doc Version 1.40 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. 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