Inspection on 08/12/05 for The Old Rectory

This inspection was carried out on 8th December 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 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 04/04/09

The Old Rectory 09/04/08

The Old Rectory 29/10/07

The Old Rectory 15/06/07

The Old Rectory 07/12/06

The Old Rectory 31/05/06

The Old Rectory 07/07/05

The Old Rectory 06/11/04

The Old Rectory 22/06/04

The Old Rectory 24/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE The Old Rectory 195 Wigan Road Standish Wigan Greater Manchester WN6 0AE Lead Inspector Kath Smethurst Unannounced Inspection 8th December 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Old Rectory DS0000005756.V270825.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. The Old Rectory DS0000005756.V270825.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Old Rectory Address 195 Wigan Road Standish Wigan Greater Manchester WN6 0AE 01257 421635 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 Megraj Jingree Mrs Premila Jingree Mrs Premila Jingree Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10), Physical disability over 65 years of age (1) of places The Old Rectory DS0000005756.V270825.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within the maximum number of 10 registered places , there can be up to10, OP and up to 1 PD(E) place. 7th July 2005 Date of last inspection Brief Description of the Service: The Old Rectory is a large detached property in Standish. The home is situated on the main road to Wigan and Standish town centres and is approximately five minutes drive from local amenities. The Home offers 8 single rooms on the first floor, of which 3 have en suite facilities and 1 shared room on the ground floor. There is limited parking at the front of the Home and a small garden area at the rear. The Old Rectory Care Home provides care and support for up to 10 male and female residents over the age of 65 years. The Old Rectory DS0000005756.V270825.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 started at 10 am. It took place over four and a half hours during the morning and afternoon. The inspector looked around some but not all of the home, checked care plans and some records. To get more information about the home the inspector spoke to four residents, three visitors, the manager and one member of staff. What the service does well: What has improved since the last inspection? What they could do better: Staff need to make sure that residents who administer their own medication have a risk assessment in order to ensure they able to do this safely. The Old Rectory DS0000005756.V270825.R01.S.doc Version 5.0 Page 6 Additional staff need to be recruited in order that staff don’t work very long hours. This needs to be addressed to make sure the quality of care provided for residents is of a good standard. Not all staff have received the training they need. More first aid and NVQ (National Vocational Qualification) training is needed in order that staff can do their jobs properly. Residents and their relatives need to be consulted more often and asked what they think about the care, food, staff and environment. By doing this the manager will be able to put things right people are unhappy about, as well as showing residents views are taken seriously and acted upon. 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 DS0000005756.V270825.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Old Rectory DS0000005756.V270825.R01.S.doc Version 5.0 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): Not inspected during this visit. EVIDENCE: Standard 3 was examined during the inspection undertaken on the 7 July 2005 and was found to be satisfactory. The Old Rectory DS0000005756.V270825.R01.S.doc Version 5.0 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&9 Care plans were detailed, up to date and provide staff with the information they need when delivering care. Medication administration systems need to be reviewed to ensure resident’s medication needs are met. Some medication records did not accurately record handling of medication in the home. EVIDENCE: Three care plans were inspected. All contained information relating to residents personal, social and health care needs. The plans were easy to read, had been regularly reviewed and set out clear guidance for staff to take when providing care. There was written evidence that the plans had been signed and agreed by either the residents or their representatives. The residents and visitors spoken to all said they were satisfied with the care provided. For example one visitor said staff “ looked after residents tremendously well”. The care plans examined contained some very good information in respect to residents past lives, needs, likes/dislikes and chosen lifestyle. For example one read, “X likes to spend most of her time in her room” a second “Enjoys TV and chatting does not like activities”. The Old Rectory DS0000005756.V270825.R01.S.doc Version 5.0 Page 10 Risk assessments were in place in all files examined. They covered areas such as nutrition, pressure areas and moving and handling. All had been reviewed and updated on a regular basis. Procedures were seen in the Home that described safe medication handling. There are no residents who had been prescribed controlled drugs but a system is in place for recording controlled drugs if prescribed. Records of unwanted medication sent for disposal were maintained. A name and initial list is not maintained for trained carers administering medication, this is recommended to assist in the identification of initials used on the administration records. The medication storage was secure and orderly. Medication Administration Records (MAR) were supplied by the pharmacy except for example when additional medication was provide mid-month then, care staff made hand written entries. Handwritten entries were not signed, checked or independently countersigned. This is recommended to reduce the risk of errors. The medication records inspected were in the main up to date. However there was an occasional lack of clarity in records. For example it was noted that one resident had pain medication stored. This medication was dispensed in May 2005 but was not recorded on the MARS sheet. This was discussed with the manager who indicated the resident no longer required it. In this situation it should be returned to the pharmacy for destruction. None of the service users currently administers all their prescribed medication but one resident self-administers some of her medication. There was no assessment of this resident’s ability to safely self-administer. Assessment documentation needs to be completed for any resident who self-administers his or her own medication. The risk assessment needs to be signed and dated by both the resident and staff. Risk assessments must also be regularly reviewed to ensure resident’s ability to manage their own medication is not compromised. The Old Rectory DS0000005756.V270825.R01.S.doc Version 5.0 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): 14 In the main personal support is offered in such a way as to enable residents to exercise choice and control over their lives. EVIDENCE: Residents and visitors spoken to expressed satisfaction with care provided and organisation of life at the home. Observation of care practice and information in care plans indicated residents are encouraged to make choices. For example in respect to where they spend their day. While some residents chose to sit in the lounge a number were observed to spend their time in their own rooms. This was further illustrated in care plans. For example one care plan instructed staff that a resident is “able to choose outfits” while a second indicated that the resident likes to go to bed “ about 9 to 10 pm” and “ has personal items in her room but likes to use the lounge”. The Old Rectory’s policy on admission is that residents are encouraged to bring in personal items that will help them to settle in to life at the home, the extent of which is agreed prior to admission. Evidence of personalisation was seen in resident’s bedrooms where personal mementoes and photographs were on display. The manager advised that residents were able rise and retire when they wished. Residents who were able to comment also confirmed this. Most residents hand over hand the responsibility for their financial affairs to their The Old Rectory DS0000005756.V270825.R01.S.doc Version 5.0 Page 12 representatives. However if possible residents are encouraged to manage their own finances. The Old Rectory DS0000005756.V270825.R01.S.doc Version 5.0 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): 18 The policies of the home ensure residents are safeguarded from abuse or harm, but staff need updated training so they are fully conversant with procedures to ensure they are aware of the steps to take in a case of suspected abuse. EVIDENCE: The Home has an adult and whistle blowing policy and procedure in place. The procedure includes details of potential indicators of abuse and the steps to take if there was a suspicion or allegation of abuse. The procedure states “Staff who know that abuse may be happening should report their suspicions immediately to management, person in charge or in the absence of a manager appropriate third party”. Discussion with the staff indicated they were aware of the action to take in the event of a case of suspected abuse. Although the procedures give clear guidance for staff the manager is advised to obtain a copy of the new local authority “Protecting Vulnerable Adults” policy in order to make sure the homes own policy is compatible. It was noted in training records that staff had not routinely undertaken training in the protection of vulnerable adults. This needs to be addressed in the staff development programme to ensure staff are fully aware of abuse procedures and of the action to take if such a situation arises. The Old Rectory DS0000005756.V270825.R01.S.doc Version 5.0 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 There have been no recent changes to the décor or furnishings and although this does not pose a risk to resident’s plans need to be made to renew furniture to ensure standards don’t fall below an acceptable level. EVIDENCE: Externally the home is well maintained. There is a small garden area, which is accessible to residents. Communal areas comprise of a lounge and dining room. Ornaments and pictures enhance the homeliness of these areas. Residents have personalised their bedrooms with small items of furniture, ornaments and personal mementoes. A number of residents were seen to use the privacy of their own rooms. Residents and visitors spoken to made no adverse comments about environmental standards in the home. During the last inspection it was noted that a written planned programme of maintenance had not been developed. Some progress has been made in addressing this however further development is required to ensure residents live in a well-maintained environment. For example in respect to dining room The Old Rectory DS0000005756.V270825.R01.S.doc Version 5.0 Page 15 and bedroom furniture. While functional dining room chairs, some wardrobes, dressing tables and lockers are old and showing signs of wear and tear. As part of the renewal programme plans should be made as to when in the future these items are to be replaced. The Old Rectory DS0000005756.V270825.R01.S.doc Version 5.0 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 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 & 30 Additional staff need to be recruited to ensure the needs of residents are fully met and the standard of care is not compromised. A staff training programme is in place, but further development is needed to ensure staff receive more training, in order they are equipped with the skills and knowledge needed when delivering care. EVIDENCE: Discussion with the manager and information in care plans indicated that the dependency levels of residents in the home are relatively low. For example the majority are independently mobile and require minimal assistance with personal care and during the night. The duty roster indicated that during the day of visit two care staff were on duty supported by the owner who was responsible for preparing meals. One member of staff covers the waking night shift, whilst one member of staff sleeps in. While the numbers of staff rotered to work was sufficient to meet residents needs it was noted that both the owner and manager had been working very long hours. For example during one week in November the manager worked 70 hours and undertook 4 sleep in duties. This was discussed with the manager who advised this situation had arisen recently due to staff resignations. The manager said she was in the process of recruiting additional staff and hoped to resolve this issue in the near future. It is important additional staff are recruited as the number of hours worked by both the manager and owner could eventually compromise the quality of care provided. For example while dependency levels of residents are relatively low this can change given that the The Old Rectory DS0000005756.V270825.R01.S.doc Version 5.0 Page 17 needs of older people can increase suddenly as a result of an accident, illness or as part of the ageing process. In addition the effect of working very long hours for an extended period could eventually take a toll on staffs own health and well being which could affect the quality of care provided. This needs to be addressed as a priority to ensure an appropriate number of staff is provided. While recruitment was not examined in depth during this inspection the manager was advised that when new staff were recruited new POVA/CRB checks would need to be completed as the checks could not be transferred between from one employer to another. Residents spoken to said that the staff looked after them well. However from checking staff training records it was found that some areas of staff training programme needs to be further developed. No new staff have been employed recently so induction training could not be examined in depth. However a blank induction pack was seen and was found to meet the National Training Organisation (NTO) specifications. Examination of a sample of staff training records showed that in 2005 they had completed moving and handling, food hygiene, medication and health and safety training. While the manager and owner are in receipt of NVQ level 4 (National Vocational Qualification) only one of the care staff has attained NVQ level 2. The manager is advised to undertake a detailed review so as to assess progress in meeting the required 50 target of NVQ qualified staff. It was also noted that not all staff left in charge of the home had completed first aid training. The manager advised that first aid training had been organised in January, February and March 2006. To be followed up at the next inspection. The Old Rectory DS0000005756.V270825.R01.S.doc Version 5.0 Page 18 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): 33 Quality assurance systems need to be improved to ensure the performance of the home is regularly monitored and to provide evidence resident’s views are sought and acted upon. EVIDENCE: While some quality assurance systems are in place further development is needed. The home has a system for recording the complaints of those who don’t wish to complain formally. Residents are informed of CSCI inspections and inspection reports are available for visitors and residents to read. Staff meetings are held regularly the last one took place on the 30/9/05. It was apparent from the comments of residents and visitors spoken to that they were consulted on an informal basis there was no written evidence of the feedback received. For example one visitor who was visiting from overseas said the manager contacted her regularly to discuss her relatives care and ascertain her views. However discussions with resident’s representatives had The Old Rectory DS0000005756.V270825.R01.S.doc Version 5.0 Page 19 not been recorded. The manager indicated that residents meetings were held but there was no written evidence of the outcome of these meetings or the issues discussed. Satisfaction surveys have been developed but have not been completed by residents or their relatives since 2003. All these areas need to be addressed to provide further evidence the home is run in the best interests of the residents. The Old Rectory DS0000005756.V270825.R01.S.doc Version 5.0 Page 20 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 2 X X X X X X X STAFFING Standard No Score 27 2 28 2 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X X X The Old Rectory DS0000005756.V270825.R01.S.doc Version 5.0 Page 21 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. 1. Standard OP9 Regulation 13 Timescale for action For residents who self-administer 31/12/05 some of their medication a risk assessment must be completed. An audit must be undertaken to ensure medication stored (Paracetamol) for residents is still prescribed and if it is this must be detailed on the MARs sheet. 31/12/05 Requirement 2. OP9 13 3. OP27 18 Additional staff must be recruited 31/01/06 to ensure staff do not work excessive hours and that unexpected contingencies can be covered. Details of how this is to be addressed to be forwarded in the action plan. Action must be taken to ensure 31/01/06 that 50 of staff attains NVQ level 2. Details of this to be addressed to be forwarded in the action plan. All new staff must complete a 31/12/05 new POVA/CRB application before they commence work, as these checks are not transferable between employers. DS0000005756.V270825.R01.S.doc Version 5.0 Page 22 4. OP28 18 5. OP29 19 The Old Rectory 6. 7 OP30 OP33 12 24 Staff must undertake first aid training. An effective quality assurance system must be developed with the results of surveys published and made available to service users, significant others and the CSCI. See body of report for details. 31/03/06 31/03/06 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. 3. 4. 5. Refer to Standard OP9 OP9 OP18 OP18 OP19 Good Practice Recommendations Handwritten MARs entries should be signed, checked and countersigned by two staff. A list of trained carers responsible for administrating medication, their initials and training date should be maintained. A copy of the new local authority “Protecting Vulnerable Adults” procedure should be obtained. Vulnerable adults training should be updated every two years. As part of the planned programme of renewal consideration should be given to replacing dining chairs and bedroom furniture. The Old Rectory DS0000005756.V270825.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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 DS0000005756.V270825.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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