Inspection on 08/07/08 for The Old Rectory

This inspection was carried out on 8th July 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Old Rectory 20/12/07

The Old Rectory 24/09/07

The Old Rectory 24/11/06

The Old Rectory 30/01/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE The Old Rectory Langton Matravers Swanage Dorset BH19 3HB Lead Inspector Catherine Churches Unannounced Inspection 09:30 8 and 15th July 2008 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 The Old Rectory DS0000064826.V366767.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Old Rectory DS0000064826.V366767.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Rectory 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 425396 DAH Healthcare Ltd Vacant Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places The Old Rectory DS0000064826.V366767.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. 3. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 34. A maximum number of 23 service users who require nursing care may be accommodated. 20th December 2007 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 34 people in the category of Care Home with nursing. A maximum of 23 people with nursing needs may be accommodated. Certain rooms, known to the owner and manager, may only be used for residential care, as they are too small to support good nursing care practice. Three rooms are registered as doubles. Accommodation is arranged on the ground and first floor levels in twenty eight single rooms and 3 double rooms. All of the rooms have ensuite facilities. There are two passenger lifts to the first floor enabling level access to all but four bedrooms. Fees at the time of the inspection ranged from £595 to £695 The Old Rectory DS0000064826.V366767.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced inspection, which took place on 8th and 15th July 2008. In total 10 hours were spent in the home undertaking the inspection. As the home had previously been noted by the Commission as poor, two inspectors were present for the whole inspection. The inspection took place as part of the regular, programmed inspection schedule for the home. The last inspection was December 2007. The purpose of this visit was to monitor the homes compliance with National Minimum Standards and progress with requirements and recommendations made during previous inspections. Also, to check that the home is run in a satisfactory manner and that the people who are living in the home are properly cared for. The premises were inspected and a number of records examined. Time was also spent time observing routines within the home and talking with residents, visitors and staff. Prior to the inspection surveys were sent to residents and staff in the home. Ten surveys were completed by staff and returned. None were received from residents. During the inspection 4 surveys were handed to visiting relatives and these were completed. What the service does well: The service has made many improvements since the last inspection in December 2007 and January 2008. We found the home to be relaxed with a happy and homely atmosphere. Residents looked happy and settled; they were dressed in clean clothes, were clean and looked well cared for and exhibited signs of positive well-being. Staff were smiling and friendly and made positive comments to the Inspectors about the improvements in the home and the management of it. The Old Rectory DS0000064826.V366767.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The last inspection report highlighted a great deal of work was required to ensure that the home met National Minimum Standards. The Clinical Director has appropriately prioritised the work that was required and there are now only four requirements. Improvements now need to be evidenced with regard to: The Old Rectory DS0000064826.V366767.R01.S.doc Version 5.2 Page 7 The must have suitable sluicing facilities to help prevent the spread of infection and ensure that proper cleaning can be undertaken. The complaints system needs to be used properly and any complaints made must be suitable documented to evidence that they have been investigated and what actions have been taken. The safe recruitment of staff - no staff have been recruited since the last inspection although existing staff files have been properly updated. The proposed Quality Assurance and Quality Monitoring system needs to be fully implemented. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Old Rectory DS0000064826.V366767.R01.S.doc Version 5.2 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 The Old Rectory DS0000064826.V366767.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A satisfactory pre admission procedure is now in place. Assessments are undertaken and this means that the home tries to ensure that only those residents whose needs can be met by the home are offered places at The Old Rectory. EVIDENCE: Only one person has been admitted to the home since the last inspection. Their file was reviewed: Assessments have improved and the documentation has been expanded. Evidence was available that the resident and/or their representative had been involved. A Letter to the prospective resident confirmed that, following an assessment, the home can meet their needs, was also available. The Old Rectory DS0000064826.V366767.R01.S.doc Version 5.2 Page 10 The Old Rectory DS0000064826.V366767.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care planning system has been improved. Each individual has a detailed, person centred plan of care and residents or representatives are involved where possible in its development and review. The care plan provides good evidence of the care that is being delivered. The health needs of residents are actively promoted with good consultation and communication with local health services. Management and administration of medication has improved leading to better healthcare for residents and reduced risk to residents from wrong administration of their medication. EVIDENCE: The Old Rectory DS0000064826.V366767.R01.S.doc Version 5.2 Page 12 The care documentation for three residents was reviewed. Each file contained up to date risk assessments, care plans, daily records and reviews. Care plans covered all areas required under the National Minimum Standards and were individual, person centred documents that were up to date and informative. The quality of the entries by staff in records has improved following training. Reviews were being undertaken at the required intervals and changes in need were reflected in an updated care plan. Nutritional screening has been introduced since the last inspection. Evidence was available that the resident and/or family member had been involved in the creation of the care plan. Staff confirmed that residents have access to medical services. Records are kept of visits from GP’s, district nurses, chiropodist, optician and dentist. The home has a satisfactory medication policy and procedure. Medicines are stored securely and only those staff that have undertaken appropriate training in medicines administration are authorised to give medicines to the residents. Records were kept of the receipt, administration and disposal of medicines. Examination of records indicated that medicines are properly administered in accordance with the prescriber’s instructions. Observation during this inspection and discussion with staff evidenced that resident’s privacy is respected and that they were treated with dignity. Staff were seen to knock at bedroom doors and treated residents with courtesy and kindness. Records noted resident’s preferred form of address and these were heard to be used by staff. All residents seen were well presented. During the course of the inspection visiting relatives were spoken with and surveys were also received from 4 relatives. The following comments were received “My mother feels safe, comfortable and happy as she can be given her great age and failing health. She is treated with respect and tenderness and her dignity is always preserved. The nursing care is excellent and staff talk to her about treatment even if she is really unable to understand it fully, so she feels she is consulted. She has a sense of humour and the staff nourish this too. This maintains her identity I think.” “The nursing and caring staff attend to my mother with great care” The Old Rectory DS0000064826.V366767.R01.S.doc Version 5.2 Page 13 The Old Rectory DS0000064826.V366767.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Old Rectory provides a caring, homely and relaxed environment. The range of recreational activities available in the home has been reviewed and improved. Open visiting arrangements are in place enabling residents to retain contact with families and friends. The food in the home is good quality, well presented and meets the dietary and cultural needs of people who use the service. Staff are trained to help those individuals who need help when eating and are sensitive in their approach. EVIDENCE: The provision of appropriate and meaningful activities for the residents has improved since the last inspection; Furniture in the main communal area has been rearranged making the room far more spacious and easier for residents The Old Rectory DS0000064826.V366767.R01.S.doc Version 5.2 Page 15 to move around. This also created clusters of seating and quiet areas. Attention has also been paid to making the building more homely and less clinical – some corridors are still awaiting these “finishing touches” but the owner confirmed that pictures etc were on order. There is also an organised programme of activities and trips out are being planned. Staff reported that they have had success in encouraging people to join in activities and residents had cleared benefited from greater interaction with others. One relative commented “ No one is made to do anything he or she doesn’t want to do. Mum likes privacy and she is never pressured to go to the lounge. She prefers her room and is supported in that. To ensure she’s not lonely, staff pop in and out and chat to her. She is happy in her won little kingdom and staff respect that.” 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. During the course of the inspection visitors were observed in the home. They were made welcome by staff and clearly had a good relationship with them. Discussion with residents and staff as well as examination of records and observation during the inspection evidenced that residents are assisted appropriately to exercise choice and control over their lives. Dining tables are nicely presented, as is the food which is produced by a qualified chef. Food records reflected a varied and nutritious diet is provided for residents with the use of plenty of fresh fruit and vegetables as well as home cooked items rather than frozen or convenience food. The Old Rectory DS0000064826.V366767.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory procedure but complaints are not always fully recorded. This means that the home cannot evidence that it deals appropriately with complaints and makes improvements when required. EVIDENCE: The Old Rectory has a satisfactory complaints procedure that is displayed in the home as well as included in the Service Users Guide. Of the four surveys received from relatives, three were clear that they knew how to complain. One complaint had been made to the home by a relative since the last inspection. The home was unable to provide evidence of the investigation that was undertaken or the outcome of the investigation. Satisfactory policies and procedures for adult protection and whistle blowing are in place at the home. Most staff have received training in the protection of vulnerable adults / abuse awareness. All of the ten completed staff surveys stated that they knew how to deal with a complaint or possible abuse. The Old Rectory DS0000064826.V366767.R01.S.doc Version 5.2 Page 17 The Old Rectory DS0000064826.V366767.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well presented: it is nicely decorated and furnished and has a homely atmosphere. The grounds are also well maintained, providing lots of colour and interest as well as a variety of places to sit and relax. The home maintains a good standard of hygiene and all areas seen were clean and free from offensive odours. EVIDENCE: Residents at the home enjoy the delightful surroundings of the Purbeck Countryside. The home was originally a Rectory and this has been extended The Old Rectory DS0000064826.V366767.R01.S.doc Version 5.2 Page 19 and improved in a sensitive manner. All rooms are furnished to a good standard. Matching soft furnishings complement each room, which are refurbished as they become vacant. Specialist equipment such as for moving and handling is available. Dorset Fire and Rescue Service have visited the home and confirmed that it complies with their requirements. Individual accommodation is pleasantly furnished and decorated to a high standard, providing personal surroundings, with which residents expressed satisfaction. All rooms have ensuite facilities. A number of residents were spoken with in the privacy of their own rooms. All were very happy with the environment, commenting on how they had been assisted to bring furniture with them, the dedication of the cleaning staff and the pleasure that the beautiful surroundings gives them. All areas of the home visited were clean, hygienic and free from offensive odours. However, the home still has only one very small sluice facility on the first floor and this is not adequate for a home of this size. The Old Rectory DS0000064826.V366767.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The number of staff working in the home meets residents’ needs. The home has identified staff training needs and implemented a training programme to address areas of weakness. The home has a good ratio of care staff who have achieved National Vocational Qualifications and has introduced the Skills for Care Induction training; thus working to ensure that residents are in safe hands at all times. People living at The Old Rectory should now be satisfactorily supported and protected by the home’s recruitment policy and practices. The Old Rectory DS0000064826.V366767.R01.S.doc Version 5.2 Page 21 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. All residents spoken with confirmed that staff were always available, kind and helpful. At the time of the visit seventeen of the nineteen care staff working in the home held a National Vocational Qualification at a minimum of level 2 with some holding higher qualifications. No new staff have been recruited since the last inspection. At the last inspection it was noted that there were serious omissions in staff files such as no CRB checks or no references. All of these omissions had been rectified. A recommendation has been carried over in this report regarding recruitment, as safe recruitment from start to finish has not yet been evidenced. The Clinical Director has completed an analysis of staff training needs and has implemented a training plan, which includes mandatory subjects, to address these. The new Skills for Care induction programme has been implemented in the home and the three new staff had undertaken this with the appropriate documentary evidence available. All of the staff surveys received stated that they were happy with the content and level of training now being provided and that it gave them the skills to undertake their duties. Seven staff stated that there were always enough staff available and 3 said there was usually enough. All said there was with always or usually enough support available from the management of the home. The Old Rectory DS0000064826.V366767.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is without a manager. The owner has made temporary arrangements for the management of the home as well as taking active steps to appoint a suitable person. Steps are being taken to implement a quality system to ensure people receive a good service but without a manager this is difficult to achieve. Resident’s finances are safeguarded with clear policies and procedures and management guidance. The health, safety and welfare of residents and staff is protected by the systems that the home has in place for staff training, maintenance and risk assessment. The Old Rectory DS0000064826.V366767.R01.S.doc Version 5.2 Page 23 EVIDENCE: The Owner has been unable to recruit a suitable manager. Management of the home has been undertaken by the company’s Clinical Director who has been supported by senior staff in the home. Improvements have been made in the home but a full time manager is needed to ensure that all minimum standards including those not inspected on this occasion are met. 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. A satisfaction survey and regular meetings have been implemented for residents and a suggestion box placed in the main hallway. The Clinical Director confirmed that residents are encouraged to retain control of their own finances for as long as possible. Where they state that they no longer wish to or they lack the capacity to do so then the home ensures that either family or other representatives such as solicitors take on this role. Small amounts of cash are held and records and balances for these were checked. Fire records and accident books were examined and found to be up to date and detailed. It was advised that accident books should be audited regularly to identify anyone with frequent problems or areas of the home, times of day etc that might be of particular concern. As stated elsewhere, staff training is being reviewed and programmes put in place. The Old Rectory DS0000064826.V366767.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 1 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 The Old Rectory DS0000064826.V366767.R01.S.doc Version 5.2 Page 25 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 OP16 Regulation 22(1) Requirement There must be a simple, clear and accessible complaints procedure which includes the stages and timescales for the process, and that complaints are dealt with promptly and efficiently. All complaints must be recorded as well as any investigation and the outcome. Timescale for action 31/10/08 2. OP26 13(3) 3. OP31 8(1) Adequate sluicing facilities must 31/10/08 be provided to help with the control of possible infections as well as ensure suitable standards of cleanliness are maintained. The provider must appoint a 31/10/08 suitably qualified, competent and experienced person to manage the home and put them forward for registration with the Commission. 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 DS0000064826.V366767.R01.S.doc 4. OP33 24(1) 31/10/08 The Old Rectory Version 5.2 Page 26 residents. 15/08/08 This repeated for a fourth time but progress has been made. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Old Rectory DS0000064826.V366767.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Old Rectory DS0000064826.V366767.R01.S.doc Version 5.2 Page 28 - 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!