Inspection on 11/11/05 for The Old Rectory Care Home

This inspection was carried out on 11th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.

Other inspections for this house

The Old Rectory Care Home 04/05/07

The Old Rectory Care Home 11/05/06

The Old Rectory Care Home 21/06/05

The Old Rectory Care Home 28/01/05

The Old Rectory Care Home 15/09/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE The Old Rectory Care Home Norwich Road Acle Norwich Norfolk NR13 3BX Lead Inspector Mrs Dorothy Binns Unannounced Inspection 11th November 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 Care Home DS0000061106.V265953.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 Care Home DS0000061106.V265953.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Old Rectory Care Home Address Norwich Road Acle Norwich Norfolk NR13 3BX 01493 751 322 01493 751 322 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) Pearlcare (Acle) Ltd John Mills-Darrington Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places The Old Rectory Care Home DS0000061106.V265953.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to thirty-four (34) Older People of either sex, not falling into any other category, may be accommodated. 21st June 2005 Date of last inspection Brief Description of the Service: The Old Rectory is a period residence located in the small rural market town of Acle, mid way between Norwich and Great Yarmouth and close to the Norfolk Broads. There are shops, a weekly market, pubs and a church all within walking distance and there are bus and train services to Acle. The property has been purposefully adapted and extended to provide residential accommodation for up to 34 older people. There are 3 double and 28 single rooms and many have direct access into a well planned garden. The double rooms and 24 of the single rooms have en suite facilities. The Old Rectory Care Home DS0000061106.V265953.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection lasting three hours. During that time service users were spoken to in the sitting rooms and in private, one senior staff was spoken to in private, and the requirements of the last inspection were discussed with the manager. In addition parts of the building were toured and records and policies were examined. What the service does well: What has improved since the last inspection? What they could do better: The Old Rectory Care Home DS0000061106.V265953.R01.S.doc Version 5.0 Page 6 The systems of communication in the home need to be more formalised to ensure all staff know what is expected of them. This is a friendly home with an approachable manager but sometimes information given informally gets lost. The care plans need to be more specific about the tasks staff have to carry out and handover meetings at change of shift need to be attended by all staff. In similar vein, complaints need to be investigated in a more formal way with a record kept of the actions taken, conclusions drawn and any recommendations coming out of the investigation. It should be clear what improvements were made. The system for reviewing the quality of the service also needs to be developed. 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 Care Home DS0000061106.V265953.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 Care Home DS0000061106.V265953.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): 1 and 3 The statement of purpose is now prepared but needs to be made available in the Home so prospective service users can see what the Home offers. The initial assessment provides full information to enable staff to meet the needs of the service users. EVIDENCE: Following a requirement at the last inspection, an amended statement of purpose was seen ready on the computer. A minor correction was identified and the document now reflects the requirements as laid down in schedule 1. This now needs to be made available in the Home. Three care records were examined and found to contain a general assessment of each service user outlining their needs and abilities. Subjects covered included, mobility, personal care, and medication as well as routines and whether assistance was needed during the night. In addition there was a manual handling assessment. These documents gave a good foundation for the provision of care and the forming of a care plan. The Old Rectory Care Home DS0000061106.V265953.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 and 8 The service users personal and social care needs are not well enough set out in a care plan to ensure that their needs will be met. The health care needs of the service users are monitored and service users have good access to health professionals. EVIDENCE: Three care plans were examined. As stated under standard 3, the home carries out and documents a full assessment of each service user so that the needs of the service users can be identified. The care record details the areas where each person needs assistance from staff. Staff then write reports on how the person is progressing. Prior to November these reports were sparse and mainly about medical matters. Following a requirement at the last inspection, staff have been documenting more about the care they are providing though this has just recently been actioned. Good reports showing whether the service user had visitors, how the person fared that day and whether they ate or slept well are now written though some entries were not appropriate and more staff training is recommended. The Old Rectory Care Home DS0000061106.V265953.R01.S.doc Version 5.0 Page 10 Whilst acknowledging the progress, there was some concern about the detail of each care plan ie the clarity of the instructions to staff as to how each service user should be assisted. For example following a complaint to the Home, a promise of more detailed care was agreed for one service user. This file was examined and found to have no amended care plan to ensure that staff gave the right assistance. On paper it looked as if no changes to the care offered had been made as a result of the complaint despite a letter to the complainants that this would be instigated. No reviews had been carried out. This is not acceptable. Staff need to have access to the details of the care plan so that they know what they have to do. A further requirement has been made to sort this out. In addition a handover meeting needs to take place between shifts with all staff coming on duty hearing from the previous shift. Currently staff are rostered to come in at the time that the previous shift leaves and this leaves no time for a handover except with the senior in the morning who comes in slightly earlier. She then has to see that staff coming on duty are kept informed. One agency staff who returned a survey form to the Commission reported that she did not receive information about the care needs of the service users before starting her shift. One meeting of all in coming staff with one member of the previous shift would be more affective and improve on the current flawed communication systems in the home. The files showed good reference to medical matters with visits by the GP, the optician and community nurses recorded. Staff also documented if a person was unwell and what the symptoms were. There were references to attendance at hearing aid clinics, to infection control and to falls. Staff recorded what advice they had received from the doctor or nurse and recorded any tests carried out. Staff seemed to be more comfortable with such recording and it was clear that liaising with the doctors and nurses was seen to be part of their role. Continence promotion and access to flu injections were also mentioned and seen to be part of the monitoring of the health of the service users. The Old Rectory Care Home DS0000061106.V265953.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): 12 and 15 Service users are satisfied with the lifestyle in the home and express contentment with the way things are run. Service users receive a wholesome and balanced diet and enjoy their food. EVIDENCE: Service users spoken to were in general very happy with the home. One described the staff as “very good “ and “it is very nice here” and another said “staff are very willing to help” and “can’t praise them enough”. Routines were felt to be flexible with bedtimes described as “anytime”. One person stayed mainly in their room as she preferred her own company, others sat in the sitting rooms. One man was having a glass of beer with a visitor which was clearly a regular event. The sitting room was quite crowded and the inspector did wonder whether service users were able to exercise choice and stay in their rooms as they wished. One member of staff did say this was the case though the sheer numbers in the main lounge did look as if service users may be encouraged to sit in the lounge rather than asked what they wanted to do. However there were no complaints from the service users. The Old Rectory Care Home DS0000061106.V265953.R01.S.doc Version 5.0 Page 12 In terms of activities, more effort has been made and there are now entertainers coming in and a communion service is held once a month. One service user said she enjoyed the reminiscence sessions and played scrabble. She also had her own pots in the garden outside of her room which she greatly enjoyed. Another thought there weren’t any activities but he was not bothered. Activities were mentioned occasionally in the care records and one staff member mentioned a flautist had been in to entertain and that they were planning a Christmas party. On the day of the inspection (11th November), some service users were being taken to the war memorial in the town to pay their respects. Overall it felt as if activities were now on the agenda and staff were thinking more about how to keep service users stimulated. Menus were not examined in detail but the menu board advertised the menu for the day. It was a friday so cod and chips was on the menu but there was an alternative of pasta or jacket potatoes. One service user told the inspector she would have the pasta. For tea there was ham or cheese salad or sandwiches. The cook said she had no special diets to prepare. Service users were asked about the food and described it as “very nice” and “homely with a choice”, “very good” and “adequate”. Homemade cakes are also made. On balance the service users had no worries about the food. The Old Rectory Care Home DS0000061106.V265953.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): 16 Whilst service users feel the staff would respond to their concerns on a day to day basis, it is not clear that service users or their relatives will have their concerns listened to and acted upon once a complaint is made. The home must take a more formal approach to this. EVIDENCE: The home has a complaints procedure which is available to relatives and the service users. The Commission’s address is provided. A recent complaint drawn to the attention of the Commission was dealt with by the home. The documentation of this complaint was scrutinised at the inspection. It was found that there was no document outlining what the investigation had entailed nor was there evidence of changes in practice that had taken place as a result of the investigation. Training which had been mentioned as an outcome of the complaint had not taken place. From talking to the manager it was clear that there had been discussions with the complainants to allay concerns but the lack of formality and documentation did not give confidence that further problems would not arise later on. Staff spoken to did not know what the complaint entailed and therefore were not in a position to change their practice. Whilst it is expected that concerns raised with the staff or managers can be informally ironed out, a much more formal approach to written complaints must be made showing clearly what actions the investigation entailed, what were the conclusions and recommendations and when and how these will be carried out. The Old Rectory Care Home DS0000061106.V265953.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): 19,20 and 24 The home is well maintained and safe for the service users and provides a homely environment. The communal space is varied and comfortable providing service users with a choice of where to sit. A very attractive garden is also available to enjoy. Service users have comfortable and well equipped bedrooms which are spacious and homely and where they can have their own possessions. EVIDENCE: The home is located in a residential area not too far from the centre of this small town. It has wide corridors and is fitted with a shaft lift and adapted bathrooms to cater for the needs of the service users. It also has a very attractive garden with seating areas and lawns. It is well maintained and comfortable and homely. The Old Rectory Care Home DS0000061106.V265953.R01.S.doc Version 5.0 Page 15 The communal space is varied with a large and a small sitting room, a long conservatory area and a large dining room with tables for 4 – 6. Some rooms have lovely views to the garden. Furnishing is homely and comfortable and the décor is satisfactory. All the bedrooms are very attractive with good decoration and furnishing. Service users have personalised them with their possessions and photos and can enjoy their own televisions if they wish to. All are on the call bell system and have covered radiators to prevent burning. Locked facilities and locks on doors are also provided. One service user mentioned that the sheets were changed every week and the towels every day which she greatly appreciated. The Old Rectory Care Home DS0000061106.V265953.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 and 28 The staffing is beginning to stabilise and this will enable service users needs to be more satisfactorily met. Training is encouraged and progressing which ensures the service users are in safe hands. EVIDENCE: For the number of service users accommodated, the rota produced for the week of the inspection looked sufficient in terms of numbers of staff. However the inspector was concerned at the last inspection about the extensive needs of the some of the service users and questioned whether there were sufficient staff on duty. The manager reported that since then some service users have been reassessed and the problem has eased. The policy on admissions has also become more rigorous which is good. The other concern was about the shortage of permanent staff and the use of agency staff. Service users had commented on the constant change and shortage of staff and were well aware of the strains this put on the permanent group. This problem has now receded with no agency staff required this week and only four hours recorded for the previous week. This will allow much more consolidation in the staff group with benefits for the service users. The Old Rectory Care Home DS0000061106.V265953.R01.S.doc Version 5.0 Page 17 It was noticed on the rota that one or two staff have quite a heavy timetable for instance working an evening shift and going through to a night shift. The same person on another day works an 8-2 shift then returns the same day for a night shift. Care needs to be taken that staff are not overtired and a reasonable time between shifts is recommended. The manager reported that eleven staff now have their NVQ certificates which meets the standard of 50 of staff trained. The Old Rectory Care Home DS0000061106.V265953.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 and 35 The finances of the service user are safeguarded with proper records. To ensure the home is run in the best interests of the service users, the quality assurance system could be more thorough. EVIDENCE: The home has the beginnings of a quality assurance system with annual surveys for the service users and for the relatives. They give their views about the Home. However to be useful, the surveys need to be analysed and a summary made of the findings and actions taken as a result. Similarly complaints should be analysed and whether training targets and supervision of staff has been met. This helps to give a plan for improvement in the following year. The Old Rectory Care Home DS0000061106.V265953.R01.S.doc Version 5.0 Page 19 Several service users have their money looked after by the home and sample records were checked. Two records were matched against the cash held and were appropriately recorded. Receipts were kept. The Home does not cash benefits but receives cash from relatives or solicitors to be administered on a service user’s behalf. They do not bank money for the service users. The Old Rectory Care Home DS0000061106.V265953.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 2 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 x 3 3 x x x 3 x x STAFFING Standard No Score 27 2 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x 3 x x x The Old Rectory Care Home DS0000061106.V265953.R01.S.doc Version 5.0 Page 21 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 OP7 Regulation 14(2) and 17 Requirement The care records must be more fully documented to show how the staff are monitoring the service users and meeting their needs. Previous timescale given 30/9/05 has been partially complied with but further work is to be done. The registered manager shall ensure that the assessment of the service users needs is revised when it is necessary. In this regard, there was no noticeable response to a complaint. The registered person must ensure that staff are appropriately supervised and that communication is clear. In this respect all staff should be briefed about the service users when they come on duty. The registered person shall ensure that any complaint made under the complaints procedure is fully investigated and acted upon. The registered person does have a system of consultation with the DS0000061106.V265953.R01.S.doc Timescale for action 31/01/06 2 OP7 14(2)(b) 31/12/05 3. OP7 18(2) 31/12/05 4. OP16 22(3) 31/12/05 5 OP33 24(1)(b) 31/03/06 The Old Rectory Care Home Version 5.0 Page 22 service users in terms of a quality assurance system but has no formal system of analysing information. A more formal system should be developed which highlights the improvements to be 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. 1. 2. Refer to Standard OP1 OP27 Good Practice Recommendations The statement of purpose should be printed and made available to service users and their representatives. Care should be taken to ensure that staff have enough time between shifts for a full rest period and should ideally not be working longer than 10 hours in any one day. The Old Rectory Care Home DS0000061106.V265953.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Care Home DS0000061106.V265953.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. Re-publishing this information is in breach of the terms of use of that website. 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