Inspection on 04/05/07 for The Old Rectory Care Home

This inspection was carried out on 4th May 2007.

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.

Other inspections for this house

The Old Rectory Care Home 11/05/06

The Old Rectory Care Home 11/11/05

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 Jenny Rose Unannounced Inspection 4th May 2007 09:30 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.V338930.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 Care Home DS0000061106.V338930.R01.S.doc Version 5.2 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 sue@oldrectoryacle.plus.com 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 Position Vacant 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.V338930.R01.S.doc Version 5.2 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. 11th May 2006 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 local bus and train services. 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.V338930.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care Services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out, by using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgements for each outcome group. This was an unannounced, key inspection undertaken on 5th May 2007 over 8 hours and was carried out as part of a routine inspection plan. There were 33 people living in the home on the day. The manager, who has been in post for 9 months, was available throughout the day and was helpful in facilitating the inspection. The inspection took the form of a tour of the premises, examination of care plans, records, certificates and compliance of requirements and recommendations from the last inspection. Four comment cards had been received from relatives, four from Healthcare Professionals and seven from residents, with positive comments overall. There were individual discussions with the manager, three members of staff, one visitor, a GP; discussion in passing with several residents, a group discussion with five residents and discussion with three residents in private. The information from the comment cards and from the people spoken to has been incorporated in the report. What the service does well: • The Home is in a period building, which has been purposely extended and provides a variety of pleasant, light communal areas situated in a well planned and maintained garden, to which a number of bedrooms have direct access. It is within walking distance of the town with good transport links and amenities including access to the surrounding rural area. There is a friendly, relaxed atmosphere and one relative described the Home as “like staying in a Hotel”. A resident spoken to said the “Staff are friendly and kind”. There are a number of staff members who have worked in the Home for several years, one such person said that the Home was greatly improved and that she was proud of it and the family atmosphere. Comment cards from Healthcare Professionals and the GP spoken to DS0000061106.V338930.R01.S.doc Version 5.2 Page 6 • • • The Old Rectory Care Home gave a positive picture of the healthcare available to residents. What has improved since the last inspection? • All new residents receive an information pack with the Statement of Purpose and Service User Guide and a CSCI Inspection Report prior to admission. The care plans have been reorganised and these are now stored in individual files in a lockable cabinet and include weight charts. However, details of actions care staff must take, based on the assessed and changed needs of individual residents, could still be clearer. Risk assessments are recorded in individual care plans, but there is still room for improvement in this area. There is a keyworker system, but this role could be further expanded upon, especially to collect information regarding life histories, interests and hobbies in order for the Home to deliver more holistic care. Staff and residents’ meetings have been held, but these should continue to be held on a more regular basis. All staff have now received new terms and conditions of employment. There is an activities programme; games have been purchased and there have been arts and crafts sessions once a month, but there is still room for development in this area. The quality assurance system has been widened, but still needs to be more robust to ensure that the Home is auditing its quality of care. New carpets have been laid in several areas to replace worn carpets. New flooring has been laid in bathrooms and there is a rolling programme for cleaning curtains and redecoration in several areas. New lighting has been installed in the upstairs corridor; stereo systems in the lounges and a digital TV in the main lounge. Waterproof seals have been fitted to joints in kitchen worktops and a new cooker installed. • • • • • • • • The Old Rectory Care Home DS0000061106.V338930.R01.S.doc Version 5.2 Page 7 What they could do better: • Care plans and risk assessments need to be expanded to give clearer information, particularly in cases of changed needs of residents, for staff to carry out their tasks Informal, verbal staff supervision takes place, but individual supervision and appraisals need to take place on a regular basis and recorded. There needs to be a training programme developed for individual staff members and opportunities for training in the Protection of Vulnerable Adults and Care Planning and Recording need to be given priority. The Quality Assurance system needs to be more robust with means of ascertaining residents’, relatives, healthcare professionals’ and staff views and to include care planning audits. The Keyworker role needs to be reviewed and made more pro-active. The Activities programme could be expanded to take account of life histories and interests and hobbies of residents. A questionnaire on food and a Comment Box would enable those residents who do not attend residents’ meetings to voice their preferences. Residents’ money needs to be more securely stored inside the present locked facility. Consideration should be given to enlarging the laundry area, which is a very cramped working space for staff. • • • • • • • • 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 Care Home DS0000061106.V338930.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 Care Home DS0000061106.V338930.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, 6(N/A) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective individuals receive clear information to enable them decide if the Home can meet their needs and admissions are not made until a full needs assessment has been undertaken. EVIDENCE: There was evidence from a thematic inspection carried out in December 2006 that prospective residents and/or their relatives or friends often visited the home prior to admission and were given verbal and written information, in the form of a preadmission pack about the Home. This included the Statement of Purpose, Service Users’ Guide, brochure with photographs and the last key inspection report about the Home, to assist them in deciding if the Home could meet their needs. Information was also gathered prior to admission from the person making the referral, the prospective resident, family members or advocate and GP to ensure that their health and social care needs could be met. The Old Rectory Care Home DS0000061106.V338930.R01.S.doc Version 5.2 Page 10 Case tracking, comment cards and relatives and residents spoken to indicated that residents had received sufficient information about the Home before they moved in. “We visited the Home before admission, were given a brochure and informed about all aspects of the Home”. The Old Rectory Care Home DS0000061106.V338930.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): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the Home are happy with the way that most staff deliver their care and respect their dignity, but decisions on how personal care is delivered are not consistently recorded. EVIDENCE: All Comment cards, including all those received from healthcare professionals, one visitor, a GP and the residents spoken to were very positive about the healthcare delivered in the Home. “Staff are very quick to obtain medical support if they or I think it is needed”, stated one resident. “A close eye is kept on your physical condition and action taken as considered necessary”, said another. The Old Rectory Care Home DS0000061106.V338930.R01.S.doc Version 5.2 Page 12 The Manager has worked very hard in organising the care plans and storing them individually in a locked cabinet, as required at the last key inspection. These are appreciated by at least one member of staff spoken to, who said the system makes it easier for recording and checking information. There was relevant information on health, social and personal care, monthly reviews and from visiting professionals. However, although some care plans were completed satisfactorily, recording tended to be patchy and one or two did not contain photographs. Risk assessments have been included in the care plans, and there are separate risk assessments for self medication. However, other risk assessment charts are very general and not specific to individuals. There is no space for information for the necessary action staff are to take to mitigate the risk. There is therefore a requirement that risk assessments are written specific to individuals, particularly in regard to falls and for those returning from hospital with changed needs, for example; together with action to be taken by staff in fulfilling those care needs. These should be signed by the resident and/or their relative, if appropriate, and regularly reviewed. In addition, the action to be taken by staff to ensure the comprehensive health, personal and social care assessment of need of each resident is met, must be regularly reviewed. The GP spoken to and the comment cards from other Healthcare Professionals said that the standard of healthcare was very satisfactory. Residents spoken to, who had lived locally, expressed satisfaction at being able to still be registered with their own doctor. The visitor spoken to and comment cards stated that they were always kept informed of any problems for their relatives. The District Nurses visit on a regular basis and staff are able to ask their advice. However, the recording in this area is also inconsistent. A medication round was observed and it was seen that medication was administered satisfactorily. The Pharmacy produces its own MAR sheets, which are securely fastened in the file. Medication is dispensed from a lockable trolley, kept in the medical room, which is also locked. The file contained photographs of residents and the initials for signatures in the front. The Senior Carer administering the medication had several years experience and had received training. She was responsible, together with one other member of staff for ordering medication and counting it in. There was a clear audit trail for all medicines and the staff said they could ring the Pharmacy, or the Surgery for advice. The Pharmacy regularly sends its own inspector to review the medication procedures. From residents spoken to and observation, the interaction between staff and residents was good humoured and respectful. Residents confirmed that their dignity was respected and it was noted on a tour of the building, many residents choosing to lock their doors when leaving their rooms safeguarded residents’ privacy. The Old Rectory Care Home DS0000061106.V338930.R01.S.doc Version 5.2 Page 13 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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are given the opportunity to take part in some activities both within the home and in the community, but these and the content of meals could be more resident focussed. EVIDENCE: Residents, one visitor, the comment cards and staff confirmed that residents are offered choice and expressed contentment in general with the way things are run. A group of residents spoken to said they had enjoyed a musical entertainment the previous evening. There was evidence of new ideas of stimulating residents and involving families, for example, for those residents who wished, there were photographs of themselves as teenagers on the notice board. A ‘For Sale’ or ‘Wanted Board’ for use by residents, relatives, as well as staff, was displayed in the corridor. There were Arts and Crafts sessions once a month. A shopping trolley had been organised as a result of a resident’s suggestion at a residents’ meeting and a large game of Connect had been purchased, which could be played indoors or out. The Rector and Methodist Minister visit the Home and some residents are well enough to go to Church, if they wish. The Old Rectory Care Home DS0000061106.V338930.R01.S.doc Version 5.2 Page 14 Families and friends are welcomed to the home at any time. One visitor spoken to say that he came frequently to visit his relative, as did other members of his family, which was confirmed by his relative and other residents spoken to talked of going out with their families or receiving visits. One resident comes and goes, with the help of an electric buggy to the Social Club. Another resident likes to walk into the town each week with the Manager, although this was not recorded in the care plan. The Home tries to be flexible to accommodate residents’ individual needs. One resident in a comment card mentioned that, because of her poor sight, she is seated in the lightest place to take her meals, which she appreciates. All residents spoken to expressed their enjoyment of the lovely garden. However, one resident spoken to said that there had only been one residents’ meeting in the time she had been in the Home and she felt there were many residents who could contribute to such a meeting, given the opportunity. A recommendation for regular residents’ meetings to take place is, therefore, made. (See Standard 32) Although a keyworker system is now in place, it would appear that there is still improvement which could be made in collating information in care plans regarding the life histories of residents and their particular interests/hobbies and relating particular activities to individuals’ needs. The requirement from the previous inspection is therefore repeated, that the keyworker’s role should be reviewed to ensure that residents’ needs, choices and rights are known, protected and promoted. Menus seen demonstrated that there is some variety of meals and residents confirmed that there was some choice and alternatives offered, which were also seen on the menu board outside the kitchen. However, choice of the evening meal seemed limited, hot meals only being served every other day to sandwiches and cake. On the day, it was observed that staff were conveying residents’ wishes to kitchen staff and meals were served individually, taking into account such things as whether a resident wanted a hot, or cold, plate. It was also noted that residents were able to take their meals in different areas of the home and residents took their meals in their rooms if they wished. Residents who needed help, were offered assistance discreetly by staff and one comment card stated ”. “I have to have a special diet, which is always provided”. A further comment was that the meals were served earlier, if required, in order for residents to be able to keep appointments. For those residents unable to manage a full diet, fluid and food charts were kept in their rooms. The Old Rectory Care Home DS0000061106.V338930.R01.S.doc Version 5.2 Page 15 However, comment cards and residents spoken to revealed that residents were not entirely satisfied with the menus and the individual choices within them. It was observed there was a lack of fresh vegetables and fruit on the day. There was also a remark about the size of portions, which one resident found particularly off-putting as they were too large. There is therefore a recommendation that a wider choice should be offered to residents based on recorded preferences, ascertained by such means as questionnaires and a Comments Box for anonymous suggestions or other means and that the menus should be regularly reviewed. It is also recommended that there should be recorded monitoring of residents’ nutritional needs linked to the weight charts in the care plans. The Old Rectory Care Home DS0000061106.V338930.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): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home feel that complaints and concerns would be listened to and acted upon, but staff training in Safeguarding Adults would further ensure the protection of residents. EVIDENCE: Policies and procedures in place for dealing with complaints and these are included in information pack given to all new residents. Comment cards, residents, the visitor and GP spoken to said they would know how to make a complaint and further remarks such as, “Yes, the list of procedures is displayed in the Home”, “Yes, I think so, we don’t make many” and “Yes, I would approach the manager”. The Old Rectory Care Home DS0000061106.V338930.R01.S.doc Version 5.2 Page 17 At the previous inspection in December 2006, there was evidence that the Home had an active procedure on the protection of vulnerable adults that protected residents and supported the investigation of any concern. During this inspection, two members of staff spoken to gave an account of the procedures for dealing with any potential abuse. These two members of staff had much experience of working in the home and held NVQ2 qualifications, and had received training in Safeguarding Adults, as had the manager. However, another member of staff was not clear about the procedures, although she said if there were any problems she would ask the manager. Although there is evidence of ‘on the job’ supervision and this member of staff found the manager very approachable and helpful in dealing with problems she may have, there is no recorded supervision of staff (see Standard 36). There is therefore a requirement that training surrounding this issue should be available. The Old Rectory Care Home DS0000061106.V338930.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): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the Home enjoy a good standard of homely accommodation, which is clean and safe with access to appropriate facilities and equipment. EVIDENCE: The home is located in a residential area within walking distance of the small, market town. It has an attractive, accessible, well-maintained garden. The communal spaces are varied with a large and small sitting room, a long conservatory area, within which they are smaller seating areas and a large dining room with tables for 4-6. Some rooms have direct access to the garden. All the bedrooms seen were personalised with residents’ possessions, if they wish. The Old Rectory Care Home DS0000061106.V338930.R01.S.doc Version 5.2 Page 19 There have been several improvements since the last inspections over and above the requirements and recommendations made. Bedroom carpets have been replaced, together with bathroom flooring which was worn. The whole of the upstairs corridor has been recarpetted and new lighting fitted to give much more light. Waterproof seals have been fitted to the joints in the worktops in the kitchen. Redecoration has taken place in eight bedrooms, the upstairs corridor and the large dining room. There is a rolling programme for replacing the downstairs corridor carpet, which is now worn, particularly near the kitchen hatch area and all bedroom curtains have been cleaned in rotation. Infection control measures are in place. New sanibins have been installed in the bathrooms and COSHH records are maintained. The maintenance person cleans the carpets on a regular rota, as well as on an ‘as needed’ basis. A third washing machine has been installed together with an instant hot water boiler in the kitchen. The Home was seen to be clean and tidy on the day and one comment card said, “This Home was chosen for its high standards – particularly the cleanliness, brightness and the smell is fresh”. One resident spoken to, as well as a Comment card said, they were particularly pleased with the standard of the laundry. However, there is a recommendation that at some point, consideration is given to extending the laundry room, which with three washing machines, dryer and individual boxes for residents’ laundry, is a very cramped working place for staff. The Old Rectory Care Home DS0000061106.V338930.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): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home are satisfied with care they receive meets their needs, but the lack of training and supervision could compromise the quality of care they receive. EVIDENCE: Residents spoken to and the comment cards said that the residents were well cared for. “Could not have a better staff, I am very satisfied”, said one, “Sometimes we have to wait our turn, which is only fair”, said another. However, the rotas showed that shift patterns had recently been changed to ensure that there were more staff on in the early morning to help residents get up, but this had resulted in less staff being available immediately after lunch, which was another busy period when residents needed help. It was also observed after the evening meal, another busy time, because of the geography of the building, staff were busy in one area of the building and might be needed in another. There is therefore a requirement that the Home demonstrate that staffing hours are calculated by the dependency needs of the residents. The Old Rectory Care Home DS0000061106.V338930.R01.S.doc Version 5.2 Page 21 Staff files showed that staff members had a mix of experience and skills, but only seven members of staff had completed NVQ2 and two were wishing to undertake the course. Although staff had had induction training and the relevant statutory training had been updated and training had been completed by the Manager in Dementia care and Bereavement, there had been no training recently and there is, therefore, a requirement for a staff development and training programme to be developed with training that includes, for example, NVQ, Safeguarding Adults and other areas of care related to residents’ needs. Examination of records demonstrated that an application form, references, medical form, job description, personal details, CRB check, photograph and proof of identity were held for each staff member to help ensure residents are protected by the recruitment procedures. Staff spoken to gave a good account of a handover period between shifts. However, it was evident from staff spoken to that regular staff meetings had not been taking place and neither had regular recorded staff supervision and appraisals. Therefore the requirement from the previous inspection regarding the necessity for regular staff meetings is repeated. The Old Rectory Care Home DS0000061106.V338930.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): 31,32,33,35,36,38 Quality in this outcome area is adequate. People living in the home feel their interests are safeguarded by the management approach of the home. However, the lack of auditing of care planning, recorded staff supervision and training at all levels may compromise the quality of care delivered. EVIDENCE: There has been a new manager since the last key inspection, who has been in post for 9 months. She had previous experience of working in the Home for several years and becoming a senior carer. She has the backing of the Head Office of the organisation, of which the Area Manager visits unannounced on a weekly basis. She has achieved the re-organisation of the care plans and is seen as approachable and supportive by residents and staff alike. Her personal circumstances, however, mean that she has had to alter her career plans; but she says that she will be available to support a new manager for a period of handover. The Old Rectory Care Home DS0000061106.V338930.R01.S.doc Version 5.2 Page 23 There was a Quality Assurance Report 2006, reporting improvements of the service regarding decoration of rooms, the establishment of a shop trolley and activity games being purchased, but there were no statistics regarding the number of questionnaires completed from residents and relatives and this report did not include any auditing of care, i.e. satisfaction with routines within the home, or the food. There is therefore a requirement for the quality assurance system to be made more robust and to include an audit of care planning and a questionnaire regarding the food in the home. The people living in the Home are protected by financial procedures and the records demonstrated that debits and credits of all money held for residents were held individually and was accurate. However, although the money was stored securely, with restricted access to the key; there is a requirement that the receipts and cash are stored in individual, secure wallets within the locked drawer area already used. Certificates of the servicing and testing of all equipment were seen to have been carried out, thus ensuring that as far as possible the health and safety of residents and staff is protected, but this could be compromised by the lack of training in the area of Safeguarding Adults and lack of formal supervision of staff. (See Standards 18:36) The Old Rectory Care Home DS0000061106.V338930.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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 2 X 2 The Old Rectory Care Home DS0000061106.V338930.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 OP7 Regulation 13.4 Requirement All people living in the Home must have risk assessments pertinent to that individual stored in their care plan. This will ensure that they receive person centred support that meets their needs All people living in the Home must have an up to date, detailed care plan with actions care staff must take based on the assessed needs of each individual. This will ensure that all people using the service have their needs met All people living in the Home should have their interests recorded and opportunities for stimulation through activities, which suit their needs. This will ensure that the lifestyle in the Home meets their individual needs. All people living in the Home must have access to a keyworker. (In this case the keyworker should be reviewed). This will ensure that all people using the service can be sure DS0000061106.V338930.R01.S.doc Timescale for action 01/08/07 2. OP7 12.1 01/08/07 3. OP12 14(1) 01/09/07 4. OP13 12.5b 01/09/07 The Old Rectory Care Home Version 5.2 Page 26 that their needs, choices and rights are known, protected and promoted. 5. OP27 18(1)(a) Staffing ratios must be determined according to the assessed needs of residents and that additional staff are on duty at peak times of activity during the day. This will ensure that the needs of people living in the home come first. Suitably qualified, competent and experienced staff must be working in the Home at all times to ensure that all people living in the Home are in safe hands. (In this case, training in NVQ and Safeguarding Adults) Staff should have more regular access to staff meetings carried out over the year. This will ensure that staff are enabled to affect the way in which the service is delivered to those people living in the home. The Quality Assurance system should be further improved to include records of questionnaires, meetings and comments from everyone who lives, works or visits the Home. This will ensure that the Home is run in the best interests of everyone who lives there. Secure facilities should be provided for the safekeeping of money and valuables, which will ensure that the financial interests of the people living in the Home are safeguarded. Formal staff supervision should take place at least 6 times a year. This will ensure monitoring of care practice within the Home for the benefit of the people living there. DS0000061106.V338930.R01.S.doc 01/09/07 6. OP28 18(1)(a) 01/09/07 7. OP32 24.1 01/08/07 8. OP33 24.1.2.3 01/12/07 9. OP35 16(2)(1) 01/06/07 10. OP36 18(2) 01/09/07 The Old Rectory Care Home Version 5.2 Page 27 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 OP8 OP26 Good Practice Recommendations Nutritional screening should be implemented together with the weight charts in individual plans of care to assist in the monitoring of the health of the people living in the Home Consideration should be given to enlarging the laundry area, which is cramped and would contribute to the health and safety of staff working there as part of the infection control procedures for all those people living in the Home. All people living in the Home should continue to have access to regular resident meetings throughout the year. This will help ensure that their needs, choices and rights are voiced. All people living in the Home should be offered a choice of wholesome meals to suit their wishes and feelings. This will help ensure that the meals meet their individual needs. 3. OP32 4. OP15 The Old Rectory Care Home DS0000061106.V338930.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Care Home DS0000061106.V338930.R01.S.doc Version 5.2 Page 29 - 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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