Inspection on 13/07/06 for The Old Rectory [Nunney]

This inspection was carried out on 13th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Old Rectory [Nunney] 30/07/07

The Old Rectory [Nunney] 29/01/07

The Old Rectory [Nunney] 15/02/06

The Old Rectory [Nunney] 07/06/05

The Old Rectory [Nunney] 27/01/05

The Old Rectory [Nunney] 27/05/04

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Old Rectory High Street Nunney Frome Somerset BA11 4LZ Lead Inspector Sally Murphy Key Announced Inspection 13th July 2006 10:30 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 DS0000016007.V303758.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 DS0000016007.V303758.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Rectory Address High Street Nunney Frome Somerset BA11 4LZ 01373 836747 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) MR RONALD HILL MRS MARIAN CONSTANCE HILL MR RONALD HILL Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places The Old Rectory DS0000016007.V303758.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th February 2006 Brief Description of the Service: The Old Rectory is a large detached property located in the village of Nunney, approximately four miles from Frome. Service user accommodation is provided over two floors. There is a passenger lift, assisted bathrooms, and a call system available. The Old Rectory is registered with the Commission for Social Care Inspection to provide care for up to 24 service users over the age of 65 years. The proprietors are Mr and Mrs Hill. Mr Hill is also the Registered Manager. The home has been decorated and furnished to a high standard. The garden has been well maintained and is accessible to service users. The Old Rectory DS0000016007.V303758.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out as part of the planned programme of inspection. The inspection was announced and carried out by one inspector over one day. The previous inspection was unannounced and took place on 15th February 2006. On the day of the inspection there were eighteen service users residing at the home. During the course of the inspection service users, staff members and the Care Manager, and Registered Manager were spoken with. Care practice was also observed, records examined and a tour of the premises was made. What the service does well: What has improved since the last inspection? What they could do better: The Old Rectory DS0000016007.V303758.R01.S.doc Version 5.2 Page 6 A risk assessment must be completed in relation to the storage of denture cleaning tablets as these may pose a risk of serious injury to a service user if a number are consumed. Staff must ensure that an opening or discard date is recorded for external creams. Medications within service users’ room must be stored securely. A risk assessment must be completed and regularly reviewed for all service users occupying rooms on the first floor where their window may be opened fully. The home must continue to support and encourage staff in studying for the NVQ level 2 qualification in direct care. For the protection of vulnerable adults a POVA First check must be completed prior to any staff member commencing employment at the home. The home should consider establishing systems such as residents meetings or service user surveys to seek service users views on the service provided. 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 DS0000016007.V303758.R01.S.doc Version 5.2 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 DS0000016007.V303758.R01.S.doc Version 5.2 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): 1,2,3,4 & 5. (Standard 6 does not apply). Quality in this outcome area is good. Service users are provided with appropriate information regarding the services and facilities offered at the home. An assessment of need is completed prior to any service user moving in, to ensure that the home will be able to fully meet their needs. Service users are encouraged to visit the home to assess the facilities provided. Service users are provided with a written contract outlining the terms and conditions of their stay. EVIDENCE: The home has a Statement of Purpose and Service User Guide that provide details of the services and facilities offered. The fees are £340 – £418 per week. The Old Rectory DS0000016007.V303758.R01.S.doc Version 5.2 Page 9 The Care Manager meets with any prospective service user to complete a preadmission assessment, and liaises with any health or social care professionals involved in their care to ensure that the home will be able to meet their needs. Two service users had visited the home prior to moving in. A written statement of terms and conditions was seen for one service user. This had been signed by the service user and the Registered Provider. The Old Rectory DS0000016007.V303758.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 & 11 Quality in this outcome area is adequate. The home takes appropriate action to meet the health and personal care needs of service users. Since the last inspection, care plans have been reviewed and updated. Risk assessments have been completed appropriately. The management of medications requires further action to ensure that this follows best practice. Service users confirmed that staff treat them with dignity and respect. EVIDENCE: Care plans are maintained for each service user. Four care plans were examined in detail. Each care plan provided details of the level and type of assistance required by service users, and included information regarding their individual preferences and needs. Dependency assessments had been reviewed each month, and risk assessments had been completed and updated as necessary. The Care Manager has developed a new system for recording The Old Rectory DS0000016007.V303758.R01.S.doc Version 5.2 Page 11 daily entries for each service user, that is in accordance with the Data Protection Act 1998. One care plan seen had been signed by the service user. This is good practice and this opportunity should be offered to other service users within the home. Staff seek further advice and guidance from healthcare professionals such as Community Psychiatric Nurses and dieticians as required. Pressure-relieving equipment is available. Service users’ weights are recorded on a monthly basis. It is recommended that pressure risk and nutritional risk assessments are completed to ensure that staff may effectively monitor service users needs and take appropriate action. In consultation with Social Services the home has been completing behaviour monitoring reports for one service user. Denture cleaning tablets were found to be accessible two service users’ bathrooms. These tablets can pose a risk of serious injury if a number are consumed and a risk assessment must be completed in relation to the storage of these products and any necessary action taken. Staff at the home have received medication training. A record is maintained of all medication received into the home. Medication Administration Records had been appropriately maintained. An opening date or discard date had not been recorded for external creams stored within service users’ rooms. Inhalers were not stored securely within one service users’ room. A risk assessment had not been completed in relation to this service user self-administering their medication. It is recommended that the reason is recorded when medications are returned to the pharmacy. The home will offer care and support to service users until the end of their life whenever possible. The home works closely with the District Nursing Team to ensure the service users are comfortable and that they are able to continue fully meeting service users’ needs. The Old Rectory DS0000016007.V303758.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14, & 15 Quality in this outcome area is good. Service users are able to participate in a range of activities and are encouraged to exercise choice over their lives. Meals are of a high standard and offer a well-balanced diet. EVIDENCE: Service users are encouraged to maintain interests and hobbies. Staff are available each day to spend time with service users. Current activities provided include: bingo, board games, playing catch, flexercise, card games and quizzes. At present not all of the activities provided are recorded. It is recommended that individual activities records are maintained for each service user, to ensure that all have the opportunity to meet their social needs. An Activities Co-ordinator visits the home twice each week. Entertainers regularly visit the home. Trips are also provided. Daily routines are flexible. Service users are able to spend time within communal area, or their own room, as they prefer. Service users are able to access the garden at the rear of the property. The Old Rectory DS0000016007.V303758.R01.S.doc Version 5.2 Page 13 Visitors are welcomed at the home. A church service takes place within the home each month. Service users spoke very highly of the meals provided. Service users are able to eat meals in the dining room or their rooms as they prefer. The menu is displayed each day. The home is able to cater for specialist needs such as a soft diet. Staff are aware of service users’ dietary preferences and needs. The Old Rectory DS0000016007.V303758.R01.S.doc Version 5.2 Page 14 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 & 18 Quality in this outcome area is good. The home has appropriate policies in place to safeguard vulnerable service users. The Registered Provider and Care Manager ensure that service users are listened to and their views taken seriously. EVIDENCE: A copy of the home’s complaints procedure is displayed in the hallway. This includes details of external agencies that may also be contacted such as CSCI. There have been no complaints received by the home or CSCI since the last inspection. The whistle blowing policy has been updated since the last inspection and now contains details of external agencies, which staff members may contact with any concerns. The Old Rectory DS0000016007.V303758.R01.S.doc Version 5.2 Page 15 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): 19,20,21,22,23,24,25 & 26 Quality in this outcome area is good. The home has been decorated and furnished to a high standard. A risk assessment must be completed, and regularly reviewed for all service users occupying rooms on the first floor where their window may be opened fully. There is sufficient communal space and bathing facilities to meet service users’ needs. The home was found to have a good standard of cleanliness. EVIDENCE: Service user accommodation is provided on the ground and first floor. All service user rooms have en suite facilities, or sole use of a bathroom nearby. There are two assisted bathrooms, a passenger lift and call system available to service users. Communal space comprises of a large lounge, large dining The Old Rectory DS0000016007.V303758.R01.S.doc Version 5.2 Page 16 room, and quiet room. Service user rooms have been personalised to reflect individual tastes and preferences. The home has been decorated and furnished to a high standard. Since the last inspection a new carpet has been fitted in three service user rooms. Radiator guards have now been fitted in all parts of the home. During the inspection it was noted that the door to room 8 did not close fully. This room is not occupied at present and the Registered Provider agreed that the door would be adjusted. There is an ongoing program of maintenance and redecoration within the home. Hot water outlet temperatures were tested and found to be within appropriate limits. The windows fitted are of the ‘turn and tilt’ design. This means that they could be opened fully, and may pose a risk of service users falling from an upper floor. This was discussed with the Registered Provider and Care Manager. Mr Hill (Registered Provider) advised that where a service user is considered to be at risk, brackets would be fitted to ensure that the window cannot be fully opened. A risk assessment therefore must be completed, and regularly reviewed for all service users occupying rooms on the first floor where their window may be opened fully. The home has emergency lighting, which is tested on a monthly basis. The home is maintained to a good standard of cleanliness. Hand washing facilities consisting of liquid soap and paper towels have been made available for staff in all areas of the home where staff provide assistance with personal care. The laundry is well organised. The washing machine has a sluice facility. The Old Rectory DS0000016007.V303758.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. Staff are provided with regular updates in mandatory training. The home must encourage and support further staff to obtain the NVQ level 2 qualification in direct care. For the protection of service users, a POVA first check must be received prior to any staff member commencing employment at the home. EVIDENCE: Duty rotas are maintained. There are generally three care staff on duty in the morning, two during the afternoon, and one member of waking care staff on duty at night. Domestic and catering staff are also employed. Newly employed staff are provided with Induction training. The home has a training program that links to the NVQ 2 qualification. Staff are provided with training in food hygiene, infection control, COSHH, manual handling, coping with aggression and dementia. Currently only one member of staff has completed the NVQ level 2 qualification in direct care. The home must continue to support and encourage staff in obtaining this qualification. The National Minimum Standards for Older People states that at least 50 of the care staff employed should have completed this qualification. The Old Rectory DS0000016007.V303758.R01.S.doc Version 5.2 Page 18 Since the last inspection, the number of management hours available to the Care Manager has been reviewed, and Lorraine Montieth is now supernumerary for a minimum of one day each week, and additional time as required. The files were examined for three recently recruited members of staff. It was found that an application form, and two references had been received for all staff members. However a POVA First check had not been completed prior to one member of staff commencing employment at the home. This was discussed with the Care Manager. For the protection of vulnerable adults, a POVA First check must be received before a staff member begins work at the home, and appropriate supervision must be provided until an enhanced CRB disclosure is received. The Old Rectory DS0000016007.V303758.R01.S.doc Version 5.2 Page 19 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): 31,32,33,34,35,37 & 38 Quality in this outcome area is adequate. The Care Manager has provided strong leadership to the staff team. Records relating to service users are stored securely. Equipment servicing records have been appropriately maintained. The Registered Provider has taken appropriate actions to promote the health and safety of staff and service users within the home. EVIDENCE: The Registered Manager and Provider is Mr Ronald Hill, who has run The Old Rectory for many years. Mr Hill is supported by Lorraine Montieth who is the Care Manager for the home. Ms Montieth has recently commenced study for the NVQ level 4 qualification in Management. The Old Rectory DS0000016007.V303758.R01.S.doc Version 5.2 Page 20 There is a relaxed and open atmosphere within the home. Service users spoke highly of the Registered Manager, Care Manager and staff team. At present service users views are sought on an informal basis. The home should consider establishing systems such as residents meetings or service user surveys to seek feedback on the service provided. Records relating to service users are stored securely, and are maintained in accordance with the Data Protection Act 1998. The home will keep money securely for service users that wish them to. Records are maintained of all transactions involving service user finances. Three records were examined and each tallied with records kept. The home displays appropriate Employers Liability Insurance. All staff have received regular updates in fire safety training. The home has taken appropriate action to comply with the requirements from the Fire Officers recent visit. The fire system has been tested and serviced as required. The passenger lift, hoist and bath hoist have been tested under LOLER regulations. The electrical hardwiring, gas and portable appliances have been appropriately maintained. Accidents have been recorded and reported as required. The Old Rectory DS0000016007.V303758.R01.S.doc Version 5.2 Page 21 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 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 2 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 3 X 3 3 The Old Rectory DS0000016007.V303758.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 13 (4) Requirement Risk assessments must be completed in relation to the storage of denture cleaning tablets, and any necessary actions taken. An opening date or discard date must be recorded for external creams stored within service users’ rooms. Inhalers must be stored securely within service users’ rooms. A risk assessment must be completed in relation to any service user self-administering their medication. 3. OP25 13 (4a) A risk assessment must be completed, and regularly reviewed for all service users occupying rooms on the first floor where their window may be opened fully. The home must continue to support and encourage staff in obtaining this qualification. The DS0000016007.V303758.R01.S.doc Timescale for action 25/08/06 2. OP9 13(2) 25/08/06 25/08/06 4. OP28 18 (c ) 01/04/07 The Old Rectory Version 5.2 Page 23 National Minimum Standards for Older People state that at least 50 of the care staff employed should have completed this qualification. 5. OP29 19 & Schedule 2 For the protection of vulnerable adults, a POVA First check must be received before a staff member begins work at the home, and appropriate supervision must be provided until the enhanced CRB disclosure is received. 18/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP8 Good Practice Recommendations It is recommended that a pressure risk and nutritional risk assessment is completed for each service user on admission to the home, and reviewed on a regular basis. It is recommended that the reason is recorded when medications are returned to the pharmacy. At present not all of the activities provided are recorded. It is recommended that staff maintain individual activities records are maintained for each service user, to ensure that all have the opportunity to meet their social needs. The home should consider establishing systems such as residents meetings or service user surveys to seek feedback on the service provided. 2. 3. OP9 OP12 4. OP33 The Old Rectory DS0000016007.V303758.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 DS0000016007.V303758.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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!