Inspection on 01/04/09 for The Old Vicarage

This inspection was carried out on 1st April 2009.

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

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

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE The Old Vicarage Ford Street Wigmore Near Leominster Herefordshire HR6 9UW Lead Inspector Philippa Jarvis Unannounced Inspection 1st April 2009 09:00 DS0000072974.V374779.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Old Vicarage DS0000072974.V374779.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Old Vicarage DS0000072974.V374779.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Vicarage Address Ford Street Wigmore Near Leominster Herefordshire HR6 9UW 01792 524 988 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) UG Care Ltd Sherry Joy Guimbal Guanzon Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places The Old Vicarage DS0000072974.V374779.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age not falling within any other categories (OP) 16 The maximum number of service users to be accommodated is 16 This was the first inspection of The Old Vicarage with new service providers. Date of last inspection Brief Description of the Service: The Old Vicarage is a large, detached period house and a ground floor extension has been added to the home. It has a central location in the small village of Wigmore a rural area in the north of Herefordshire within easy reach of the local amenities, such as the church, post office, village stores and public houses. Accommodation for the residents is on two floors; access to the first floor is via a shaft lift although this is not big enough to take a wheelchair. There are thirteen bedrooms, three of which are shared. There are two lounges. The home is owned and managed by UG Care Ltd and managed by Mrs Guanzon. It is registered to accommodate up to sixteen people. People who live in the home must have care needs arising from old age. Fees are £500 per week; further information about fees can be obtained from the home. The Old Vicarage DS0000072974.V374779.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this home is 1 stars. This means that the people who use this service experience adequate outcomes. Two inspectors spent a day at the home talking to people who use the service, staff and the manager. We looked at some records that must be kept by the home to show that it is being run properly. These included records relating to the care of people who live in the home. We looked at the experience of care for three people in detail. This is called case tracking. Before we visited the home had completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that tells us how the home thinks they are performing, what they think they are doing well and what they think they could do better. This helped us to plan how to do the inspection, and some information from the AQAA is included in this report. We also received completed surveys from people who use the service (some of these were filled in by their relatives), from staff and from health care professionals who work with the home. The information in these helps us to understand how well the home is meeting the needs of the people who live there. What the service does well: The home provides a homely and friendly environment for people to live in and to visit. There is written information available for people to help them decide if they wish to live in The Old Vicarage. They are also welcome to visit the home to help them make up their minds. People who live in the home told us, “Since moving in I have settled in well as one of the residents and enjoy staying here.” and “I find I am very comfortable here and my needs are well attended to.” The home has involved health care professionals appropriately when they have concerns about someone’s health. The Old Vicarage DS0000072974.V374779.R01.S.doc Version 5.2 Page 6 There is an intention to provide a good range of activities for people to take part in, including visits outside the home. There is sensitivity to the wishes of people who prefer not to take part in organised activities. The home provides a varied menu of good home cooked food. The home has a clear complaints procedure that is made available to people who live in the home and their representatives. The premises are kept clean and people are able to bring their own belongings in to make their room personal to them. There are sufficient care staff on duty both by day and night to ensure that the needs of the people who use the service can be met. People like the staff and spoke highly of the way in which the staff care for them. The manager has promoted a supportive and open feeling in the home amongst the staff and the residents. There is regular formal supervision for staff. What has improved since the last inspection? What they could do better: There are initial assessments carried out when people consider moving into the home but the service needs to be make sure that it does not admit people who are not in a category that they are registered to accommodate. The initial assessments do not lead to a care plan being set up. There are assessments for people who live in the home but the care plans are not up to date so they do not make clear the care that is needed to meet people’s needs. There are some aspects of medication practice that are not carried out to the expected standard for example the storage of medication and recording of medication in the home. The Old Vicarage DS0000072974.V374779.R01.S.doc Version 5.2 Page 7 Whilst the new service providers have started to improve the environment, for example by the provision of new laundry equipment, there are a number of aspects of the premises that are not of a good standard and need to be addressed. These include access to the first floor, redecoration and suitable call bell provision. We have asked them to submit an action plan, with timescales, for upgrading the premises. There are some aspects of the staff pre-employment checks that are not fully carried out before staff start to work in the home. This places residents at risk of unsuitable staff being employed. New staff do not take part in induction training that is to the expected standard to help them know how to work safely and correctly with people living in the home. There are a number of elements of management practice that need more attention, such as ensuring there are up to date care plans and risk assessments. The manager works for all but one shift as a care worker. Whilst some caring time may be appropriate in a small care home she needs to ensure that she has sufficient time available to carry out the management function. The home does not have a system in place for monitoring the quality of the service it provides. There were some areas of health and safety practice that caused concern. We referred issues about fire safety practice to the local fire safety authority. The home also needs to ensure that it has a trained first aider on the premises at all times to assist any resident in need of help. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. The Old Vicarage DS0000072974.V374779.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 Vicarage DS0000072974.V374779.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. The home does not provide intermediate care. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information provided for people at the time they are admitted needs some attention to ensure they receive the required details about the home. An assessment is carried out of people’s care needs before they are admitted to the home but this does not lead to an initial care plan being in place to tell staff how to provide their care. EVIDENCE: There is a Service User Guide that provides people with information about the home. This needs some amendment to fully comply with the standards expected, for example it does not provide a description of the accommodation The Old Vicarage DS0000072974.V374779.R01.S.doc Version 5.2 Page 10 or the relevant experience and qualifications of the staff. The manager told us that a copy of this document is provided to each person on admission. In their surveys all the residents told us that they had received enough information about the home before they came to live there. The manager told us that people are encouraged to look round to help them make a decision about whether to move into the home. Indeed someone came to view the home, by prior appointment, while we were doing our inspection. The home does take people as emergency admissions and there is a policy about how the home manages this. We read this policy and found that it described suitable procedures in terms of the general process. This included ensuring that they carry out an assessment of the persons care needs or that they receive information from the agency that referred the prospective resident. Currently the home is registered to accommodate people whose care needs arise from the aging process and both these emergency admissions were made through the Department of Mental Health for Older People. The home needs to be careful to ensure that it does not admit people whose needs are related to mental health or dementia issues. It is not registered to accommodate people with these needs and the registered provider and manager may be liable to prosecution if people are admitted outside the categories of registration. We read the file for the person who had come to live at The Old Vicarage most recently and found that there was an assessment in place, carried out before admission. This was sufficiently detailed. However the information had not been written into a plan of care and there were some elements that identified significant areas of concern such as skin care and nutrition. They had not, therefore, been formally drawn to staff attention nor had the staff been provided with written guidance about how to meet that person’s care needs. The Old Vicarage DS0000072974.V374779.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of suitable care plans and risk assessments means that residents in the home are at risk of not receiving the care that they need. EVIDENCE: People living in the home generally appeared well presented but their care plans and risk assessments were not well maintained. It was also difficult to confirm from the records available when/whether they had received assistance with their personal care. There was, therefore, a risk that people would not receive care in a safe and reliable way. We read four files. Except for one person, the most recently admitted resident, these each included a plan of care. These had been written some The Old Vicarage DS0000072974.V374779.R01.S.doc Version 5.2 Page 12 time ago, examples we saw included 2004 and 2006. The manager had carried out reviews of their assessments in November 2008 and in some areas there was significant change but there was no amendment to their care plan. The home has started carrying out monthly reviews of each resident. The senior care assistants do this. The information in these assessments shows that the home does maintain an overview of each person’s progress. The plans we read did not, however, reflect people’s current care needs or provide guidance for staff about how these should be met. For example, we read one example where the care plan said the resident walked long distances and was continent, neither of which were accurate at the time of inspection. Some people had developed further care needs that were not reflected in their plan of care, examples being pressure area care, continence management, diabetes and nutritional needs. This meant that there was no care plan in place about significant areas of care and those that were there were out of date. One person had pressure area care needs but there was no clear plan about how to mange their needs in this area and no records to confirm that the recent damage had either healed or was being dealt with. Another resident actually had pressure area sores at the time of our inspection, although her pressure sore risk assessment said that her risk was low. There was no guidance in the care plan about how to manage her pressure area care needs but a district nurse was involved and a carer was able to verbally describe the action that the home was taking. There were records kept in a number of files in different locations and it was difficult to identify whether care tasks had been completed. There was a risk for staff of duplication, confusion or omission. It was difficult to tell from some whether appropriate action had been taken e.g. one resident had a bowel chart on which there were very few entries in March; we found that this resident was prescribed “as required” medication for this problem but they had received few administrations during the month of March. We were unable to find out whether the medication was not needed or not given. There was no information available to detail when this medication should be administered and why it had been omitted during this period of time. We found problems in identifying whether people’s weights had been taken at appropriate intervals. In one person’s pre-admission assessment, it indicated that their weight should be taken weekly but we could find no evidence that this had happened. In their surveys people told us that they thought that their health care needs were well attended to by the home. Within each person’s file was a record of contacts they had with their GP and district nurse. It was evident from these that people were referred when problems were identified with their health. In a survey we received from a health care professional they commented that the home had good involvement with health care professionals. Guidance about action to be taken following visits was not placed within their working care The Old Vicarage DS0000072974.V374779.R01.S.doc Version 5.2 Page 13 plan. The home depends on information being passed on verbally. This is not sufficiently robust to ensure that the right action is taken nor is it accountable. We found no information in people’s files about chiropody, dental or optical care. This is particularly significant for those residents with diabetes. The manager told us that the home has a hoist but because of limited storage space it was kept in the laundry (which is outside the home and down some stairs). This meant that it was not readily accessible for use in the event of need. In their survey one district nurse told us that they thought the home would benefit from having a hoist which suggests that the hoist may not be used when needed. The medication in current use was stored in a suitable trolley that was fixed to the wall. This was placed in a room that was designated as a lounge for residents. This is not a suitable storage area. There were also a number of resident records kept in this room. They were not secure and they contained information that was personal. We also found a number of records where information about everyone living in the home was kept on one sheet or book. This compromised their confidentiality and there was the potential for important information to be lost if it was not transferred to individual records. Additional medication was stored in two further cupboards, one fixed appropriately to the wall, the other free standing. All medication should be stored in a suitable and secure location. Each administration of medication was recorded on a record sheet for the purpose. We found that there was no system in place to monitor the medication kept in the home or to enable the home to audit that medication had been correctly administered. We found that a number of boxes and packets of medication had not been dated when they were opened. This meant that the home did not know that medication had been used within the correct timeframe. We saw one bottle of liquid that had to be used within three days of opening but because the date it was opened was not recorded the staff could not check when it needed to be removed from use. Also it was not possible to carry out an audit that the right amounts of these medications were in the home. We did count one medication in the CD cupboard and found that the correct amount was detailed in the CD register. There was no guidance available for staff about the use of “as required” medication and the circumstances in which it should be used. We found one medication in the trolley that needed to be stored below a certain temperature. The senior staff on duty was not aware of there being a thermometer in the medication trolley with which to check the storage temperature. All staff who administer medication have received training in how to do this and we found that the record of administration, including the CD register, was appropriately recorded after each administration. The Old Vicarage DS0000072974.V374779.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13,14 and 15. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to maintain choice in their daily lives although the service needs to assess this more carefully through the care planning process. The home has started to provide activities for people to take part in if they choose. A varied menu of nutritious food is provided. EVIDENCE: There is a homely atmosphere at The Old Vicarage. In their survey one person told us that, “It felt like home straight away.” People living in the home choose their daily routine e.g. they get up and go to bed when they chose. We saw people decide where to spend the day, either in the lounge or in their room and one person chose to go for a walk outside to get some fresh air. The Old Vicarage DS0000072974.V374779.R01.S.doc Version 5.2 Page 15 There was no information in people’s care plan of an assessment of their interests or what they might like to do on a one to one basis. They are, however, aware of people’s preferences of whether to join in events or to stay in their room. In their surveys people told us that there were sometimes activities to join in and some told us that they did not want to join in activities. The manager reported that she hopes to take people out more and that she has shared use of a minibus (with other homes in the group) for this purpose. She told us that she also plans to start weekly exercise classes. The home is in the process of setting up various activities for the residents to join in. They told us that on the previous day they had played carpet skittles. On the afternoon of our visit there was a DVD of “Around The World in Eighty Days” shown in the lounge. This was shown on a small television set that was difficult for the residents to see. The manager told us that they planned to buy a larger television when they had raised enough money in the residents fund through fundraising activities. We told the manager that our view was that this was an amenity that should be provided by the home and that the residents’ fund should provide extras for treats and comfort. The home has started having residents meetings. People living in the home told us that their visitors were welcome at any time. We saw little information in the care plans about people’s spiritual needs. There is a vicar who visits about once a month to provide Holy Communion. People told us that they enjoyed their diet. Most ate in the dining room but those who needed assistance were helped on a one to one basis in the lounge. Lunch was roast chicken with roast potatoes and a selection of vegetables followed by steamed treacle sponge and custard. Tea was egg on toast or sandwiches with home made cakes. The food was nicely presented and looked appetising. A soft diet was provided for those who needed this. There was no reference in their care plan nutritional assessment about the presentation of their meals. We saw that drinks were offered at regular intervals. The home has achieved a rating of “Very Good” from the local environmental health department for their food hygiene standards. The Old Vicarage DS0000072974.V374779.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to a complaints procedure but the absence of robust recruitment procedures means that there is a risk that unsuitable people could be appointed to work at the home. EVIDENCE: There is a copy of the complaints procedure in each person’s room and also in the Service User Guide. People who live in the home told us that they know how to make a complaint if they need to. The information in the AQAA told us that the home has not received any complaints since the new provider took over. There was a procedure about protecting vulnerable people from abuse. This appeared satisfactory but phone numbers of who to contact in the event of need could be more prominent. There has been staff training in this area and staff we spoke to knew the right action to take if they had suspicions of abuse. We asked to look at the files for three members of staff including two who had been appointed recently. There was no recruitment policy available and we The Old Vicarage DS0000072974.V374779.R01.S.doc Version 5.2 Page 17 found that the procedures for the two people recruited recently had not been carried out properly in a way that safeguarded the people living in the home. We found application forms not fully completed, unsuitable references, references received after the person had started working in the home and some references not received. We also found that one person had a CRB disclosure check that had been transferred from another employer. This is not acceptable practice. The manager was not aware that CRB checks were not transferable. The Old Vicarage DS0000072974.V374779.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst providing a homely environment for the people who live in the home, there are a number of aspects of the accommodation that are in need of attention to improve the facilities and provision for the residents. EVIDENCE: The Old Vicarage is a detached house in the village of Wigmore. There is a homely atmosphere in house. The home appeared clean and smelled fresh. In their surveys people told us that the home is always clean and fresh. Whilst the home is set in large gardens that have been tidied, these are not safe and readily accessible for the residents. The Old Vicarage DS0000072974.V374779.R01.S.doc Version 5.2 Page 19 There is one main lounge furnished with armchairs and a television. Bedrooms are located on both the ground and the first floor. The single bedrooms that we saw were well personalised. There are thirteen bedrooms, three for shared use. Those for shared use have a curtain separating the beds to help privacy, but not round the washbasins. Some bedrooms have ensuite facilities. There is an assisted bath but the home does not have a shower. People living in the home do not therefore have a choice about whether to shower or bathe. Access to the first floor is via staircase, which is steep and not easy for people to negotiate, or a shaft lift. The shaft lift is also small. We saw a prospective resident come to visit the home who was unable to go up to the first floor in the lift because it was not big enough to take a wheelchair. This means that people with mobility problems would have difficulty accessing the first floor. The manager told us that there were plans to replace the shaft lift at some stage during the future. The new service providers are aware that there are a number of areas that need attention and have started to make improvements. These are detailed in the AQAA and include new laundry equipment, a new dishwasher, some new soft furnishings, a new settee and display cabinet in the small lounge and creation of a staff room. However there are a significant number of aspects of the premises that we saw that are in need of attention. These include: • The decoration in many areas of the home is in need of attention with paintwork chipped or stained and wallpaper coming away from the walls. • The front drive was pitted and in poor condition. • One bedroom we saw had vinyl floor covering. Carpet should be provided in bedrooms unless there is an identified need. • The carpets were well worn although we did not see any areas that posed a risk for residents. • Call bells can be cancelled on the board located in the small lounge. There should only be facility to cancel them at point of call, that is where the resident has called for assistance. The current arrangement carries the risk of the call being switched off at the board and the call not answered. • The small lounge was not fully available for resident use. The medication trolley was stored there, some resident records, the board for the call bells and an airing cupboard. This has implications for confidentiality and privacy. • The concrete floor and breezeblock walls in the laundry are permeable and a potential infection hazard. • There was no risk assessment for residents potentially accessing the second floor via the door, which is not locked. The Old Vicarage DS0000072974.V374779.R01.S.doc Version 5.2 Page 20 We expect the service providers should carry out a detailed assessment of the physical environment and prepare an action plan setting out their intentions for upgrading the premises. There were several photographs of the children of the manager and the service providers displayed in the lounge areas of the home. We indicated that this was inappropriate in the resident’s home and that it would be nice to see more photographs relating to them on display. The husband of the manager works as the handyman for the home. There is a maintenance book where staff record matters that need attention. We were told that the items listed in there had been dealt with although there were a number that had not been signed off as complete. In the AQAA the manager told us that all staff have been trained in infection control although this was not reflected in the training information provided during the inspection. The home have made steps forward with infection control by improving facilities in the laundry including installing a washbasin, and putting alcogel/handwash dispensers by washbasins in toilets throughout the home. The Old Vicarage DS0000072974.V374779.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff to meet the needs of people who use the service and they can be confident that they are kind and caring. There are aspects of their recruitment and induction training that need attention and may place people who use the service at risk of harm. The home is working hard to ensure that staff receive appropriate mandatory training. EVIDENCE: People living in the home told us that they liked the staff. One person said in their survey, “The staff are brilliant” another that “Every one is very kind and caring.” The staff told us that they enjoy working in the home and they and the residents have found recent changes in management good: “Since the new owners have taken over this has become a happier environment putting residents needs first and making sure staff are happy and have a good open door policy.” We were provided with a copy of the staff rota, which showed that there are three staff working with the residents from 8am till 2pm and two staff from The Old Vicarage DS0000072974.V374779.R01.S.doc Version 5.2 Page 22 2pm till 8pm. Overnight there is one waking night staff and one person sleeping either in the home or from the managers’ house in the grounds. There is a cook and a domestic on duty each morning. Whilst this appeared adequate most of the day, we observed that at teatime both care assistants were in the kitchen and there was no one out on the floor to oversee or assist the residents. We were concerned that some aspects of the recruitment of staff did not meet the required standards as described in the Complaints and Protection section above. Following recruitment, we expect staff to follow a structured induction programme that meets the standards set down by Skills for Care, the sector training organisation. Whilst new staff had followed a form of induction within the home, the manager did not have a full knowledge of the required standards and they had consequently not been followed. The home does not have any supporting material for the knowledge base at induction. The home has set up a significant amount of training this year and the staff told us in their surveys about the amount they had done. One said, “New management have only been here for a short time but are very eager for all staff to have up to date training.” The manager is trying to ensure that all staff have completed the training they need both at a mandatory level and to improve their knowledge base. For example most staff are doing training in dementia care. They have also completed moving and handling, fire safety and medication in recent months. A number are also training in nutrition. This is in addition to ongoing NVQ training. One said, “Our new management team are very keen for us as staff to get a widest range of knowledge and understanding possible, but courses seem to be coming very frequent though I do enjoy doing them we do need time to take it in.” Staff are not paid when they undertake mandatory training such as moving and handling, health and safety and first aid. This is essential for their work and should be provided by the employers, in compliance with health and safety legislation. The Old Vicarage DS0000072974.V374779.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management style in the home is open and appreciated by staff and residents. There is lack of understanding of some of the processes that are needed to manage the service in a way that promotes the health and well being of the people who live in the home. EVIDENCE: The manager had previous care management experience before coming to The Old Vicarage working with client groups other than older people and is now The Old Vicarage DS0000072974.V374779.R01.S.doc Version 5.2 Page 24 taking relevant training for this role. The management style in the home is open and inclusive. The manager is well known by the residents and the staff and they appreciate the daily contact. One member of staff commented that they were, “Asked on a daily basis if things are alright and if I need anything. Can make an appointment if I need to speak to manager if a problem occurs.” They also appreciate the openness and delegation that is now the practice in the home. However the manager showed that she has some lack of understanding and knowledge of some aspects of managing a care home e.g. recruitment and induction practice. We found that, whilst she was making notifications to us under the requirements of Regulation 37, she was using old forms to do so. She was not aware that they had been replaced more than once since the copy she was using and she was also not aware of the recent change of the registering authority to CQC. She was advised to use the CQC website for guidance in this and some other areas. She also works a considerable number of hours as a carer in the home, which means that she has not had time to complete some aspects of the management task such as ensuring that up to date care plans are in place. The Old Vicarage is a home in the UG care group and a representative from this company should visit on a monthly basis to inspect the conduct of the home. They should then write a report that they provide for the company and the manager. There were no records available in the home to indicate that a visit had been made since December, that is for four months. The content of the reports up to that time was limited in depth and scope. We asked to look at the quality assurance policy about how the home monitors the quality of the service it provides. This could not be found during the inspection. The home returned the AQAA as requested. There were a number of policies and procedures laid out on a table by the staff room that were available for staff to read. We looked at the record keeping for monies held by the home on behalf of he people living there and found that it was kept to a satisfactory standard. However there was no information in the files for residents about the arrangements for the management of their personal finances. The manager has set up staff supervision and appraisal systems in the home. In the files we examined we found records of regular staff supervision. In their surveys staff told us that they were appreciative of the support they receive from the manager. Equipment in the home is regularly serviced and the home employs a maintenance man to carry out minor repairs. We saw records in the home that The Old Vicarage DS0000072974.V374779.R01.S.doc Version 5.2 Page 25 confirmed that water temperatures are regularly checked and that there has been a test for legionella carried out since the new providers took over. In the AQAA there was no information about when various pieces of equipment in the home were last tested or serviced e.g. the emergency call system and the lift. We did not find evidence that there is always a qualified first aider available on the premises. We looked at the fire log. This recorded that the required checks and tests are carried out at appropriate intervals. The fire safety risk assessment had not been reviewed since 2005. We also saw that wedges were in use in fire doors. Residents had signed disclaimers indicating that they were prepared to accept the risk in event of fire. This is not satisfactory because each room being wedged open potentially could increase the risk of fire throughout the home. We also saw fire doors that did not close properly and this also puts people at risk if there is a fire. Because of our concerns over fire safety we informed the local fire brigade following our inspection. The Old Vicarage DS0000072974.V374779.R01.S.doc Version 5.2 Page 26 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 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X 1 The Old Vicarage DS0000072974.V374779.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No, new providers. 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 15(1)(2) Requirement Timescale for action 30/06/09 2 OP9 13(2) 3 OP29 19(1) You must ensure that there is a care plan in place for each person, which is reviewed periodically and is up to date and sufficiently detailed for staff to understand how to meet their health and personal care needs. You must ensure that there is 30/06/09 written guidance available to inform staff about how and in what circumstances “as required” medication can be used. This will ensure that people who live in the home receive this medication for the right reasons and in the right way. You must ensure that you obtain 30/06/09 all the required information about potential employees with reference to Schedule 2 of the Care Homes Regulations . This must include two references, one of which must be from the person’s most recent employer, and a CRB check. This will help to determine the suitability of applicants before they start working in the home. DS0000072974.V374779.R01.S.doc Version 5.2 The Old Vicarage Page 28 4 OP30 18(1) 5 OP37 17(1)(b) 6 OP38 13(4) 7 OP38 26 8 OP38 24 You must ensure that staff who are new to working in the home undertake induction training to the standards set down by Skills for Care. This will help to ensure that they have the right knowledge and skills to work with the people who live in the home. You must ensure that all records kept by the home are securely maintained. This will help to ensure the confidentiality of information about each person living in the home. You must ensure that there is a member of staff trained in first aid who is available in the home at all times to assist any resident who may have an accident or sudden illness. A representative of UG Care must visit the home on a monthly basis to carry out an inspection and prepare a report on the conduct of the home. This will help the company understand the way the home is running and to take responsibility for achieving necessary improvements. You should ensure that there is a policy and procedure for reviewing the quality of the care provided in the home. This should include a process for consultation with residents and their representatives. This will help you to ensure that you are meeting the needs of the people who live in the home. 30/06/09 30/06/09 30/06/09 30/06/09 30/06/09 The Old Vicarage DS0000072974.V374779.R01.S.doc Version 5.2 Page 29 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 OP1 Good Practice Recommendations You should review the Service User Guide to make sure that it contains the information set down in the National Minimum Standards. This will provide prospective residents with the details they need to help them know that the home will meet their needs. You should date each packet and bottle of medication with the date that it is opened. This will help to ensure that medication is used within the correct timeframe and help in the auditing of medication in the home. You should ensure that there is a thermometer in place where the medication is stored so that staff can check that it is being stored at the correct temperature. You should set up a system to monitor the medication kept in the home to enable the home to audit that medication has been correctly administered. You should consider how to store medication more appropriately so that it ensures security of the medication, confidentiality of the residents’ records and impact on their living space. You should ensure that there is a system in place to assess residents’ needs for chiropody, dental and optical care and that a record is kept of their access to these services. You should carry out a detailed assessment of the physical environment and prepare an action plan, with timescales, setting out your intentions for upgrading the premises. This should be submitted to the CQC. You should carry out a review of the training needs of the manager to ensure that she has the necessary knowledge and skills to manage a care home for older people. You should ensure that the manager is rostered for sufficient hours in the management role to provide time for all the management tasks to be undertaken. You should undertake a review of fire safety arrangements in order to ensure compliance with the Regulatory Reform (Fire Safety) Order 2005. 2 OP9 3 4 5 OP9 OP9 OP9 6 OP8 7 OP19 8 9 10 OP31 OP38 OP38 The Old Vicarage DS0000072974.V374779.R01.S.doc Version 5.2 Page 30 Care Quality Commission West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway, Birmingham B1 2DT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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