Inspection on 10/05/07 for The Old Vicarage

This inspection was carried out on 10th May 2007.

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 Vicarage 20/12/05

The Old Vicarage 19/07/05

The Old Vicarage 14/03/05

The Old Vicarage 05/08/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE The Old Vicarage Main Street Hornby Lancaster Lancashire LA2 8JT Lead Inspector Mrs Joy Howson-Booth Unannounced Inspection 10th May 2007 11.00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Old Vicarage DS0000009865.V332852.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 Vicarage DS0000009865.V332852.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Vicarage Address Main Street Hornby Lancaster Lancashire LA2 8JT 01524 221284 01524 222578 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) Forrester Retirement Homes Mrs Karen Anne Robson Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places The Old Vicarage DS0000009865.V332852.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th December 2005 Brief Description of the Service: The Old Vicarage is situated in the quiet country village of Hornby. Hornby is a small hamlet approximately 9 miles north of Lancaster. The Old Vicarage is situated just off the main road, which runs through the village and is accessible to local shops, pubs, churches and general amenities. The home is an impressive Victorian-style building, which previously provided accommodation to the Vicar of the next-door church. The home has a small extension built on the side and provides accommodation for four people. The home is a two storey building with accommodation on both the ground and first floors. There are bathrooms and toilets accessible on both floors. Most rooms are single (some with ensuite facilities) and two shared rooms. There is a separate dining room and lounge, and the addition of a conservatory, which leads onto the gardens, has provided an additional facility for people to use. The walled garden is well maintained and provides an excellent outdoor facility for people to use. The home is very well maintained and provides a pleasant and homely environment for those people accommodated. The current range of fees are from £370.00 to £417.00 per week. Further details over fees can be obtained from the registered manager of the home. The Old Vicarage DS0000009865.V332852.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first site visit and was unannounced so the registered providers, registered manager, staff and people who use the service were not aware of the visit. The site visit was carried out by the inspector for the service and forms part of the overall inspection for the home which makes sure people are being cared for properly and to make sure the home is a safe place for people to live in. As well as the site visit, judgements have been made about the service based on information supplied by the registered manager. Comment cards were made available to people who use the service, their relatives and GP surgeries. 10 responses were received from people who use the service, all satisfied with the care provided. 9 responses were received from relatives who also were very satisfied with the service provided, and 3 responses were received from healthcare professionals, again with very positive comments. Some individual issues raised in comment cards were discussed with the registered manager who welcomed these as an opportunity to further improving the service. The site visit took place over one day and included taking time to sit and speak with people who use the service, speaking with staff, speaking with a visiting relative to the home. As well as this, a selection of documents were examined. The home’s registered manager made herself available during the inspection to answer questions and provide additional information. The inspector looked around parts of the home, including communal rooms, a small number of personal rooms, bathrooms and toilets to see first hand if the home was a comfortable, clean and safe for people to live in. Additional information was also supplied from a pre-inspection questionnaire completed by the registered manager. The site visit was positive with everyone welcoming, friendly and co-operative during the visit. The Old Vicarage DS0000009865.V332852.R01.S.doc Version 5.2 Page 6 What the service does well: The Old Vicarage provides a very pleasant and homely environment which has a relaxed and friendly atmosphere. The registered manager and staff make sure equal care is given to the people who use the service, considering their individual choices and preferences, and giving equal support to all, irrespective of their race, gender, disability, sexuality, age religion or beliefs. Individual comment included – “my relative is very happy at the Old Vicarage. My relative is always saying how kind the staff are and how good the food is. I am extremely grateful for the care and attention that my relative receives and feel that they could not be in a better place”; “they make my relative feel at home. The place is clean and well maintained and does not smell as some homes do. The staff are friendly and treat the residents with dignity”; “all of the staff are so lovely with my relative. They always have a ready smile and they have incredible patience. They inform me of any slight changes in health or behaviour, get in medical advice promptly if they suspect any problem. The home is always clean and the meals are excellent”; “personal, friendly care. Very good food”; “(the home) looks after everybody very well, nothing is too much trouble”; “all the staff are caring and thoughtful” and “(the home) is well run with the staff working well together as a team. I could recommend this home to anybody”. During the site visit, a number of people who use the service were seen and spoken with and all appeared to be very well cared for and content. People spoken with all said they felt well cared for and the staff were very good and they are treated as an individual and given the time and attention needed.. The registered manager works at the home on a full-time basis which gives an opportunity to talk with the people who use the service and pick up immediately on any concerns or issues. There is equal consideration given to all prospective employees, however only female staff are currently employed. Training programmes are offered to all members of staff. At present only 25 of the care staff are trained to National Vocational Qualifications (NVQ) Level II, although a number of staff have worked at the home for several years. This means that people who use the service are cared for by both suitably qualified and experienced staff. The carers were friendly and understood the personal needs of each resident. Whilst all the people who use the service have a range of differing care needs, they are encouraged to maintain their lifestyles as much as they are able to do so. Visitors to the home are always made welcome and are able to visit at any time. Individual comments include – “I visit regularly, the home contacts in between visits if necessary” and “in addition to caring you always get a warm welcome when visiting”. A visiting relative was also spoken with who was very positive in her praise for the care provided. The Old Vicarage DS0000009865.V332852.R01.S.doc Version 5.2 Page 7 Information supplied by the home confirms that there are a range of policies and procedures which ensure people who use the service are provided with the care they need and respects their rights irrespective of their race, gender, disability, sexuality, age, religion or beliefs. The home is well maintained and homely with communal rooms being accessible to the people who use the service. For the bedrooms upstairs there is a passenger lift for the people who use the service to use. There are a range of aids and adaptations for use within the home to help maintain people who use the service’ independence and dignity. The small number of personal rooms seen during this site visit were well maintained and homely. People who use the service are also encouraged to bring in treasured personal items to personalise their rooms. Communal rooms are well maintained and provide a homely and comfortable environment for the people who use the service to use. From talking with the people who use the service and staff on duty it is clear all work hard to ensure the home is maintained to a high standard and the registered manager is approachable for any ideas and suggestions that would improve the service. What has improved since the last inspection? What they could do better: No requirements have been made following this site visit. A number of recommendations have been made which can be found at the end of this report. Specific comments made about “needing more activities” was discussed with the registered manager, although the people who raised them were not identified. The following was noted : From speaking with people who use the service and the registered manager, the feelings about activities in the home was mixed. Some people who live at the home are able to organise themselves and enjoy the freedom and support the home provides and have stated they do not want any activities. However, it was noted that some people are probably more dependent on support to take part in and enjoy activities. This is something that the registered manager should develop further along with interested members of staff. The Old Vicarage DS0000009865.V332852.R01.S.doc Version 5.2 Page 8 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 Vicarage DS0000009865.V332852.R01.S.doc Version 5.2 Page 9 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 DS0000009865.V332852.R01.S.doc Version 5.2 Page 10 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): Standards 3 and 6 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home continues to have good arrangements to assess people who may like to live at the home which means only people whose needs can be met will be accommodated. EVIDENCE: Discussions with the registered manager confirmed there have been no changes to the home’s admissions procedure. Discussion also took place over the needs of people being referred to the home and advice given that the home should ensure its Statement of Purpose reflects the needs that can be met. The registered manager is to review the SOP to ensure it is up to date and reflects such information. The Old Vicarage DS0000009865.V332852.R01.S.doc Version 5.2 Page 11 Care assessments were examined for two newly admitted people and found to contain a good range of information, although for one person more information was being obtained The two people whose care assessments were examined were spoken with. They confirmed that their admission had been very well done, with support and help from the manager and staff. They also confirmed that they remember being given information about the home. Other comments from people who use the service and their relatives confirmed that they felt they had been given enough information about the home to enable them make a decision over its suitability and one comment indicated that the 4 week trial period was important in giving an opportunity to experience the care provided - “We were recommended to this home and was given a 4 week trial period and it was this that convinced us of the quality of the home.” Comment cards received from people who use the service confirmed that they have received a copy of the home’s contract. This home does not have an intermediate care facility. The Old Vicarage DS0000009865.V332852.R01.S.doc Version 5.2 Page 12 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): Standards 7, 8, 9 and 10 People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. An excellent quality of care is provided to the people which means their health and personal care needs are generally met and people are treated with dignity and respect. Medication systems are generally good but some systems need improving to ensure people are safeguard. EVIDENCE: Two care files were case tracked, including talking with the people concerned, and there appears to be good information which mean staff get to know individual needs and wishes. Care plans include daily routines and preferences and risk assessments. Daily records were also seen and record individual care input, addressing of healthcare issues, etc. The Old Vicarage DS0000009865.V332852.R01.S.doc Version 5.2 Page 13 There is also evidence of healthcare input, including ongoing weight charts, visits by GP/DN and other healthcare professionals. A member of staff was spoken with regarding care needs and had a good understanding of the needs of the people concerned. The member of staff confirmed that information concerning the day-to-day needs and any changes to the people who live at the home are passed on by the registered manager personally during handover. Staff also confirmed that each person is treated on an equal basis, regardless of their gender, race, religion or sexuality. Advice was given to the registered manager that staff may benefit from having some specialist training e.g. on Parkinson’s disease so that they can better understand the needs of the individual. From talking with the people who use the service and from comment cards received, it was confirmed that the staff at the home listen and act on what the people who live there say, work hard to meet individual needs and to ensure healthcare needs are met. Comments from people who use the service included: “all the staff are friendly and helpful”; “the staff are caring and kind”; “staff are always cheerful”. Comments from relatives included - “my relative is always saying how kind the staff are. I am extremely grateful for the care and attention that my relative receives and feel that they could not be in a better place”; “all of the staff are so lovely with my relative. They always have a ready smile for her and they have incredible patience. They inform me of any slight changes in her health or behaviour, get in medical advice promptly if they suspect any problem” and “the staff are friendly and treat the residents with dignity” and “they make my relative feel at home”. Positive comments were also received from 3 healthcare professionals. These included – “I visit my patients regularly and always find the Old Vicarage an attractive, welcoming place with individual personal care”, “my patients resident in the Old Vicarage are always treated with respect and their dignity maintained. I have no concerns with regard to health care” and “excellently run home”. Medication administration records (MARs sheets) and some stocks were examined. The following comments were made: Some records of administration for creams had not been completed. It was advised that it might be more useful to keep these sheets in individual rooms for staff to complete at the time. Medication administration sheets included contraindications for medications. However the registered manager was advised to obtain patient information leaflets and put these in a folder for staff to read and refer to. The Old Vicarage DS0000009865.V332852.R01.S.doc Version 5.2 Page 14 One administration of medication had not been signed for but it was not possible to audit this medication to identify if it had actually been given or not. The registered manager was advised that there needs to be a system for auditing medications in the home – from receipt (including the checking of drug/dosage, etc), administration and disposal (detailing drug and actual number of tablets/medications returned). When medications need to be given at set times, it was advised to specify on the medication administration sheet the actual times so that there is no risk of confusion or error. Discussions with people who uses the service and one relative confirmed that medication is always given properly and on time. Eye drops need to be dated on opening. A coding system should be developed for non-administration of medications e.g. ‘R’ for refused, ‘H’ for in hospital, etc. rather than the current method of. The current system of circling the staff members’ initials has the potential for confusion. Controlled drugs were checked and stocks and records were accurate. The Old Vicarage DS0000009865.V332852.R01.S.doc Version 5.2 Page 15 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): Standards 12, 13, 14 and 15 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Social contact and meals are good which means the people are provided with a good quality of lifestyle. Individual activities should be developed to ensure people receive social stimulation. EVIDENCE: People who use the service were spoken with and were able to confirm that they are able to follow their own routines as much as they are able to do so. Support is provided by the home, for example, one lady is assisted to attend Church, other people are helped to attend coffee mornings, plays at the local institute – “A carer takes my relative to church when I cannot do so. I am happy with what is done for her”. Peoples’ interests are recorded on their care plans and staff spoken with were aware of individual interests. Comment cards received from both people who use the service and their relatives all confirmed that they are able to keep in contact and the home makes sure they are kept up to date with important matters, as required. One The Old Vicarage DS0000009865.V332852.R01.S.doc Version 5.2 Page 16 person spoken with has their own phone in place and another new resident is having a phone installed. Relatives also confirmed the home keeps in contact “I visit regularly, the home contacts in between visits if necessary”. Time and trouble is clearly taken with people so that they can enjoy the family celebrations that occur – one person spoke of her enjoyment in attending the wedding of her grandson. The staff made sure she had had her hair and nails done, dressed in a new outfit and supported at the reception. A photograph on display evidences that this was a highly enjoyed day out. A relative spoken with said that she is able to visits her relative very regularly and a differing times of the day. A number of comment cards from both people who use the service and their relatives indicate there is insufficient activities on offer – “not enough activities available”; “the care home could provide more stimulation instead of sitting them down in front of the TV”; although the garden party and Christmas party were mentioned a few times and are enjoyed by all. Activities provided by the home include - dominoes and card games, jigsaws and puzzles, attending Church, attending plays at the local institute, coffee mornings, etc. People are free to use their own rooms, with most having their own television. At the time of the site visit people were enjoying choosing books from the mobile library visiting the home. Discussions with people who use the service were mixed over the question of activities. Generally, activities for those people who are able to self determine are well managed and respected. However, activities for those people who perhaps need more additional or 1 to 1 support require thought and planning to ensure social stimulation is offered to everyone, regardless of their presenting needs. Staff spoken with felt that more activities could be organised and this is something that was discussed with the registered manager. The registered manager is to support staff to develop appropriate activities within the home. Comment cards and people spoken with personally confirmed that they are very happy with the food that is provided. The cook visits each person individually in the afternoon to ask them what they would prefer to eat for the next day’s meals. Individual choices and likes are respected. A relative spoken with confirmed that she has heard people ask for something different to eat and the staff have brought them their chosen dish. Other comments include - “the meals are excellent”, “very good food”, “food very good and freshly prepared” and “my relative is always saying how good the food is”. The menus provided evidence that good nutritional food is provided. At present there are no special diets for nutritional or cultural needs – the registered manager this would be found out at the assessment stage prior to admission. Some peoples’ nutrition is being monitored, along with their weights, to ensure their health is maintained. The Old Vicarage DS0000009865.V332852.R01.S.doc Version 5.2 Page 17 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): Standards 16 and 18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Concerns can be voiced and staff are trained in safeguarding adults which means that people are protected. EVIDENCE: The home has a well-written policy on complaints. The procedures are that people should in the first instance speak to the manager if they have any complaints. This can be followed up by contacting either the registered owner or the CSCI (Commission for Social Care Inspection) if there is still dissatisfaction. The home has confirmed it has not received any complaints and the commission has not received any complaints regarding this home either. People spoken with, and comment cards received, all confirm that they know who to speak with if they are unhappy with any aspect of their care. Individual comments include - “I have had no need to complain”; “I have never needed to complain”; “we are satisfied with all aspects”. The Old Vicarage DS0000009865.V332852.R01.S.doc Version 5.2 Page 18 Information supplied by the home confirmed that staff have undertaken abuse training. Training files for this were seen in the home. Staff spoken with confirmed what they had covered during this training and also what they would do if they suspected any abuse were occurring. Importantly staff know to immediately contact the registered manager. The home has not made any safeguarding adults referrals since the last inspection. The Old Vicarage DS0000009865.V332852.R01.S.doc Version 5.2 Page 19 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): Standard 19 and 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a well-maintained and safe environment which provides a pleasant and homely place for them to live in. EVIDENCE: The home is well maintained, homely and provides a comfortable and relaxed environment for the residents to live in. Routine maintenance is carried out as needed. Although not all areas of the home were viewed, communal areas and some rooms were seen. The Old Vicarage DS0000009865.V332852.R01.S.doc Version 5.2 Page 20 The layout of the home is homely and the larger lounge is split into two areas with comfortable armchairs and settees. There is a separate conservatory which leads onto the garden and provides another pleasant seating area. The dining room is pleasantly and informal with a range of tables and seating. The lighting and furnishings are all domestic in character and add to the relaxed environment. The home continues to maintain a very good standard of facilities, with individual rooms being clean, well maintained and providing a comfortable private space for the people who use the service. Individual rooms have been personalised with treasured possessions to make them familiar and homely. Generally people who use the service do not have a choice of room but discussion will take place as needed. People who use the service all confirmed that they are very happy with their rooms, the communal areas and the home is clean, warm and comfortable for them to feel at home. There is a secure and very pleasant garden which is accessible by people. A number of people spoken with commented on how much they enjoyed the gardens. The toilet and bathing facilities are sufficient for the residents, with some rooms having their own ensuite facilities (toilet and washbasin). The registered manager was made aware that the ceiling in the downstairs bathroom needs attention, as does the corner of the ceiling in the dining room. In addition to this, the window in the downstairs bathroom also needs repairing as part of it is currently boarded up with cardboard. The registered manager was also informed that at least two carpets in individual rooms need to be cleaned or replaced as they were quite badly stained. Apparently the carpet cleaner has broken and is to be replaced. However, the registered manager is aware that cleaning may not be satisfactory and will replace if needed. There are a range of aids and adaptations in the home which meet the needs of those currently in residence. The registered manager is aware and would make the appropriate contacts should additional needs be identified. It has previously been confirmed that all rooms are individually and naturally ventilated with most windows overlooking the gardens. All rooms are centrally heated with pipework and radiator guards in place. All baths and sinks have pre-sent valves to prevent any resident being scalded. Emergency lighting is also in place. There are no CCTV cameras in use in the home. The Old Vicarage DS0000009865.V332852.R01.S.doc Version 5.2 Page 21 It has already been recorded that there is a separate laundry and the washing machine conforms to the requirements for washing foul laundry. Floors are impermeable and walls are readily cleanable. The home has policies and procedures in place for infection control, safe handling of clinical waste. Information supplied by the home confirmed that infection control training has been undertaken by staff. On visiting the home there were no noticeable odours and the home was clean and tidy. Individual comments from people who use the service and their relatives include – “the home is very clean and fresh and all the staff are excellent”; “the place is clean and well maintained and does not smell as some homes do”; “the home is always clean”. A healthcare professional commented – “I visit my patients regularly and always find the Old Vicarage an attractive, welcoming place. Nice environment”. The Old Vicarage DS0000009865.V332852.R01.S.doc Version 5.2 Page 22 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): Standards 27, 28, 29 and 30 People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The calibre of staff is excellent. People who use the service are safeguarded as their care is provided by a staff team who are vetted, qualified and competent EVIDENCE: Staff files were examined for the two new staff appointed since the last inspection – these were found to contain all the required information as outlined in the regulations. CRB checks have been carried out for these new staff and their forms were seen during the site visit. The difficulties of recruiting staff in such a rural area were again discussed with the registered manager, although the home is successful in retaining staff, with the majority of staff having worked there for several years. People who use the service and staff also confirmed that the staffing levels are generally good, although one comment was received that “occasionally sickness affects staffing levels”. The Old Vicarage DS0000009865.V332852.R01.S.doc Version 5.2 Page 23 Individual comments from both people who use the service and their relatives were all very positive in their praise for the staff at the home. Several comments have already been noted in this report but include - “all staff are very friendly and helpful”; “the staff are caring and kind”; “all the staff are excellent”; “the staff are friendly and treat the residents with dignity”; “all of the staff are so lovely with my relative”; “(the staff) look after everybody very well, nothing is too much trouble”; “all the staff are kind, caring and thoughtful” and “ the staff work well together as a team”. Information supplied by the home confirmed that staff continue to undertake training and recent training has included – abuse, infection control, health and safety, food hygiene and moving and handling. Training is ongoing and next training will be on first aid. Staff spoken with evidenced a good understanding of the training undertaken and training files examined contained copies of appropriate certificates. Comment by a healthcare professional noted “the staff appropriately trained”. It was noted that a specialist care task is being carried out by staff for one person in the home. Although the registered manager confirmed that staff have been trained to undertake this procedure it was advised that the training provided needs to be recorded on individual staff training files. In addition, written confirmation obtained from the district nurse that each member of staff has been individually assessed as competent. The Old Vicarage DS0000009865.V332852.R01.S.doc Version 5.2 Page 24 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): Standards 31, 33, 35 and 38 People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The residents live in a home that is well managed and provides a safe and comfortable environment for them to live in. EVIDENCE: The registered manager confirmed that there have been no changes to the management of the home since the last inspection. Whilst the role has changed to enable her to undertaken more administrative work, when staffing needs dictate the registered manager undertakes hands-on care tasks. The Old Vicarage DS0000009865.V332852.R01.S.doc Version 5.2 Page 25 Comment cards from healthcare professionals, people who use the service and their relatives were outlined to the registered manager, with both positive comments and comments for improvement being welcomed as an opportunity to improve the service further. The registered manager confirmed that there have been no changes to the existing quality assurance systems – i.e. Questionnaires sent out each year and daily discussions with people in the home. Evidence of completed questionnaires were seen. It was advised that more formal quality assurance systems (for example ISO) may be worth considering alongside the existing in-house system. There are no “residents” or staff meetings held at the home. Resident are spoken with on a daily basis, with any issues or concerns being ironed out at the time. It was advised that a record of these meetings be kept as part of the quality assurance system. Staff are informed of information/changes/care issues at the time of the staff handover. Regulation 26 reports are not being completed by the responsible person. The last report is dated December 2006. This has been addressed in a separate letter The registered manager confirmed all finances are done by relatives of the people who live at the home. However, a small amount of money is kept for some people for sundry items. A selection of records and personal monies kept for people in the home were examined and found to be accurate, safe and respecting privacy. The registered manager confirmed that a fire risk assessment has been done for the home. It was also confirmed that (through discussions with the fire officer) a monthly evacuation of the home is not needed, although a monthly run through the procedure with staff should take place. The registered manager is currently updating the “fire safety” file and all staff will receive update training on the fire drill. This needs to be completed and staff involved recorded. The registered manager also needs to ensure that anyone left in charge is competent in the fire procedure should a fire occur. Electrical and PATT certificates for the home were seen. However, the registered manager was asked to confirm that the work recommended in the electrical certificate has been carried out as this is unclear. The fire alarm system is tested on a weekly basis and the emergency lighting checked monthly. Records of these tests were seen. Staff confirmed that regular maintenance takes place, with prompt action being taken if any issues are raised. The accident forms were seen and all appeared accurately completed and followed through. The Old Vicarage DS0000009865.V332852.R01.S.doc Version 5.2 Page 26 Individual comments from both people who use the service and their relatives include - “(my relative) could not be in a better place”; “personal, friendly care”; “looks after everybody very well, nothing is too much trouble”; “I think they have everything just about right”; “the care home does well, it is well run with the staff working well together as a team. I could recommend this home to anybody” “well run. No problems with it. Nice touches – all residents get carefully chosen Christmas presents” and “we are satisfied with all aspects”. Comments from healthcare professionals included – “excellently run home” and “a well run care home”. The Old Vicarage DS0000009865.V332852.R01.S.doc Version 5.2 Page 27 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 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 The Old Vicarage DS0000009865.V332852.R01.S.doc Version 5.2 Page 28 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. Standard Regulation Requirement Timescale for action 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 OP38 Good Practice Recommendations Confirmation should be sent to the commission that the recommended works outlined in the electrical certificate for the home have been fully addressed as the current documentation is unclear Records of administration of external medicines such as creams need to be improved to show that they are being used as prescribed Patient information leaflets should be obtained so that staff can read about the medications people are using An effective auditing system should be put in place for medications received, administered and disposed of. Individual activities should be developed so that people who use the service receive social stimulation Minor works outlined in this report should be addressed promptly and include – ceiling in downstairs bathroom, window in downstairs bathroom, corner of ceiling in dining room, carpets in peoples’ rooms DS0000009865.V332852.R01.S.doc Version 5.2 Page 29 2. 3. 4. 5. 6. OP9 OP9 OP9 OP12 OP19 The Old Vicarage 7. 8. 9. 10. 11. OP30 OP38 OP33 OP33 OP28 Specialist care tasks should be recorded on individual training files and confirmation of competence obtained All staff should be updated in the home’s fire procedure and anyone left in charge should be assessed for competency The registered manager may wish to look into external quality assurance systems as a means of improving the existing systems The registered manager should record formal chats with people who use the service which can then be used as part of the quality assurance systems The home should continue with the NVQ training programme to ensure 50 of staff are trained The Old Vicarage DS0000009865.V332852.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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. 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