Inspection on 12/02/08 for The Old Vicarage

This inspection was carried out on 12th February 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Old Vicarage 11/02/09

The Old Vicarage 06/09/07

The Old Vicarage 20/02/07

The Old Vicarage 05/06/06

The Old Vicarage 18/10/05

The Old Vicarage 26/10/04

The Old Vicarage 11/05/04

The Old Vicarage 25/11/03

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE The Old Vicarage Warren Road Hopton On Sea Great Yarmouth Norfolk NR31 9BN Lead Inspector Mrs Judith Last Unannounced Inspection 12th February 2008 08:55 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 DS0000027487.V359777.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 DS0000027487.V359777.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Vicarage Address Warren Road Hopton On Sea Great Yarmouth Norfolk NR31 9BN 01502 731786 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) Estateband Limited Mrs Jill Chaplin Care Home 20 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (20) of places The Old Vicarage DS0000027487.V359777.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Twenty (20) older people of either sex may be accommodated. Two (2) older people who have dementia and are named in the Commission’s records may be accommodated. The total number of people accommodated shall not exceed twenty (20). 6th September 2007 Date of last inspection Brief Description of the Service: The Old Vicarage is a two storey detached Georgian house that provides residential care and accommodation for up to twenty older people. The home stands in its own grounds of approximately two acres, there is parking to the front of the home and the gardens are mainly laid to lawn and are accessible by wheelchair from the main front door. People living at the home have the use of a passenger lift to the first floor and communal use of three lounges, a dining room, two bathrooms containing adapted bath, washbasin and toilet on each floor, two toilets on the ground floor and one toilet upstairs. There are nineteen single and one double bedroom. The home is situated in the village of Hopton-on-sea, between the coastal towns of Great Yarmouth and Lowestoft and is surrounded by caravans and sited in the centre of a holiday caravan village that is densely populated at certain times of the year. There are local amenities and the beach within walking distance of the home and a public transport service that provides a link to the main towns. The range of fees are not yet published in the service users guide. We know from this that there are with additional charges for private chiropody, hairdressing, newspapers or personal spending. There is an additional charge for some outings. The Old Vicarage DS0000027487.V359777.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 service is 1 star. This means the people who use this service experience adequate quality outcomes. Care services are judged against outcome groups which assess how well a provider delivers outcomes for people using the service. We have rules that tell us how to do this. Our visit was unannounced and lasted over 9 hours. Medication was inspected separately by our specialist pharmacist inspector, as there have been so many problems with this in the past. We got information from the manager, staff and people using the service that we talked to. We also got information from comment cards people sent to us. These were from staff, people living at the home and their relatives or friends. Other information came from records and what we saw and heard in the time we were at the home. What the service does well: What has improved since the last inspection? We were pleased that the manager has worked hard to do the things we said she needed to and that she has responsibility for. Mrs Chaplin has been working hard to try to keep care plans more up to date so that these properly set out how people’s needs are to be met. There is still The Old Vicarage DS0000027487.V359777.R01.S.doc Version 5.2 Page 6 work to do with this, but she has tried to involve people living at the home and their relatives in the process. We were particularly pleased to see the effort that had gone in to improving the way medication is managed in the home. Systems, records and practice have improved a lot so that we can see people are now generally having the medicines they need at the right time. We have repeatedly made requirements and considered enforcement in this area in the past. These improvements need to be sustained. This has not happened in the past. Staffing levels are more consistent and this has allowed some improvement in activities and how often these can take place. This includes staff trying to get people out of the home for short periods. There is still more work to do with people living at the home to see how they feel this could improve, but we have had more positive comments in this area than we had previously. The manager has provided a more organised “structure” to each shift so that staff are clear about their responsibilities and are deployed more effectively. Everyone living at the home, who completed a comment card for us, told us that the home was always clean and fresh. This is an improvement on last time we visited when not everyone was sure about this. What they could do better: There are still lots of things that must improve by law in order for the home to properly show they are able to meet people’s needs, to protect them and to promote their welfare. Information about fees needs to be included in the right pieces of information about the home. This is so people who are thinking about moving there have access to all the information they need to help them make the decision. There are several things that need to happen with individual care plans setting out how people’s needs are to be met – and the assessments used to compile them. o Assessments of people’s needs and abilities need to be accurate. At present they are not and so cannot properly underpin the way that care plans are developed. The company’s own assessment package does not help this process, as questions are not well structured. More work is needed to make sure that these and care plans are kept up to date as people’s needs change. o Care must be taken that dangers people might be exposed to are set out properly and kept up to date, with clear and unambiguous guidance for staff about what they should do to promote safety. If this is not set out clearly in care plans, people might be exposed to avoidable risks. The Old Vicarage DS0000027487.V359777.R01.S.doc Version 5.2 Page 7 o Care plans need to reflect particular individual dietary needs and be consistent with reference information about any medical conditions, as well as previous dietary advice. If this does not happen people’s general health may be compromised because nutritional and dietary needs have not been addressed at an early stage. There are still some things that need to be done to ensure medication management helps to properly protect people living at the home. o Medicines no longer needed by the person for whom they were prescribed, need to be disposed of. o The risk to someone from withholding their medicine because they have drunk alcohol needs looking at to make sure the balance between the person’s wish to drink is weighed with the benefits of the medication that has been prescribed. The work towards improving activities and talking to people about their recreational and social interests needs to continue. This is so more people feel they are satisfied with what goes on. The manager and staff must continue to work towards achieving qualifications to help them understand their roles and give them the underpinning knowledge they need to support people well. Mrs Chaplin must supervise staff with the agenda and frequency that minimum standards set out for her to follow, so that she can be sure they are meeting people’s needs properly. At the last inspection we saw that the manager had surveyed some of the “stakeholders” in the service for their views, (for example, staff, relatives and some residents). She had not analysed the results and still has not done so. She needs to do this and include them in an overall audit and plan for improving the standard of service at the home. The people who run the home are also not monitoring the service sufficiently regularly and supplying reports on service quality to the Commission. This is despite previous requirements for them to do so. The manager must complete the records the law says she needs to have. This includes notifying the Commission of the events set out in regulations and in guidance on our website. This is so we can be sure that legal obligations are met and that, when events occur, the proper actions have been taken. 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 DS0000027487.V359777.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 DS0000027487.V359777.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 People who use 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. Although information for prospective service users has been revised, it is not yet full and complete. This means that people considering using the service would not necessarily have all the information they need to make a decision. Further work is needed to ensure that assessments are full, complete and accurate. Standard 6 is not applicable. EVIDENCE: The statement of purpose has been revised, as has the service users’ guide. However, information about fees is still not included in the service users’ guide as required by regulations and at the last inspection. See outstanding requirement. We looked at assessments for four people. These continue to present concerns. The Estateband Ltd package for completion (prospective resident The Old Vicarage DS0000027487.V359777.R01.S.doc Version 5.2 Page 10 assessment portfolio) is ambiguous in the way questions are asked and so does not prompt collection of the right information. The assessment for one person we have spoken to before continues to say that they do not understand verbal communication. There are no nutritional assessments on file, including for those for whom there is now an identified need resulting from weight loss and from physical conditions (see health care section). We cannot therefore conclude that the requirement we made at the last inspection has been wholly met. However, when we discussed information about people’s needs with staff they were able to give us good descriptions of what people’s needs were and how they managed things like diet, together with information from the GP. There has been an improvement in setting out goals for care although these are still limited in their range in that they generally only relate to mobility, personal hygiene and continence. The Old Vicarage DS0000027487.V359777.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use 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 have been improvements in the review and update of care plans with some showing that people or their relatives are involved. Further work is needed in this area, particularly in relation to ensuring there is clarity about how risks are to be managed. Oversights in providing specific guidance in their individual plans for supporting and monitoring people whose nutrition may be compromised, means we cannot be sure people’s health needs are fully met. The management of medication is much improved and shows that people are better protected from error. EVIDENCE: The manager has worked to try and improve the clarity of individual plans. The rigour of the process remains compromised by inaccuracies in the assessment process particularly around diet and communication. The Old Vicarage DS0000027487.V359777.R01.S.doc Version 5.2 Page 12 Mrs Chaplin has tried to increase evidence of the involvement of people living at the home and their representatives. We saw some information that had been signed by relatives regarding the support needed. This is variable practice and in some cases other information is not signed and dated by the staff who have completed it. There is still some slippage in reviewing care plans to show changing needs are taken into account. For example – “incontinence” listed as one of the care plan goals is unsigned and with no recorded date for when it is due for review. The sheet is headed September 2007; the next review we could find on file was 16th January 2008. Because of this we cannot conclude that the requirement made at the last inspection has been fully met. See partially outstanding requirement. Risk assessments are not always updated promptly so leaving ambiguous guidance in care plans. For example, records in one care plan seen showed that on 30th Dec 2007, “cot sides” had been identified as high risk as the person would try to crawl down the bottom of the bed and get out. They had been removed and a pressure mat put in situ – documented and signed by the manager. However, the accident book shows on 9th January that the person had sustained a skin tear from bed rails when they tried to crawl out of the bed from the bottom. This shows that the bed rails are still in use contrary to the most recent recorded assessment. The manager told us that a relative wanted the “cot sides” back following a review as they consider it more risky for the person to do without. This has not been updated in the care plan and risk assessment to provide clear and unambiguous guidance for staff showing how they are to promote the person’s safety. We have made a requirement about this. Files for two of the four people we checked indicated concern about weight loss. However, no nutritional assessment has been carried out (despite a blank Croners assessment of dietary needs seen in the treatment room, and ready availability of the MUST screening tool via the internet, as well as nutritional guidance on our website). One person referred to the GP for weight loss has an assessment that shows the person has a good appetite and no problems. This is despite a copy letter on file from the dietician seen before admission, which says that the person had been referred because of concerns about nutrition while they were in hospital. This says that the person should have a high protein, high calorie diet, build up drinks and Calogen. Records dated 10th January 2008 show the GP was consulted appropriately and that “ensure” was due to be started “tomorrow”. There is no information regarding this on the person’s medication administration record to confirm that it is given them regularly or that other changes in diet have been arranged. The Old Vicarage DS0000027487.V359777.R01.S.doc Version 5.2 Page 13 The person’s weight is not being checked regularly (one recorded since admission), and so interventions cannot be properly reviewed to see whether they are successful or not. Neither of these two people’s care plans shows what staff are to do to try and increase calorific intake of basic diets or to reflect the need for high fibre and fluids for the one person with diverticulitis. They only refer to supplements (and these are not always documented on medication charts). We have made a requirement about this. Care plan goals do record interventions needed to support people with personal care and continence. They also record for one person that issues about managing pressure area care have been discussed and that the person is cooperating with managing this. Pressure relieving equipment is in place (mattress and cushion). Notes showed that the district nurse was involved on a regular basis for one person whose file we checked. Seven people living at the home completed comment cards that show that four always feel they receive the support they need, and three feel this usually happens. Comments from relatives include: I feel the care that is given to my dad is beyond reproach. “They fulfil the duties above wonderfully giving my mum full support in all that she wishes to do. The care home looks after my dad very well. He seems happy there, which is the most important thing to me Two thirds of relatives say in their comment cards that they feel the home always meets the needs of the person they visit, one third says they do usually. We spoke to two people who told us the staff were good. We discussed issues we identified from inconsistencies in care plans or lack of clarity of information with two of the support staff. They had a clear understanding of how they were to support people and of recent interventions by the GP or guidance from the district nurse. It is possible therefore that records do not do justice to practice. There have been serious concerns about the way that the home has managed medication in the past. This have led to the issue of statutory requirement notices and to the interviewing of the responsible person and registered manager, under caution at the Commission’s offices. We saw that medicines were secured and stored properly. The morning medicine round had been completed and all scheduled medicines had been given to residents and records completed. During a brief discussion at the start of the inspection the manager said the home was no longer experiencing The Old Vicarage DS0000027487.V359777.R01.S.doc Version 5.2 Page 14 problems obtaining medicines. Records confirmed there was no evidence that residents had recently gone without their medicines. Medicines of limited life are being dated on opening to ensure they are not used following their expiry times. There are photographs of people in place to assist in ensuring medicines are safely administered but some were not named. This could lead to an error if the photographs become placed alongside incorrect medication charts. We have made a recommendation about this. There were two unlabelled inhalers in the medicine trolley that are no longer prescribed. These should have been removed to avoid the possibility of confusion with other residents’ inhalers. One resident was being given nutritional cartons that had been prescribed but no longer in use for another resident. The manager reported that the doctor requested this, but this is inappropriate practice. We have made a requirement about this. Unlike previous inspections, there were few gaps in the records for the administration of medicines. Of a sample of 25 audits of medicines against records there were only 3 minor discrepancies identified. These related mostly to prescribed painkillers. There were improvements in the way warfarin doses were set out in the records following blood tests and there were no longer discrepancies with this important medicine. The manager says she is conducting audits regularly and that improvements were being noted. There was evidence from the records that a liquid laxative prescribed for twice-daily administration has been given only once daily. The manager said she believed the GP had changed the dose to once daily, but the record had not been amended. There is no risk assessment one person who is regularly not given a prescribed evening sedative because of intake of alcohol. We have made a requirement about this. The training of members of care staff in medicine management was looked at. There are currently seven members of care staff authorised to handle and administer medicines. There was evidence that each had received training and a further training event was being planned. The manager also said that these members of staff had also successfully completed an in-house competence test set by the manager in November 2007. People told us they felt staff respected their privacy. We heard people knocking on doors. Staff meeting notes show that staff have had some added instruction and advice from the manager about dignity issues and “customer care” because of feedback we had at our last visit. However, one relative still expresses the view that things could be improved in: The Old Vicarage DS0000027487.V359777.R01.S.doc Version 5.2 Page 15 “More training for the young carers in how to communicate to the elderly respectfully rather than telling them off” This indicates that issues need to be kept “live” in staff meetings and training. We have not made a requirement but we will want to monitor this in future visits. We have made a recommendation about this. The manager considers that staff are now paying more attention to the “niceties” of personal care like making sure that people are dressed with attention to detail. We saw women living at the home had their nails painted and hair done tidily, and were wearing jewellery. Records show these things take place. Some people have made comments to us like: I am treated really well here I like living there very much This home was chosen from an option of six and is by far the better one The Old Vicarage DS0000027487.V359777.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use 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 who use services can make some choices about their life style. However, although things continue to improve, the home cannot yet show that social, cultural and recreational activities wholly meet the expectations and needs of each person. EVIDENCE: There has been a continued improvement in the activities that are offered by the service. The record of these continues to be held separately but now records the names of people involved and those who have been offered something but refused it. These show in house activities and opportunities to go out locally e.g. for walks. Two people did this with staff support when we visited. During both the morning and the afternoon, games were organised in the dining area and we heard people being asked if they wanted to take part. Records also show activities that have been tried but have not been popular. Three out of seven people say there are always activities they can take part in, three say usually and one says sometimes. One person says they do not like to do things but the manager says they like to watch. One person commented to us that there were not many activities and one relative suggests that things The Old Vicarage DS0000027487.V359777.R01.S.doc Version 5.2 Page 17 could be improved by “providing more stimulating activities appropriate to meet the needs of the resident through consultation”. Another relative considers that options are limited for people being supported to live the life they choose. The manager has attempted to structure each shift so that there is an expectation staff would have time to spend with people engaged in activities. Five out of seven people completing comment cards say they always like the food, and two say they do usually. One person told us that the meals have improved recently. We saw that staff sit next to and support people who need assistance or supervision with their meals. The dining room is set out with tablecloths and condiments, and at teatime we saw people had their own teapots. The practice of filling jugs with hot water for use in making drinks in the sitting rooms continues. However, a relative commented that it would be nice if people could offer their visitors this in their own rooms, as they would in their own homes. We have commented elsewhere about the need to increase the calorific content of meals in specific cases. We have made a recommendation about this. The Old Vicarage DS0000027487.V359777.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use 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. Most people and their representatives know how to express their concerns about care but some are reluctant to do so in case they get themselves or someone else into trouble. We think this means that not everyone is confident they would not be victimised for raising a concern. Staff misconduct is not always dealt with robustly and promptly and in accordance with the home’s own policies. This means that people may sometimes be at risk. EVIDENCE: All of the relatives completing written comments to us say that they know how to complain. Only two thirds of people living at the home say that they know how to do so, although there are service users guides in people’s rooms that contain the information. At our last visit some people in comment cards told us they weren’t sure who to talk to if they had concerns. However, the manager’s own quality audit showed that 12 out of 14 people knew how to complain if they needed to. One relative commented that the person they visited was reluctant to have them complain or make complaints on their behalf in case they got into trouble. We had three comments from people living at the home: I am reluctant to make any I do not like to complain The Old Vicarage DS0000027487.V359777.R01.S.doc Version 5.2 Page 19 I dont know what else to say - I dont want to get anyone into trouble In response to the question about expressing concerns two people commented that it depended who was on duty. There have been a number of allegations about behaviour of staff, including behaviour that fits within the home’s disciplinary definition of gross misconduct and liable to summary dismissal. (Allegations of people sleeping when they were supposed to be on waking night duty.) The manager told us about various monitoring visits and a staff meeting which shows that the incident was not dealt with immediately and as set out within the home’s own disciplinary procedures. This means that potentially people were at risk from inadequate staffing levels at these times. One staff member has been disciplined for shouting at people. Comments from a relative indicate that some staff come across as “telling people off”. There are repeated allegations from one person who is very confused including some allegations that could not possibly be true. These are dealt with by the agreed method of informing a relative and by staff working together to protect themselves from allegation. The relative concerned speaks highly of the standard of care offered to the person and expresses no concern about the incidents. We discussed the issues ourselves with the adult protection team who have decided not to pursue the matter further as they consider the service is managing the situation. We know from discussion with the manager and staff, as well as from training records that people have had refresher training in safeguarding vulnerable adults. It is clear from the way that concerns have been brought to the manager’s notice, that newer staff have been prepared to “blow the whistle” where staff conduct presented concerns. However, the Commission has not been notified as required of all allegations of misconduct against staff members. The Old Vicarage DS0000027487.V359777.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from an environment that the manager continues to try and improve. The home is clean and hygienic so helping minimise the risk of infection for people. EVIDENCE: Areas of the home we looked at were in good condition and work to decorate a corridor has been completed. The leaking conservatory has been replaced, as has flooring. The manager continues to maintain her proposed programme of refurbishment recording what she has identified needs doing with proposed and actual completion dates. This is good practice. We saw maintenance testing records and audits of the premises safety. Staff have protective clothing available to them to minimise infection and there is soap and paper towels available. Everyone living at the home who completed comment cards tells us the home is always fresh and clean. The Old Vicarage DS0000027487.V359777.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use 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 by sufficient numbers of staff who are currently working towards qualifications and training that they need to help them understand people’s needs. The improvements noted in training now need to be sustained. EVIDENCE: The manager reports that staffing levels are stable. Duty rosters seen show that there are generally three care staff on duty on each shift and that there is catering support most of the time. This means that staff do not have to remove themselves from supporting service users in order to prepare meals on a regular basis. It has resulted in improvement in the number of activities that can take place in the home. There are separate housekeeping and catering staff. In written comments, three people say that staff are always available when they need them. Four say they are usually. People told us that staff came when they needed them. Observation was that call bells were answered promptly and that staff had time to organise and assist people with activities. The manager told us that work towards achieving the appropriate National Vocational qualifications (NVQ) for staff is continuing. Four people are continuing to work towards the qualification according to the manager. Three The Old Vicarage DS0000027487.V359777.R01.S.doc Version 5.2 Page 22 people whose files we checked had the qualifications certificated. See outstanding requirement. There is evidence from certificates in staff files that induction is delivered as required. We checked files for three existing staff and found that there were appropriate checks on people to make sure that they were safe to work with vulnerable adults. The manager and staff confirm that training has improved recently. First aid training has been arranged – half the staff team have completed it and the remainder, the manager says, will complete in March. The date has already been arranged. (Staff had to pay for their own first aid training three years ago, according to information obtained at our last visit and from staff. This time the providers are paying. This represents an improvement as it is their obligation to ensure they train staff appropriately”.) The improvement needs to be sustained and funding made available where specific training is needed to help meet people’s needs (for example with dementia or presenting health conditions). Individual training profiles in people’s files need to be kept up to date to show that people receive three days paid training per year as set out in national minimum standards. At present this does not show with limited records for 2007 (including the in house profiles and certificated training). The manager does implement in house training with staff working through the provider’s policies and answering questions on these. Two thirds of relatives (4 out of 6) have told us they feel staff always have the skills and experience to meet people’s needs. One person says they do “usually” and one says they do “sometimes”. The providers policy manual recognises that people will have challenging behaviour at some time or another and states that there is ongoing training and yearly refresher training for staff to help them develop skills to reduce unacceptable behaviour and that the training will involve de-escalation and breakaway skills and techniques. None of this is delivered as Estateband Ltd claims. The Old Vicarage DS0000027487.V359777.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31. 33, 35, 36, 37 and 38 People who use 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 manager has still not completed her qualifications so that she has the underpinning knowledge to help her run the home effectively and in the best interests of those who live there. She has looked at the quality of the service so that people’s views are taken into account but has not yet developed a plan to improve. The providers have failed consistently in their obligations to monitor the service. Mrs Chaplin has not kept us informed of events in the home so we cannot be confident she has always sought advice and taken the right action promptly to ensure people are protected. The Old Vicarage DS0000027487.V359777.R01.S.doc Version 5.2 Page 24 EVIDENCE: The manager still has not completed her registered manager’s award. Our reports show she was working towards this almost three years ago. She needs this in order to provide her with underpinning skills and knowledge to help her run the service effectively. The last time we visited we agreed a timescale that the manager thought was achievable and realistic. This has still not been met and we have been given a variety of reasons. This requirement remains outstanding. The manager has secure arrangements for holding people’s finances if relatives bring in money in their behalf. We did not check balances but have discussed this with her before. She says that she is the only person with access. She is not appointee for people living at the home and so has no direct access to their accounts. The manager has undertaken a survey of people’s views about the service including that of residents and staff. She is in the process of analysing these results but has not yet developed an action plan for improvement arising from these findings. The Annual Quality Assurance Assessment (AQAA) she sent us before our last visit was poorly completed and did not contain the evidence expected under each heading. We have spoken to her about including the survey findings as evidence in her next AQAA and supplying us with her completed survey results and action plan. In the meantime, we cannot conclude the requirement we made at the last inspection has been fully met. See outstanding requirement. The provider, despite requirements over time, has failed to comply with the requirement to make unannounced visits on a monthly basis and to comment on the quality of the service. The improvement plan submitted following the last inspection gave the provider’s undertaking that this would happen from the end of October last year. Given concerns about the failure of the manager to notify us of events, failure to carry out these visits appropriately exacerbates problems as the provider is expected to check notifications as part of the visit and should have been able to raise with the manager that issues of concern needed to be reported. See outstanding requirement. Staff supervision is still not taking place with the nature and frequency specified in standards. This is unchanged from the last inspection. As before, that which has taken place is in the form of routine monitoring of practical tasks and checking of understanding by questionnaire. Despite requirement at the last inspection, some staff have had no recorded supervision since July last year based on notes and supervision schedules. See outstanding requirement. The Old Vicarage DS0000027487.V359777.R01.S.doc Version 5.2 Page 25 The manager says that errors in the register occurred before she assumed management responsibility for the home. She has not acted to correct or amend these to the best of her knowledge. The register showed 16 people living at the home where the manager and care plans supported there were 14. There were five people listed in the register as being there who did not appear on the resident list. We made a requirement about keeping statutory records the last time we visited. See outstanding requirement. The manager has failed to notify us consistently and promptly of deaths taking place in the home. She did tell us verbally about the conservatory being unusable following a serious leak and having to relocate the dining room by taking over one of the lounges. This was not notified in writing as per regulations as an event affecting the wellbeing of service users and in accordance with CSCI guidance available on the website. Staff files show one staff member given a verbal warning for sleeping on duty and another being warned for allowing this. A second person was also accused of sleeping while on waking night shift. One person was also given a verbal warning for shouting at residents. We have received no written notifications of these. WE have made a requirement about this. We looked at fire safety records, checks and the manager’s routine audits. These showed that there are arrangements on a day-to-day basis to ensure that people’s health and safety is promoted. The home was noted at our last visit to have achieved 5 out of 5 stars for food hygiene. There has been an improvement in the training of staff in first aid recently with more planned. Moving and handling training is also booked. The policy manual contains relevant policy statements. However, the organisation has probably purchased these “off the peg” as relevant information about who is responsible for health and safety in the home, infection control and routine cleaning has been left as blank. However, there is general information about the health and safety police in the staff handbook. The Old Vicarage DS0000027487.V359777.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 2 x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 1 2 2 The Old Vicarage DS0000027487.V359777.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5 Requirement Outstanding requirement People who live at the home (or who are thinking about moving there) must have the information the law says they need. This is so they or their representatives can make an informed choice about moving into the home. It is also so they can be sure of the arrangements for charges or increases in these. Previous timescale of 30/11/07 has not been met. Outstanding requirement Proper and accurate assessments of people living at the home must be obtained. If assessments are not accurate the home cannot show that it is able to meet the needs of people living there. Previous timescale of 30/10/07 has not been met. Partially outstanding requirement Assessments and care plans must be kept under review involving people living at their DS0000027487.V359777.R01.S.doc Timescale for action 31/03/08 2. OP3 14 31/03/08 3. OP7 14(2) 15(2) 30/04/08 The Old Vicarage Version 5.2 Page 28 home and their representatives (family members particularly) if they wish. This is so changing needs or wishes are better recognised. Previous timescale of 31/12/07 has not been met. Care plans must accurately reflect what actions are required of staff in order to help keep people safe. If this does not happen then people may be exposed to avoidable risk and their safety may not be properly promoted. The manager must be able to show in care plans, how problems with people’s changing dietary needs are to be addressed. This includes changes to people’s basic diets to increase nutritional content. If this does not happen and there is not proper monitoring, people are at risk of poor nutrition and associated health problems. Medicines no longer in use for the people for whom they were prescribed, must be promptly removed. This is to avoid possible confusion and their reuse. The risks to an identified resident regularly missing doses of prescribed medicines because of alcohol intake must be assessed and if necessary action taken to protect the resident’s health and welfare. Work towards consulting everyone living at the home about recreational and social opportunities must continue so that more people are satisfied what is on offer suits their DS0000027487.V359777.R01.S.doc 4. OP7 13(4) 31/03/08 5. OP8 15(1) 30/04/08 6. OP9 13(2)&(4) 31/03/08 7. OP9 13(1)&(4) 31/03/08 8. OP12 16.2.m&n 30/04/08 The Old Vicarage Version 5.2 Page 29 9. OP28 18.1 needs, preferences and abilities. This is so the service can increase how well people feel their social and recreational needs are being met. Outstanding requirement At least half of the care staff must achieve NVQ level 2 or above, so that people living at the home are cared for by staff who can show they are competent do meet their needs. Previous timescale of 30/06/08 has not been met. Outstanding requirement The manager must complete the appropriate training. For the purposes of the National Minimum Standards this is NVQ 4/Registered Manager’s Award. This is so she has the underpinning knowledge to effectively run the service in the best interests of those who use it. 30/06/08 10. OP31 10, 18.1 30/06/08 11. OP33 24 Timescale of 31/01/08 still applies. 30/04/08 Outstanding requirement The views of stakeholders must be incorporated into an audit of service quality and a plan for its improvement. This is so people can be confident the service is being monitored and will improve, and that their views will be taken into account in the process. Timescale of 31/01/08 has not been met. The report compiled as a result of the above requirement, to monitor and improve service quality, must be submitted to the Commission. This is so we can see that the registered DS0000027487.V359777.R01.S.doc 12. OP33 24 30/04/08 The Old Vicarage Version 5.2 Page 30 13. OP33 26 people are taking proper responsibility for improving the service they run, in the best interests of the people who use it. Outstanding requirement A representative of the registered providers must complete reports monitoring the service quality and supply these to the Commission and the company. This is so people can be confident someone other than the manager makes regular and structured checks on the quality of the service and the views of people living and working in it. The previous timescale of 31/10/07 has not been met. Outstanding requirement Staff must receive supervision with the agenda and frequency set out in national minimum standards. This is so the management team can be sure that people understand their roles, work effectively with service users and can identify shortfalls or training needs at an early stage. Previous timescale of 31/12/07 has not been met. Outstanding requirement The manager must keep the records the law says she must have, and must keep these up to date. This is so people are protected by the accuracy and adequacy of record keeping systems. Previous timescale of 31/01/08 has not been met. The Commission must be told about the events set out in regulations (and in guidance on DS0000027487.V359777.R01.S.doc 31/03/08 14. OP36 18.2.a 30/06/08 15. OP37 17, Sch 3 and 4 30/04/08 16. OP37 37 31/03/08 The Old Vicarage Version 5.2 Page 31 our website). This must be done in writing. This is needed so that we can be sure the registered people are being open in their dealing with us. It is also needed so we can see that they are acting properly to resolve issues in the interests of the welfare of people living at the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP8 OP9 Good Practice Recommendations The manager should use the term “bed rails” in risk assessment rather than “cot sides”. This is because it reflects more dignity for older people. Photographs in the Medication Administration Record (Mar) charts identifying people to assist safe medicine administration should be named. This would help to increase safety. The manager should continue to monitor the manner that staff use when addressing people living at the home. This is because feedback tells us that there may still be room for improving how staff show respect to everyone living at the home. The manager and catering staff should undertake training in providing good nutrition for older people, particularly in eating well with dementia. This could help in promoting a healthy diet for those whose nutrition is compromised and would bolster the effectiveness of (or avoid the need for) prescribed supplements. 3. OP10 4. OP8 OP15 The Old Vicarage DS0000027487.V359777.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Old Vicarage DS0000027487.V359777.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!