Inspection on 18/09/07 for The Old Vicarage

This inspection was carried out on 18th September 2007.

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

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

Other inspections for this house

The Old Vicarage 16/06/08

The Old Vicarage 18/04/07

The Old Vicarage 21/04/06

The Old Vicarage 27/01/06

The Old Vicarage 26/07/05

The Old Vicarage 13/01/05

The Old Vicarage 06/09/04

The Old Vicarage 03/10/03

The Old Vicarage 14/04/03

The Old Vicarage 19/02/03

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

CARE HOMES FOR OLDER PEOPLE The Old Vicarage 32 Church Lane Littleport Cambridgeshire CB6 1PS Lead Inspector Joanne Pawson Key Unannounced Inspection 18th September 2007 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Old Vicarage DS0000015127.V350757.R02.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 DS0000015127.V350757.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Vicarage Address 32 Church Lane Littleport Cambridgeshire CB6 1PS 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) 01353 865200 01353 865227 The Old Vicarage (Ely) Limited Mrs Rigmor Paling Care Home 22 Category(ies) of Dementia - over 65 years of age (4), Learning registration, with number disability (1), Old age, not falling within any of places other category (22), Physical disability (1) The Old Vicarage DS0000015127.V350757.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 PD & 1 LD Only Date of last inspection 18th April 2007 Brief Description of the Service: The Old Vicarage is situated off a quiet road leading into the centre of Littleport. The property has been beautifully maintained and extended to offer comfortable and spacious accommodation for 20 older people and one adult with learning disabilities and one adult with physical disabilities. The majority of bedrooms benefit from en-suite facilities. There are four double bedrooms and the rest are single. All bedrooms exceeded minimum size requirements. The home is decorated to a high standard and the residents may bring in personal belongings and small pieces of furniture. A cat and small dog also live at the home. The proprietors, whom are the registered managers, live within the grounds, in separate accommodation. The property benefits from about an acre of landscaped gardens. Views of the garden can be seen from most windows. The weekly fee’s range from £340-450 and vary according to the room occupied. Mr Paling has stated that he will make the CSCI report available in the front hallway. The Old Vicarage DS0000015127.V350757.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on 18th and 28th September 2007 and lasted for seven hours. The inspection was carried out by two inspectors. Methods used for the inspection included speaking to the manager, senior carer, staff and service users, reading documentation and a tour of the home. On the day of the inspection there were twenty residents living in the home. What the service does well: What has improved since the last inspection? What they could do better: A regulation 43 notice was served on the company secretary on the 18 September 2007 for failure to protect service users from abuse. At the time of this inspection the timescale for the required action to be taken had not passed. All residents must have a full pre admission assessment before moving into the home to ensure the staff can meet their needs. All residents must have care plans that clearly set out their needs. When needs have been identified staff must follow the care plan i.e. if a service user needs to see a chiropodist then this should be organised and recorded that treatment has been received. If the service user needs change i.e. they do not need to see the chiropodist this should be recorded when the care plan is reviewed. Risk assessments must be fully completed to ensure the staff have the information to reduce risks to the service users and themselves. The Old Vicarage DS0000015127.V350757.R02.S.doc Version 5.2 Page 6 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 DS0000015127.V350757.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Old Vicarage DS0000015127.V350757.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is adequate. More information needs to be provided about a prospective service user before they move into to ensure the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has given a copy of the updated statement of purpose and service users guide to all of the residents. Prospective residents and their families are encouraged to visit the home before making a decision about whether the home is suitable. One resident had recently moved into the home for a period of respite care. There was a social workers assessment for this person but the manager did not The Old Vicarage DS0000015127.V350757.R02.S.doc Version 5.2 Page 9 think this had been received before the person had moved into the home as it contained information they had not been made aware of before she moved in. However the homes pre admission assessment had not been fully completed. It would appear that the resident was not an emergency admission as it was planned respite therefore the home should have completed a full preadmission assessment or received the care manager assessment before admission. Because the home did not have all the facts about the resident the staff were not aware of all her mental health needs. When asked about the pre admission assessment the manager stated that he had delegated the task to a senior carer. A letter received from the solicitor acting on behalf of The Old Vicarage stated that the assessment was received before the admission of the resident into the home. The Old Vicarage DS0000015127.V350757.R02.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,10 Quality in this outcome area is adequate. Staff do not have all the information they require to meet the service users needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During this inspection three care plans were seen. The inspector asked to look at one care plan for a resident who had moved into the home a week previous to the inspection for respite care. The manager could not find a care plan for this person. The manager asked one of the carers on shift if she was aware of a care plan for the respite resident and she confirmed that there was no care plan for them. The inspector asked if it was normal procedure for the carer to look at the care plans of new residents so that they were aware of their needs. The carer confirmed that this was the normal procedure but that information had been passed on to the staff verbally at shift handover times. However after the inspection the manager has stated via a letter from the solicitors The Old Vicarage DS0000015127.V350757.R02.S.doc Version 5.2 Page 11 representing The Old Vicarage that the assessment completed by the local authority care management team was the care plan for the resident. The care plan for a second resident dated 18 March 2007 states ‘Make sure X sees the visiting chiropodist when they come to the home’. However the record of medical services received (which includes an area for chiropody visits) had no record of the resident seeing the chiropodist. The homes chiropody book had records of the resident seeing the chiropodist in January and February 2007 but not in their records for April and June 2007. The reviews completed in July and August 2007 stated that there was no change to the foot care care plan. The chiropodist had visited between the two days that the inspection was carried out. Again the resident did not receive treatment. The records in the chiropody file stated ‘ not enough funds’. The home holds money on behalf of some residents and the chiropody fee is taken from this money. However the resident had spent all of her money and her daughter was away on holiday so was unable to provide more money immediately. The manager stated that the homes policy was if there was insufficient personal money it could be ‘borrowed’ from petty cash until the residents’ money was available. The manager stated that the policy was to pay from petty cash if there were insufficient funds However after the inspection the manager has stated through a letter from his solicitor acting on behalf of the Old Vicarage that the care plan is to be interpreted as referral only when needed and that on the 17th August the service user was not seen by the chiropodist as was not needed and again on the 26th September 2007 as it was not needed.. The letter also states that where insufficient funds had been entered on to the chiropody list this was only to remind them to ask the residents daughter for money when she next came in. The Risk assessment for the second resident which had been completed on 16 July 2007 stated that it should be reviewed 4 weekly. There was no care plan review available for August 2007. The Social Activities care plan for the second resident was inspected. The care plan written on 18 March 2007 stated ‘when there is a party or entertainment on always include the service user and with a bit of encouragement she will join in with other activities’. However since 18 March 2007 there were only five records of the resident taking part in activities in the home. There was also no record that activities had been offered to her that she had refused. The solicitor acting on behalf of the Old Vicarage has stated that it is not the homes policy to record if activities are offered and then refused.It is recommended that a record of all activities offered are recorded. The care plan review for social activities in July and September 2007 stated no change. There was no review available for August 2007. The care plan for a third resident stated when the chiropodist visits the home carers are to make sure the resident is seen. However the record of medical The Old Vicarage DS0000015127.V350757.R02.S.doc Version 5.2 Page 12 services received (which includes an area for chiropody visits) had no record of the resident seeing the chiropodist. The homes chiropody book which had entries for February, April, June and August 2007 did not list the third service user as being treated. The solicitor acting on behalf of the Old Vicarage has stated in his letter ‘no opportunity for the third resident to see the chiropodist had arisen by the 18th September 2007 and she refused treatment on the 26th September 2007’. The care plan for the third resident stated make sure she is weighed regularly if there is a loss or gain monitor the situation with weighing weekly. However the weight-monitoring chart for the service user had no entries. The solicitor acting on behalf of the Old Vicarage stated in his letter that there had been no significant gain or loss in weight and weekly weighing was unnecessary and the care plan has been amended to reflect this. A member of care staff stated that a residents daughter always assists her with a bath. However this information was not in the care plan. A pharmacy inspection was carried out in August 2007 and three requirements were made in relation to the storage and administration of medication. The pharmacy inspector will return to the home to assess whether these requirements have been met after the date for compliance has passed. The residents spoken to on the day of the inspection stated that they felt they were treated with respect by the staff and their right to privacy was upheld. One resident had recently been unwell and he stated that the staff had gone out of their way to help him get the medical help he needed. The Old Vicarage DS0000015127.V350757.R02.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 Quality in this outcome area is good. Arrangements are being put in place to enable residents to have a wider choice of activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Although activities have been limited since the last key inspection one of the carers is planning to work on a Wednesday and organise activities with the residents. There has been an entertainer bought into the home which the residents enjoyed so he has been booked again for a Halloween party. One of the residents stated ‘the food is very good and there is always enough’. Residents are encouraged to bring their own possessions with them to personalise their bedrooms. Residents friends and families can visit at any reasonable time. The Old Vicarage DS0000015127.V350757.R02.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. Although staff are aware of the procedure to follow if they suspect a resident has been abused this procedure has not always been followed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the staff have completed or are booked on a refresher for training on the protection of vulnerable adults. The care staff spoken to were aware of the procedure to follow if they suspected a service user had been abused. Staff spoken to said they would speak to a member of staff if they wanted to make a complaint. A regulation 43 notice was served on the company secretary on the 18 September 2007 for failure to protect service users from abuse. The notice states that the home must: • • Put arrangements in place to ensure all service users living in the home are safe from harm or abuse and are not placed at risk of harm or abuse. Always follow the correct procedure for notifying the Adult Protection Team (including notifying them of the full details) of all allegations. The Old Vicarage DS0000015127.V350757.R02.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24,26 Quality in this outcome area is good. The premises were well maintained and had a good standard of cleanliness on the day of inspection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As stated in a previous report some of the bedroom carpets are looking worn and in need of replacement. Mr Paling stated that there is ongoing maintenance throughout the home. A full audit of the home should be completed and an action plan compiled of what maintenance is due to be completed and when. The fire alarm panel has been serviced since the last key inspection and does not now show there is a fault with the system. The Old Vicarage DS0000015127.V350757.R02.S.doc Version 5.2 Page 16 During this inspection all chemicals were stored securely. The open electric sockets have been changed so they are no longer a risk to the residents. The Old Vicarage DS0000015127.V350757.R02.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28.29,30 Quality in this outcome area is good. Staff have the necessary training to meet the needs of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three staff files were inspected and found to contain all of the necessary recruitment checks. Staff files also showed that mandatory training is up to date. Staff training in the last year includes fire, dementia, medication, and protection of vulnerable adults, food hygiene and moving and handling, activities and risk assessment. The rota showed that there are three carers on shift in the morning Monday to Friday. The manager stated one of the managers always works a care shift on weekend mornings if there are only two carers on shift. The manager stated that there are two waking night staff on shift. This was a recommendation of the fire service to ensure that service users are safe in an emergency. The Old Vicarage DS0000015127.V350757.R02.S.doc Version 5.2 Page 18 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, 33,35,36,38 Quality in this outcome area is adequate Some management systems need to be strengthened to ensure that residents live in a well run home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager confirmed that quality assurance questionnaires are given out to residents and their relatives that visit the home. The managers eat dinner with the residents on most days so are available if any residents would like to speak to them about any concerns. The senior carer is responsible for many managerial tasks such as pre admission assessments, writing care plans and supervision. The Old Vicarage DS0000015127.V350757.R02.S.doc Version 5.2 Page 19 The manager agreed that some of the risk assessments are not completed in enough detail for the staff to be fully aware of what the actual rsik was and how this could be avoided. The staff spoken to on the day of the inspection confirmed that they are receiving regular supervision. The manager stated that he has not had formal supervision with the senior carer for a long time. As the senior carer is responsible for many of the managerial tasks in the home it is very important that she receives regular supervision to discuss any issues or training needs. The letter from the solicitor acting on behalf of The Old Vicarage states that the manager and deputy work together on a day-by-day basis thus satisfying one of the principle objectives of supervision to ensure that there is one to one discussion, feedback, encouragement and support. Small amounts of money are held by the home on the behalf of the residents. Six records and balances of service users money were checked. Four of the accounts were accurate, one had the wrong total but had a receipt to explain the missing money and one had £2.20 more in it than the balance. Service users money and records must be accurate and checked regularly. The fire and accident records were checked and found to be satisfactory. The Old Vicarage DS0000015127.V350757.R02.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 1 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 2 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 3 X 3 X 2 2 X 2 The Old Vicarage DS0000015127.V350757.R02.S.doc Version 5.2 Page 21 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 OP3 Regulation 14(1) Requirement Before a service user moves into the home their needs must be assessed to ensure that the home can meet their needs. Care plans must provide guidance for staff in how to meet health and welfare needs, (including the changing health and welfare needs) of service users. When service users plans are revised the service user or their representative must be informed of the changes. Service users must receive the treatment from health care professionals as identified in their care plan. Accurate Medication Administration Records must be maintained. Not assessed on this occasion 5. OP9 12(1) Service users must be protected 01/10/07 by only being administered medication as prescribed by their GP and clear guidance must be in place for staff where medication is administered on a DS0000015127.V350757.R02.S.doc Version 5.2 Page 22 Timescale for action 15/12/07 2. OP7 15(2) 29/12/07 3. OP8 12(1)(b) 15/12/07 4. OP9 13(2) & 17(1) Schedule 3(i) 01/10/07 The Old Vicarage 6. OP9 13(2) “when required” basis. Not assessed during this inspection. Medication must be stored securely and in appropriate environmental conditions. Not assessed during this inspection. Bedroom carpets that are worn must be replaced. This was a requirement from the previous inspection. Arrangements must be put in place to ensure all staff are regularly supervised. 01/10/07 7. OP24 23 01/01/08 8. OP36 18(2) 15/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Old Vicarage DS0000015127.V350757.R02.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 DS0000015127.V350757.R02.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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