Inspection on 19/07/05 for The Old Vicarage

This inspection was carried out on 19th July 2005.

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 10/05/07

The Old Vicarage 20/12/05

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 Joy Howson-Booth Unannounced 19th July 2005 10:30am 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 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 F57 F09 S9865 The Old Vicarage V238563 140705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Old Vicarage Address Main Street, Hornby, Lancaster, Lancashire. LA2 8JT Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01524 221284 Forrester Retirement Homes Mrs Karen Anne Robson CRH Care Home 15 Category(ies) of OP Old Age 15 registration, with number of places The Old Vicarage F57 F09 S9865 The Old Vicarage V238563 140705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th March 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 Lancater. 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 resident 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 consrvatory which leads onto the gardens has provided an additional facility for residents to use. The home is fortunate to be set in its own walled garden, which is well maintained and provides an excellent outdoor facility for residents to use. The home is very well maintained and provides a pleasant and homely environment for those people accommodated. The Old Vicarage F57 F09 S9865 The Old Vicarage V238563 140705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over two half days, the first half day was spent speaking with residents and staff on duty and the second half day speaking with the registered manager and viewing 2 assessments, 5 care plans and other documentation held in the home. The inspection was unannounced. As well as speaking with residents, survey forms were also provided for relatives/visitors. Two survey forms were received. During the inspection a visiting relative was also spoken with. What the service does well: The home provides a relaxed and comfortable environment in which staff are keen to ensure individual needs and lifestyles are maintained as much as possible. Residents have their own individual routines which are respected by the staff at the home. The residents all said that the staff at the home treat them with dignity and respect at all times. The location of the home is excellent and being its own grounds means that residents have a very pleasant outdoor and private area which can be used. The home takes care to make sure they have information about any resident before they come into the home so that they can be sure they can look after them properly. Residents said that they have no complaints about the home but if they have any issues these are always taken care of quickly. There are always enough staff on duty to look after the residents. The manager of the home makes sure that any money looked after for any resident is correctly recorded and kept safe. Very positive comments were received during this inspection and from survey forms returned. These included “excellent care – nothing is too much trouble for the residents” and “the home is as near to perfection as it could be”. The Old Vicarage F57 F09 S9865 The Old Vicarage V238563 140705 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: The plans of care which are written so that staff know the residents needs and how they are to meet these need to be updated to ensure that they give correct information over current needs. All the care paperwork needs to be looked at on a monthly basis to make sure it is still correct. The plans of care should also show that the resident has had their say in how their care needs are written and are going to be met. The residents health care needs must be written in the care plan and should make sure it gives a complete picture, for example, residents should be weighed every month or if there are any concerns that they may be losing weight. The accident record book should be reviewed by the registered manager on a monthly basis so that any follow up action decided on can be taken. The medication records should have a photograph of the residents on their individual sheet so that staff can be sure they are giving the medication to the right resident. The manager was advised that a book to record complaints, suggestions and compliments should be put in place so that any minor issues or suggestions can be written in along with actions taken. The one to one meetings with staff must cover all the areas of practice and development and the notes made by the manager should be clear and provide in depth information about the areas talked about. The hours that the manager works should be recorded on the weekly rota and, when she is not on duty, the senior carer should be highlighted. The Old Vicarage F57 F09 S9865 The Old Vicarage V238563 140705 Stage 4.doc Version 1.40 Page 7 When staff buy small items of confectionary, personal hygiene goods or other items for the residents the till receipt should be kept with the money records for that resident. The manager needs to ensure that files can be accessed if she is not on duty and an inspection takes place. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Old Vicarage F57 F09 S9865 The Old Vicarage V238563 140705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Old Vicarage F57 F09 S9865 The Old Vicarage V238563 140705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6 There are good arrangements for the needs of residents to be assessed and met. This means that people coming to stay at the home will be asked questions about their personal needs and come to an agreement how the staff will provide care for them. EVIDENCE: At the initial visit it was not possible to view the assessment files as the registered manager was not on duty and the senior on duty did not have keys to access the filing cabinet. During the second visit, case files for two newly admitted residents were examined and found to contain the home’s own comprehensive assessment and, for one, an assessment provided by the Social Worker involved. Both residents were spoken with and confirmed they feel their needs are well met by the staff at the home. The assessments were comprehensive but it was noted that a couple of areas still need to be added – oral care and foot care. The manager confirmed these would be added straight away for new residents. The Old Vicarage F57 F09 S9865 The Old Vicarage V238563 140705 Stage 4.doc Version 1.40 Page 10 The home does not provide an intermediate care facility. The Old Vicarage F57 F09 S9865 The Old Vicarage V238563 140705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 10 Arrangements to ensure the healthcare of the residents is very good. Written care plans are not updated and do not provide care staff with clear instructions or guidance over individual care needs. Residents are treated with dignity and respect and their privacy is maintained. EVIDENCE: Five case records were examined and provide evidence that residents medical conditions and healthcare needs are recorded and there are systems in place to review these on a monthly basis. However these had not all been reviewed on a monthly basis. The manager was advised that a review had not been recorded since May 2005 for the care plans examined. In addition, it was noted that the needs of at least two of the residents had changed significantly and these changes were not reflected in their care plans. Risk assessments are also carried out but these need to be reviewed on a monthly basis, or as needs change. It is also advised that the care plans should evidence involvement of the resident concerned. There was evidence in both the care records and from talking with residents that their health needs are generally met. There was evidence of GP involvement, Chiropodist and Dental visits, involvement by District Nurses and The Old Vicarage F57 F09 S9865 The Old Vicarage V238563 140705 Stage 4.doc Version 1.40 Page 12 Consultants. A number of residents are able to maintain their own personal care and this is encouraged by the staff at the home. The manager was advised that weight records should be maintained for residents. Where necessary, additional involvement, specialist advice and equipment would be obtained for use in the home and evidence has been seen of this in the past. Whilst medication was not assessed on this occasion, the manager was advised that a self-administration form should be completed for the new resident who self administers. There is still a need to have a photograph of the resident on their medication administration record – this is something that was raised in a previous inspection. All the residents spoken with confirmed that the staff treat them with respect and dignity at all times and their privacy is maintained. Both comment card received from residents stated that the staff treat them well, their privacy is respected and they feel very well cared for. The Old Vicarage F57 F09 S9865 The Old Vicarage V238563 140705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) No standards were assessed from this section during this unannounced inspection EVIDENCE: The Old Vicarage F57 F09 S9865 The Old Vicarage V238563 140705 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The arrangements for dealing with complaints are good. Residents can speak up and feel that they are listened to. 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 manager was advised that a complaint book needs to be purchased to record any complaints, comments or suggestions to be recorded, along with the actions taken to address them. Discussions with residents confirmed that they will speak with the manager should they have any concerns or complaints but, all said there is nothing to complain about as they always feel very well looked after. Residents have confirmed that should there be any worries or concerns these are addressed immediately. Staff have previously confirmed that should anyone have any concerns they would inform the manager. Neither the home or the Commission for Social Care Inspection has received any complaints in respect of this home. The Old Vicarage F57 F09 S9865 The Old Vicarage V238563 140705 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21. 22. 23. 24, 25 and 26 The standard of the décor within this home is good with evidence of improvement through maintenance. The home presents as a homely and comfortable environment for residents 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. No issues have been raised by the fire department or environmental health department. There are no CCTV cameras in use in the home. 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 Old Vicarage F57 F09 S9865 The Old Vicarage V238563 140705 Stage 4.doc Version 1.40 Page 16 The outdoor garden areas are well maintained, safe and accessible for the residents and are used when the weather is warm enough. The toilet and bathing facilities are sufficient for the residents, with some rooms having their own ensuite facilities (toilet and washbasin). There are a range of aids and adaptations in the home which meet the needs of those currently in residence. The manager is aware and would make the appropriate contacts should additional needs be identified. Residents rooms were seen to be personalised with treasured and familiar items and all are pleasant spaces in which to spend time. The rooms all provide the individual furnishings that are required and have their own locks. Whilst there are two double rooms, these are being used for single occupancy at present. 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 is a separate laundry and the manager has recently purchased a new washing machine which 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 although there are no residents who would require this at present. The Old Vicarage F57 F09 S9865 The Old Vicarage V238563 140705 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The level and calibre of staff is very good. Residents are cared for by a team of dedicated staff. EVIDENCE: The staffing rota was examined and evidenced that there are always the manager and/or senior member of staff on duty, along with a care worker. There is one person on waking night duty, as well as someone (usually the manager) sleeping in should an emergency occur. The home has a designated cook and cleaner. The manager was advised that the rota should reflect the hours she actually works rather than, as at present, stating “office”. In addition, the rota should indicate who is the senior on duty should the manager be absent. Discussions with residents confirmed that there are always sufficient staff on duty. A comment card received stated that the resident concerned felt well cared for and safe at the home. The Old Vicarage F57 F09 S9865 The Old Vicarage V238563 140705 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 36 and 38.7 The arrangements to protect the residents’ money and property are good. Residents’ money and belongings are safeguarded. Staff are appropriately supervised. Accident records are accurately maintained. EVIDENCE: Financial records for both charges and payments made to the home and for personal monies held were examined. The charges and payments records need to be updated as the last entries were made in May 2005. The personal monies records were examined and generally found to be accurately maintained. One record was not accurate as there was excess money and the manager felt the member of staff may have written down the expenditure before the money had been given to the hairdresser. The manager is to remind staff about this. The manager was advised that when personal items like tights, sweets, etc., are purchased for residents a receipt The Old Vicarage F57 F09 S9865 The Old Vicarage V238563 140705 Stage 4.doc Version 1.40 Page 19 should be obtained and stapled to the appropriate personal monies record sheet. The manager confirmed that she has not been appointed as an agent for any resident in the home. The home has a safe to keep valuables and money in and this is only accessible by the manager. A receipt book is also maintained should any resident wish to deposit items of value at the home. The manager confirmed that formal supervision is now in place for all staff and supervision records for staff were seen to evidence this. The manager was advised over the content of the supervision format which needs to include all aspects of care practices; philosophy of care in the home and career development needs. As well as this, the topics covered, along with actions/advice given should also be recorded rather than, as at present, a tick system. This will enable further assessment/development to be agreed and monitored. The accident book was examined and a number of falls had been recorded since January 2005. The registered manager had not reviewed these accidents since March 2005. It is recommended that such a review ensure correct, timely and appropriate actions can be taken and any patterns identified. The Old Vicarage F57 F09 S9865 The Old Vicarage V238563 140705 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x 3 2 x x The Old Vicarage F57 F09 S9865 The Old Vicarage V238563 140705 Stage 4.doc Version 1.40 Page 21 yes Are there any outstanding requirements from the last inspection? 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 9 Regulation 13 Requirement A photograph of individual residents must be put on the medication administration records (previous timescale of 30 September 2004 and 30 April 2005 are still outstanding) Care plans for residents must reflect their current needs and how the staff team are to meet these in detail. Care plans must also reflect the residents involvement in its development. Healthcare needs of residents must be comprehensively outlined in the care plan and must include weight monitoring The supervision records must provide more detail of the areas discussed and cover the areas outlined in this standard A complaints book must be put in place and used as needed Timescale for action 31.8.05 2. 7 5 31.8.05 3. 8 12 31.8.05 4. 36 18 31.8.05 5. 16 22 31.8.05 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 Good Practice Recommendations F57 F09 S9865 The Old Vicarage V238563 140705 Stage 4.doc Version 1.40 Page 22 The Old Vicarage 1. 2. 3. 4. 5. Standard 35 17 38 18 35 Receipts should be obtained for personal purchases and these attached to the records of monies held sheets maintained by the manager The key system should be reviewed so that files can be accessed if the registered manager is not on duty The accident book should be reviewed by the manager to ensure appropraite and timely actions taken be taken and patterns identified and addressed The staffing rota should reflect the hours the registered manager works and indicate the senior on duty when the manager is not on duty Financial records should be written accurately and when a financial transaction has occurred The Old Vicarage F57 F09 S9865 The Old Vicarage V238563 140705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 2nd Floor, Unit 1 Tustin Court Port Way Preston. PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Old Vicarage F57 F09 S9865 The Old Vicarage V238563 140705 Stage 4.doc Version 1.40 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. 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!