CARE HOME ADULTS 18-65
The Old Vicarage Parsonage Lane Hungerford Berkshire RG17 0JB Lead Inspector
Mrs Rhian Williams-Flew Unannounced Inspection 23rd November 2005 9:40 The Old Vicarage DS0000011143.V253603.R01.S.doc Version 5.0 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 DS0000011143.V253603.R01.S.doc Version 5.0 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 Adults 18-65. 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 DS0000011143.V253603.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Old Vicarage Address Parsonage Lane Hungerford Berkshire RG17 0JB 01488 683634 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) Cornerstone Housing Mr Gary Devlin Care Home 11 Category(ies) of Learning disability (11) registration, with number of places The Old Vicarage DS0000011143.V253603.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21st June 2005 Brief Description of the Service: The Old Vicarage is a care home providing personal care and accommodation for up to 11 adults with learning difficulties. Mr and Mrs Childs own the home. The business name is Cornerstone Housing. The home is situated near the Parish Church of Hungerford and is a short walk from the main shopping area of the town. Access to bus and train services is close by. The home consists of a large house with seven bedrooms, this is known as The Old Vicarage. All of the rooms in the main house are single occupancy. In addition, there are three buildings, which are annexed to the main house. One of these buildings is called The Lodge, which accommodates one resident. Another building is called The Coach House, which can accommodate two residents; presently one resident lives here. The third building is called Parsonage Cottage and accommodates one resident. All of the residents receive support from the same staff team who are available throughout the 24 hours of the day. Usually, there are no waking night staff unless there is a specific need. The Old Vicarage DS0000011143.V253603.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection occurring between 9:40 hrs and 13:30 hrs. Four service users were spoken with during the inspection and a tour of the premises within the main building of the Old Vicarage was undertaken. The Registered Manager was present for one hour of the inspection; the deputy manager was present for the remainder. The focus of the inspection was to review the three previous requirements and to inspect the key standards not inspected at the previous inspection in June 2005. For completeness it is advised that the previous inspection report is read in conjunction with this report. What the service does well: What has improved since the last inspection?
The three previous requirements have been met or almost met. All members of staff are due to attend training in the protection of vulnerable adults on 1st December 2005. This is an important piece of training for the staff to receive. A full ensuite facility has been provided for one of the service users. This has made a significant difference to meeting his needs and demonstrates the homes willingness to provide facilities when they are required. The fixing of low temperature covers for the radiators, that have been risk assessed as requiring them, will be completed in the near future. From the service users who was spoken with and seen it was clear that they continue to enjoy living at the Old Vicarage. The Old Vicarage DS0000011143.V253603.R01.S.doc Version 5.0 Page 6 What they could do better: 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 DS0000011143.V253603.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Old Vicarage DS0000011143.V253603.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 This home does have a thorough procedure for ensuring that all new referrals are fully assessed before placement is considered and offered. EVIDENCE: It was not possible to evidence this standard using specific client documentation, as there have been no new admissions to the home since the previous inspection. However, the home does have a procedure to ensure that all new admissions who, are referred to the home are thoroughly assessed before placement is considered. The Old Vicarage DS0000011143.V253603.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6; 7 & 9. The care plans are comprehensive and cover all aspects of the person’s life and lifestyle choices. However, fundamental changes to a clients care and its delivery should be recorded in the main care plan as the change occurs. EVIDENCE: Three service user care plans were looked at in detail. They contained comprehensive information about the needs of the service users and the goals the people wished to achieve. Details of all aspects of their lives could be evidenced and if, specific help was required by the client this was clearly documented. Any risks faced by the client were detailed and risk assessed. It was clear that service users interests and wishes are central to the care plans. The Registered Manager said that an annual review is held with all interested parties, this includes other professionals alongside the client and their representative. At six monthly intervals a smaller review is held usually involving the care staff and the client and their representatives. However trying to evidence these reviews within the care plan documents was not possible. It was also clear that some of the information in the care plans was out of date.
The Old Vicarage DS0000011143.V253603.R01.S.doc Version 5.0 Page 10 It would seem that key workers use the monthly key worker sessions for each client to discuss and record any ongoing changes for the person. It would therefore appear (confirmed by the deputy manager) that although changes to a clients care needs are recorded in the key worker sessions, substantive changes to care needs are not being altered in the care plans. It is therefore recommended that when fundamental changes occur in a clients care needs these are always documented within the main care plan documentation, as they occur. For example, when a persons health care needs change or, they change their timetable of activity and occupation. If this is not done the main care plan documentation quickly becomes out of date and potentially misleading. The Old Vicarage DS0000011143.V253603.R01.S.doc Version 5.0 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12; 13; 15; 16 & 17. The service users are offered meaningful and rewarding educational and occupational opportunities, which they access in the local community. The daily routines of the home are flexible so as to ensure that each service user is treated as an individual. The staff team are very focused on the needs and wishes of the people who live in the home. EVIDENCE: All of the service users education and occupation opportunities were reviewed. All of them take part in activities and training of their choice. Each client has their own programme of opportunities, which range from vocational activities through to work experience and further learning. One person spoke with enthusiasm of a new opportunity they had recently started taking part in. The service users are supported to use the local facilities and are involved in their local community. In the care plans reviewed, it was evident that the needs of the service users with regard to their personal and family relationships have been identified. It was also evident from these care plans and, from observations of the staff
The Old Vicarage DS0000011143.V253603.R01.S.doc Version 5.0 Page 12 team interacting with the clients, that the clients rights are respected as well as their choices on how they wish to conduct themselves. The relationships between the staff members and the clients were noted to be respectful, encouraging, guiding and friendly. Evidence was seen that service users are offered varied, balanced and nutritious meals. All of the service users have good appetites. Some service users have specific health care needs with regard to their dietary intake and these are noted in their care plans. The Old Vicarage DS0000011143.V253603.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18; 19 & 20. This home provides sensitive and flexible personal support to the residents. Wherever possible service users are encouraged to be as independent as they are able. The home has a good relationship with the GP surgery who provide good health care support. The home has a robust procedure with regard to medication. EVIDENCE: It was documented in the care plans that were reviewed how the service users wish to receive their personal support. It detailed the help they required, how they wished to receive it including the preferred gender of carer. If specific health care professionals are required to offer support to the client the members of staff access them. All of the service users are registered with the local GP service and this permits them access to other members of the primary care team located near to the GP surgery. Any specific health care needs that the clients have are promptly addressed. All the residents have regular health care checks with regards to dentistry, podiatry and ophthalmology. All the medication procedures for service users were reviewed. The home has a robust procedure with regard to the receipt, recording, storage, handling, administration and disposal of medicines. The home is in the process of
The Old Vicarage DS0000011143.V253603.R01.S.doc Version 5.0 Page 14 changing the chemist who provides their service and from discussions with the Deputy Manager this transition is proving to be seamless. None of the service users in this home administer their own medication. The Old Vicarage DS0000011143.V253603.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23. The home has responded to a previous requirement with regard to training staff in protecting vulnerable adults. EVIDENCE: The home has responded proactively to a previous requirement that all staff should receive training in protecting vulnerable adults. The Registered Manager and one member of care staff have already received the training. Evidence was seen that all other members of staff are to receive the training on 1 December 2005 when a training company will visit the home to provide the training. The training is accredited. The Old Vicarage DS0000011143.V253603.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 26. A previous requirement has been met as a service user has been provided with an en-suite facility that meets his needs. This demonstrates the responsiveness of the home to improve the service they provide to clients. EVIDENCE: A previous requirement has been met. One residents room has been provided with a full en-suite facility and has been re-carpeted. Redecoration of the room is to commence in the near future. This has been a significant improvement for the resident concerned. All of the service users rooms in the main building of the Old Vicarage were visited. During, the inspection a member of care staff noted in writing various small remedial works that, need to be completed. It is recommended that these works be commenced in the near future. The Registered Manager confirmed that the plan of redecoration has been detailed and it is anticipated that the redecoration of the service users rooms in the Old Vicarage will commence in the New Year 2006. The Old Vicarage DS0000011143.V253603.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected on this occasion. EVIDENCE: These standards were not inspected on this occasion. The Old Vicarage DS0000011143.V253603.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42 A previous requirement has been met as the Registered Manager has completed a risk assessment of all the radiators in the home and where indicated radiators have been fitted with covers. EVIDENCE: This standard was only reviewed was regard to a previous requirement which has been almost met. The Registered Manager has risk assessed all the radiators in the home and identified those that require low temperature covers. The handyman has nearly completed the task of fixing these covers. He anticipated completing the work within the next week. The Old Vicarage DS0000011143.V253603.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 X 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X X X X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Old Vicarage Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score X X X X X 3 X DS0000011143.V253603.R01.S.doc Version 5.0 Page 20 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA24 Good Practice Recommendations It is recommended that when fundamental changes occur in a clients care needs these are always documented within the main care plan documentation, as they occur. It is recommended that the list of remedial works detailed by a member of care staff during the inspection are completed as soon as practicable. The Old Vicarage DS0000011143.V253603.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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