CARE HOMES FOR OLDER PEOPLE
Old Vicarage (The) Leigh Sherborne Dorset DT9 6HL Lead Inspector
Mike Dixon Unannounced Inspection 24th February & 2nd March 2006 03:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Old Vicarage (The) DS0000026856.V284521.R01.S.doc Version 5.1 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. Old Vicarage (The) DS0000026856.V284521.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Old Vicarage (The) Address Leigh Sherborne Dorset DT9 6HL 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) 01935 873033 01935 874013 clare@tovic.com www.theoldvicarage-leigh.co.uk Tovic Limited Ms Clare Buckland Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Old Vicarage (The) DS0000026856.V284521.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16th August 2005 Brief Description of the Service: The Old Vicarage is a well established care home, situated in the village of Leigh, about six miles from Sherborne. The home is set in spacious and attractively landscaped gardens with ample communal seating, car parking is available. Services include 24 hour care, meals, laundry, domestic services and a range of social activities. The home is registered to accommodate a maximum of 35 older people (age 65 and over), both male and female. The main house is a Victorian building, originally a vicarage which has been extended. The accommodation is spread over two floors and contains 31 single rooms and 2 double rooms, most rooms are on the ground floor, 6 rooms are located on the first floor. A stair lift on the main staircase provides access to the first floor. Many of the ground floor rooms have direct access to the courtyard and gardens. Communal facilities include two dining rooms and a small lounge area. The home is registered under Tovic Limited, Annie Sinnott is the proprietor, she takes an active role in the operation of the home and is a well-respected ambassador for the social care industry. Clare Buckland is the registered manager responsible for the day-to-day running of the Old Vicarage. She is supported by a care manager and two deputy managers. An office manager maintains well organised administrative systems. The home is a member of the Dorset Forum and achieved continuation of the Investors in People Award in April 2004. Old Vicarage (The) DS0000026856.V284521.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted as part of the Commission’s regulatory duty to inspect all care homes twice a year. The purpose was to review the home’s progress in implementing the requirement and recommendations from the previous inspection report. The purpose was also to assess the home’s compliance with the remaining key national minimum standards for older persons that had not been considered during the previous inspection visit. This included a separate visit on 2nd March 2006 by the Commission’s pharmacy inspector to review the home’s medication arrangements. In order to obtain a fuller picture of the home the reader should refer to the earlier inspection report dated 16th August 2005. During the visit on 24th February 2006 which lasted four and a half hours the inspector spoke with eight service users, a visitor, Mrs Sinnott (the Responsible Individual), the administrator and one of the care managers. He looked round the accommodation, observed practice and inspected records relating to service users’ care, staffing, health and safety and other documentation relating to the running of the home. What the service does well:
The home has comprehensive care plans which are drawn up in consultation with service users or their representative. Care staff record in detail significant occurrences, providing a useful reference source for their colleagues and visiting professionals. Service users retain control over their lives, where feasible, and choose how and where they spend their time. Service users are happy with the care which they receive. The following comments were received by the inspector from service users during the course of the visit: “they are very kind and helpful; I can’t find any fault”, “I think the staff are good”, “they are very kind”. Care staff help service users with personal care tasks where needed and ensure that service users are comfortable. The home has good equipment and facilities to assist service users who have poor mobility or who spend a lot of time in bed. Staff monitor the health care needs of service users and liaise with doctors and community nurses when the need arises. There is a high standard of storing and recording medication in the home that follows good practice. Old Vicarage (The) DS0000026856.V284521.R01.S.doc Version 5.1 Page 6 The home is kept in a clean and odour free condition. The laundry arrangements and facilities are to a high standard. The management take steps to promote the health and safety of service users by such measures as the monitoring of accidents the servicing of equipment and facilities and the training of staff. The management encourage care staff to achieve nationally recognised qualifications and most have now attained NVQ level 2 or 3. The home is efficiently run by the competent and qualified manager supported by the experienced Responsible Individual. There are the necessary arrangements in place to safeguard service users’ financial interests and the home assists those service users who need it to manage their personal allowance on a day-to-day basis. What has improved since the last inspection? 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.
Old Vicarage (The) DS0000026856.V284521.R01.S.doc Version 5.1 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 Old Vicarage (The) DS0000026856.V284521.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were considered during the inspection. EVIDENCE: Old Vicarage (The) DS0000026856.V284521.R01.S.doc Version 5.1 Page 9 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 the following standard(s): 7,8 and 9 Care plans are comprehensive and provide staff with the information that they require in order to meet the care needs of service users. The risk assessment process and accompanying documentation is in need of some improvement in order to better protect service users. The home liaises effectively with the primary health care team and ensures that residents’ health care needs are met. The home has good systems in place for managing medication to protect residents. EVIDENCE: The inspector looked at a sample of four service users’ care records. Each service user has a care plan which is kept under regular review and is updated accordingly. The information contained in the care plan involves consultation with service users and/or their representative and this evidenced in the records. The noting of significant events and occurrences is comprehensive and provides a useful reference source for care staff and visiting professionals. Old Vicarage (The) DS0000026856.V284521.R01.S.doc Version 5.1 Page 10 Risk assessments are conducted and recorded covering most of the relevant topics, including the prevention of falls. The one area that is not covered sufficiently comprehensively concerns the fitting of bed rails. Although it was clear from talking with staff that suitable consideration was given to safety and other concerns regarding the matter, there was a lack of documented evidence to indicate that all relevant factors had been covered. Several of the service users currently living at the Old Vicarage are very frail and dependent. The facilities provided by the home to ensure their comfort are to a high standard and include adjustable beds, special mattresses, hoists and standaids. Care staff monitor service users’ well-being and there is close liaison with the primary health care team, including general practitioners and community nurses. The staff assist service users with personal care tasks where this is necessary and encourage service users to retain their independence, wherever feasible. From observation and comments received by the inspector during the visit it was evident that staff were attentive to service users’ care needs. Examples of comments made include: “they are very kind and helpful; I can’t find any fault”, “I think the staff are good”, “they are very kind”. Information is recorded with regard to service users’ nutritional needs and wishes regarding food and meal preferences. Weight is monitored in situations where there is concern about weight gain or loss and the home has a set of suitable scales for the purpose. The inspector suggested that the home set out a clearer rationale for determining the frequency of weighing, in accordance with service users’ wishes. The home has a good medicines policy. Medicines were stored correctly and the maximum and minimum temperature of the medicines fridge was regularly monitored. Four residents were self-medicating and one seen kept her medicines securely. The inspector saw a medication risk assessment and a good care plan on health problems and medication on another file. The inspector checked a sample of six residents’ medicines with their records. Medicines received, administered and returned for disposal were recorded. The audit trails checked agreed with the Medicine Administration Record (MAR) charts indicating that medicines were given as prescribed and recorded. Changes to medication were clearly recorded and countersigned to indicate that a second carer had checked the details as correct to protect residents. There were clear directions for using “when required” medicines and the dose given was recorded when a choice was prescribed. The inspector saw a good audit tool that the home uses to monitor their medication systems and records. This didn’t include checks of the audit trails for medicines and it is Old Vicarage (The) DS0000026856.V284521.R01.S.doc Version 5.1 Page 11 recommended that this be included to confirm that medicines are given correctly. Nine staff who give medicines have completed a safe handling of medicines course and others have done a shorter course on medication awareness. The inspector was told that the GPs were asked to review medication when prompted on the repeat prescription request and it was suggested that a chart for recording dates of reviews be kept with the MAR charts. Old Vicarage (The) DS0000026856.V284521.R01.S.doc Version 5.1 Page 12 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 the following standard(s): None of these standards were considered during the inspection. EVIDENCE: Old Vicarage (The) DS0000026856.V284521.R01.S.doc Version 5.1 Page 13 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 the following standard(s): None of these standards were considered during the inspection. EVIDENCE: Old Vicarage (The) DS0000026856.V284521.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 26 The home’s cleaning and laundry arrangements are to a high standard, providing a comfortable and hygienic environment for service users. EVIDENCE: The premises were very clean and free from unpleasant odours. Comments from service users confirmed that their rooms were cleaned regularly and that their clothes and linen were laundered to a good standard. There is a dedicated laundry room and separate sluice room and all machinery in use meets disinfection control standards. The home has guidance from the Health Protection Unit to guide staff on infection control procedures; protective equipment is in use to minimise risks to service users and staff. Designated laundry assistants are employed each day to take responsibility for the laundry service. Linen is cleaned by an external laundry contractor. Old Vicarage (The) DS0000026856.V284521.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 The home promotes the achievement of nationally recognised care qualifications and has built a staff team that enjoys the confidence of service users. EVIDENCE: Care staff are encouraged to prepare for NVQ level 2 or 3 and the majority of staff members have achieved either one or both of these qualifications. The care managers have attained NVQ level 4 in care management. As indicated earlier in the report, service users have confidence in the competence of the staff and say that they are well looked after. The management has continued to actively support the attainment by staff of national care-related awards. Mrs Sinnott, the Responsible Individual, received the Care Choices 2005 Care Employer of the Year award. A care staff member was awarded the “Care Newcomer 2005” award and another staff member was runner-up in the “Young Care Practitioner of the Year 2005” award. Old Vicarage (The) DS0000026856.V284521.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,35 and 38 The manager is experienced and qualified and manages the home efficiently in the best interests of the service users. The home has the necessary arrangements in place to safeguard service users’ financial interests. The home promotes the health and safety of service users and staff through taking effective measures which provide a safe and secure environment. EVIDENCE: Both the Responsible Individual for Tovic Ltd, Annie Sinnott, and Clare Buckland, Registered Manager, have many years experience of running a care home. Ms Buckland has a number of qualifications that relate to care practice and the management of care, including a BTec Diploma in Social Care, HNC in Social Care, City and Guilds Management in Care, Institute of Management Diploma and a Degree in Business Administration. She won the Care Choices “trained manager of the year award” in 2005. She keeps up to date with
Old Vicarage (The) DS0000026856.V284521.R01.S.doc Version 5.1 Page 17 training that relates to health and safety and the care of older persons. She works full-time and is responsible for the day-to-day running of the home in consultation with Mrs Sinnott who remains in regular contact with the home. The home does not act in a formal capacity on behalf of service users, all of whom either look after their own affairs or have a representative. The home has an arrangement in place to assist service users to manage their personal allowance and there is secure storage for the keeping of money. Lockable facilities are provided in all bedrooms for those service users who wish to keep items of value with them. Records are kept of all transactions and the accounts are regularly audited. Accidents are logged and reviewed; there is evidence of action taken to minimise a reoccurrence. Staff training is provided on health and safety topics and relevant policies/procedures are in place to guide staff. The home has measures to promote fire safety including the training of staff and the carrying out of tests of portable electrical appliances. Servicing of equipment and services, including fire precautions, hoists and other aids is undertaken at regular intervals. Water checks are conducted to minimise the risk of legionella. There is a programme in place for the fitting of guards to radiators to prevent service users burning themselves in the event of a fall. Old Vicarage (The) DS0000026856.V284521.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X 4 STAFFING Standard No Score 27 X 28 4 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 3 Old Vicarage (The) DS0000026856.V284521.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations A risk assessment should be recorded prior to the fitting or use of bed rails which takes into account all relevant issues, including a note of who has been consulted and how the measure will be monitored and reviewed. Old Vicarage (The) DS0000026856.V284521.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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