CARE HOMES FOR OLDER PEOPLE
The Old Vicarage 15 Naze Lane Freckleton Lancashire PR4 1RH Lead Inspector
Ms Susan Dale Unannounced Inspection 01:30 24th January & 6 February 2006
th 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 DS0000009853.V256004.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. The Old Vicarage DS0000009853.V256004.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Old Vicarage Address 15 Naze Lane Freckleton Lancashire PR4 1RH 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) 01772 635779 01772 633269 Aegis Residential Care Homes Ltd Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places The Old Vicarage DS0000009853.V256004.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Numbers of service users to include one person under the age of 65 years. 29th June 2005 Date of last inspection Brief Description of the Service: The Old Vicarage was originally an old Manor House standing in its own grounds, and is situated in the village of Freckleton close to local amenities. The home provides personal care for service users of both sexes but does not provide nursing care; any nursing advice or support is provided by district nursing staff. Advice is also sought from other health care professionals including General Practitioners, Chiropodists and Physiotherapists. All meals are provided and any special requirements catered for. The home is not purpose built however, a large extension has been added to the original building and this has been designed specifically for the requirements of older people. Service users are able to access all parts of the building and grounds via a lift and various ramps. The Old Vicarage DS0000009853.V256004.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and the focused mainly on the standards not assessed at the last inspection. The inspector was able to speak to service users, manager and staff and examine various records. A tour of the premises took place, at the time of the inspection the new extension had not been completed. What the service does well: What has improved since the last inspection?
There have been several improvements since the last inspection including a new extension in the process of being completed and several refurbishments including new carpets, lighting, and armchairs. One of the bathrooms has been turned into a ‘wet room’ and there is also an additional communal toilet. There are 7 additional bedrooms in the new extension all with en-suite facilities. A new manager has been employed who has lengthy experience in the provision of care and has an NVQ level 4 qualification and is also an NVQ Assessor. Staffing levels have been increased and staff have been recruited in readiness for the increase in numbers from 28 to 35 service users. A key worker system
The Old Vicarage DS0000009853.V256004.R01.S.doc Version 5.1 Page 6 is to be introduced. The domestic staffing hours have been increased with now 2 part time domestics covering the 7 days. All staff are now receiving one to one supervision once a month. All staff have to attend a comprehensive training programme and are due to commence NVQ training. 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 DS0000009853.V256004.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 The Old Vicarage DS0000009853.V256004.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): 1&4 Up to date written information is available about the home and the services provided. Prospective service users are assessed and able to determine whether the home will meet their requirements. EVIDENCE: The statement of purpose and service users guide was up to date and is being kept under review during the current changes. The information is kept on public display and accessible at all times. Any person who is considering whether to live at the home is able to have a trial visit and stay for a maximum of 4 weeks to sample the services provided. A full assessment is also carried out to ensure that their needs can be met by the home. The Old Vicarage DS0000009853.V256004.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): 9 & 11 Policies and procedures are in place that ensures the storage and provision of medicine meet the standard required. EVIDENCE: Several changes have been made in the provision of medication since the last inspection. The new manager has changed the chemist that previously provided the medication and they are now being provided in blister packs with all staff being trained on the new system. All prescriptions are seen and the Patient Information Leaflets that are provided with medication are kept in a file. The medication is stored appropriately and a record is kept of homely medications. A separate fridge is provided for any medication that requires to be kept cold and the fridge temperature is checked on a regular basis. Changes have been made to the recording of controlled drugs with two signatures instead of one. The manager checks the recording of medication provided once a week to ensure that there are no discrepancies. The Old Vicarage DS0000009853.V256004.R01.S.doc Version 5.1 Page 10 Key staff have commenced training via a distance-learning programme on the Safe Handling of Medication. Policies and procedures are in place in the event of the serious illness or death of a service user. Staff confirmed that they are familiar with these procedures and senior staff are due to commence training on palliative care. The Old Vicarage DS0000009853.V256004.R01.S.doc Version 5.1 Page 11 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): 15 Service users are provided with nourishing meals at regular intervals; they have a choice of menu as well as the time they wish to eat their meals. EVIDENCE: The menus seen were designed to ensure service users receive a varied and nutritional diet. According to service users spoken to and their relatives, meals are of an excellent quality and special diets, personal choice are accounted for. Staff provides assistance with meals where necessary in a discreet manner. A new dishwasher has been provided for the kitchen. At the initial assessment, any requirements or personal preferences with regard to food are recorded. Some of the service users require their food to be liquidised and some require extra nutrition to help them gain weight. A nutritionist has been contacted for advice where necessary and a record is maintained of weight. The home employs a chef and a cook; the chef was spoken with and confirmed that training included Food Hygiene and NVQ 2 and is also in the process of completing training in Care and Hotel Hospitality. The manager provides one to one supervision once a month. The Old Vicarage DS0000009853.V256004.R01.S.doc Version 5.1 Page 12 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): 17 The legal rights of service users are protected. EVIDENCE: Service users rights are not diminished, the home has a procedure that supports their right to vote and to participate in the civic process .The care plan also documents that each service user is placed on the electoral role. Information about advocacy services would be provided to service users in need of an independent person acting on their behalf. The Old Vicarage DS0000009853.V256004.R01.S.doc Version 5.1 Page 13 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): 19, 20, 21, 22 & 26 The home has been considerably improved and provides safe and comfortable accommodation for both service users and staff. EVIDENCE: There are ample washing, toilet and bathing facilities to meet the needs of the service users. Each service user has a toilet in close proximity to their personal accommodation. The new extension has 7 additional bedrooms each with an en-suite toilet and basin. One bathroom has been turned into a ‘wet room’ making it much easier for service users to have a shower and there is now an additional communal toilet. There are several lounges that allow for service users to be quiet when they do not want to watch T.V., one of the lounges is being turned into a ‘music room’ and new carpets and armchairs have been purchased. There is a large attractive dining room from which there is access to the grounds, which are to be landscaped. Lighting and furnishings are domestic in character and suitable for the range of activities and interests preferred by service users. Ceilings in the communal areas have been fitted with halogen ceiling lights and there are a number of ‘touch lights’ that are easier for the service user to use.
The Old Vicarage DS0000009853.V256004.R01.S.doc Version 5.1 Page 14 Throughout the building there are various aids and equipment that following an assessment have been provided to meet the needs of the service users. Grab rails and assisted toilets and bathing facilities are provided. One service user has a special bed and mattress to deter pressure sores. A large fresh flower display has been placed in the entrance hall. Five of the bedrooms have been refurbished in addition to the new bedrooms in the extension and they are all furnished and equipped to meet individual needs. Furniture and fittings are of a high standard and include lockable storage space for any valuables or medication. All rooms are centrally heated this can be regulated by the service user by means of a thermostatic valve. All radiators have been covered in order to provide safe surface temperatures. All hot taps are fitted with safety valves that ensure the safe delivery of hot water; a record is maintained of the water temperatures to confirm the temperature ranges between 40 and 46 degrees centigrade. The home has suitable policies and procedures for the control of infection, including what to do in the event of an outbreak of infection; protective clothing is available. The Old Vicarage DS0000009853.V256004.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): 27 & 28 The staffing levels have been increased and are sufficient to meet the needs of the current service users. Staff are in the process of receiving training that will assist them to care for vulnerable service users. EVIDENCE: There was concern at the last inspection over the number of staff that although within acceptable levels according to the number of service users, was not adequate enough for the high number of very dependable and vulnerable service users being cared for at the time. Staffing levels have been increased from 12 to 15 care staff and a number of new staff have been interviewed in readiness for the increase of service users expected once the new extension is complete. There was also concern about the amount of domestic hours and these have also been increased with 2 part time domestics covering 7 days; there is also a handyman. At the last inspection there was a recommendation that a key worker system was adopted in order to make individual staff more accountable for a named service user; this is now in the process of being established. Three care staff have an NVQ qualification and 12 more care staff are due to commence NVQ 2 training in the very near future. The new manager is qualified to provide assessment for NVQ training and this will be helpful to the staff.
The Old Vicarage DS0000009853.V256004.R01.S.doc Version 5.1 Page 16 The following training is now mandatory: First Aid; Basic Food Hygiene; Fire Safety; Infection Control; Health & Safety; Moving & Handling; Dementia Care; TOPSS; Abuse Awareness and Customer Care. Key staff are to receive medication training and all staff are encouraged and supported to continue with NVQ training to levels 3 & 4 if they wish. The Old Vicarage DS0000009853.V256004.R01.S.doc Version 5.1 Page 17 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, 32 & 36 The home is being run and managed by an experienced and qualified manager who is making changes that will benefit both service users and staff. EVIDENCE: A new manager has been employed that has yet to be registered by the Commission for Social Care Inspection. The new manager has very lengthy experience in the provision of care and an NVQ level 4 qualification and the NVQ Assessors Award. Staff spoken with confirmed that improvements were being made and they had every confidence in their new manager. The manager is supervising all staff once a month. Senior meetings are taking place once a week and there are meetings every 6 weeks for the rest of the staff. As the new manager has not been in post for very long, changes and improvements to policies and procedures are still in the process of being devised and will be looked at in more detail at the next inspection.
The Old Vicarage DS0000009853.V256004.R01.S.doc Version 5.1 Page 18 The Old Vicarage DS0000009853.V256004.R01.S.doc Version 5.1 Page 19 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 X X 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 X 3 3 3 3 X X X 3 STAFFING Standard No Score 27 3 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 X X X 3 X X The Old Vicarage DS0000009853.V256004.R01.S.doc Version 5.1 Page 20 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. 1 Standard OP31 Regulation 9 Requirement The current manager must apply to be registered with the Commission for Social Care Inspection. Timescale for action 28/02/06 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 OP28 Good Practice Recommendations Staff should continue to obtain a qualification at NVQ level 2. The Old Vicarage DS0000009853.V256004.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection North Lancashire Area Office 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
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