CARE HOMES FOR OLDER PEOPLE
The Old Vicarage 15 Naze Lane Freckleton Lancashire PR4 1RH Lead Inspector
Ms Susan Dale Unannounced Inspection 27th June 2006 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Old Vicarage DS0000009853.V295893.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Old Vicarage DS0000009853.V295893.R01.S.doc Version 5.2 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 Lorraine Anne Mynott Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35), Physical disability (3) of places The Old Vicarage DS0000009853.V295893.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 35 service users. Within this number up to 35 service users can be in the category of Older People (OP) and a maximum of three service users in the category of Physical Disability (PD). 24th January 2006 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 or persons with a physical disability; the new extension includes 7 bedrooms with en-suite facilities and 2 lounges. A new large patio area with seating has also been incorporated and the gardens landscaped. Service users are able to access all parts of the building and grounds via a lift and various ramps. The Old Vicarage DS0000009853.V295893.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and the focused mainly on key standards. The inspector was able to speak to service users and staff and examine various records. Comment cards were provided to service users, relatives/friends and health professionals prior to the inspection. 14 comment cards were returned from service users and 1 from a general practitioner, the comments were taken into account as part of the inspection. A tour of the premises took place. What the service does well: What has improved since the last inspection?
Since the last inspection the new manager has been registered with the Commission for Social Care Inspection. The new extension has been completed and there have been 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
The Old Vicarage DS0000009853.V295893.R01.S.doc Version 5.2 Page 6 with en-suite facilities and 2 lounges, 1 is very large and another smaller with a computer for use by service users. All the rooms are located off the sides of a wide corridor; all doorways are extra wide and suitable for wheelchair users. All areas are decorated to a high standard and the effect is bright and cheerful. There is now a new patio area that can be accessed by all service users and the gardens have been landscaped. There is a new reception area with seating and the office is located close by. There is now a staff room and a dedicated medication and sluice room. One of the original lounges has become a music room. Staffing levels have been increased and a key worker system has been introduced. At the initial assessment service users are asked about hobbies and interests and a comprehensive daily programme of activities is now in place with a dedicated activities co-ordinator. All activities and news are displayed on the notice board and a newsletter is produced once a month. Staff are now being encouraged to undertake an NVQ qualification and one to one supervision is being provided. All staff have to undertake a mandatory training programme. 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.V295893.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Old Vicarage DS0000009853.V295893.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome group was good. Information is available about the home and services provided. Service users are assessed in way that ensures the home is suitable for them and can meet their needs. 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 in the entrance hall of the home and is 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. A new pro-forma for recording the initial assessment is now being used. As part of the initial assessment process, risk assessment are carried out including a ‘room’ risk assessment and a check list is completed to ensure that the room is ready for the new occupant.
The Old Vicarage DS0000009853.V295893.R01.S.doc Version 5.2 Page 9 Several service users and a relative were spoken to about their experience of being newly admitted to the home and they all indicated that it had been a positive experience. The home does not provide intermediate care. The Old Vicarage DS0000009853.V295893.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome group was good. A plan of care is devised that meets all physical, emotional and health requirements and is delivered by staff in a sensitive manner that respects service users’ privacy. EVIDENCE: The initial assessment leads to a plan of care that is recorded on a standex system and is kept under review. The pro-forma used for recording care plans etc., is comprehensive but very prescriptive and does not allow much room in the boxes for any detail. The small print is also not user friendly for a person with sight difficulties. The care plans seen covered all areas and a separate record is kept for any visits by health professionals. The records seen were up to date and reviewed appropriately; a signature has been obtained from the service users to show they had been involved in the process. Management and staff are liaising with GP’s and District Nurses over the care of service users and the manager has asked the nurses if they would be willing to provide some training to staff on catheter care.
The Old Vicarage DS0000009853.V295893.R01.S.doc Version 5.2 Page 11 Policies and procedures are in place that ensures the storage and provision of medicine meet the standard required. Medication is stored in an appropriate purpose built trolley that can be secured to the wall. A record is kept of the medication provided and oversight to ensure the details are correctly recorded is provided by the manager. Controlled drugs are suitably stored in a separate area and a record is maintained. Currently eight staff are trained to provide medication. Service users and relatives spoken with and comments from questionnaires provided prior to the inspection indicate that staff treat service users with respect and their dignity and privacy is respected. The Old Vicarage DS0000009853.V295893.R01.S.doc Version 5.2 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): 12, 13, 14 & 15 Quality in this outcome group was good. The home provides activities that meet the expectations and capabilities of the service users and visitors to the home are made to feel welcome at all times. Service users are provided with nourishing meals that offer choice at regular intervals. EVIDENCE: At the initial assessment service users are asked about hobbies and interests and a comprehensive daily programme of activities is now in place with a dedicated activities co-ordinator. Activities include Thi Chi, exercise, karaoke, biscuit making, crafts, barbecues and cinema once a month. A coffee morning is to be held on the 11th July at the home and service users also attend coffee mornings at St Pauls Church. One of the lounges has been dedicated to the playing of music and another lounge has been fitted with a computer. All activities and news are displayed on the notice board and a newsletter is produced once a month. At the initial assessment a record is kept of service users wishes with regard to food and any requirements are recorded on the care plan. 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. A comment was made by a service user about the fact that it would be nice to have a diabetic alternative
The Old Vicarage DS0000009853.V295893.R01.S.doc Version 5.2 Page 13 when service users are provided with treats and this was discussed with the manager. The dining room is now used solely for the provision of meals, as before the extension the dining room was also a lounge. At the time of the inspection the home was experiencing some problems with the electrical supply and the dining room was out of action. The dining room was also in the process of being decorated. The Old Vicarage DS0000009853.V295893.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome group was good. Policies and procedures are in place to ensure that service users are protected from abuse and any complaints/concerns are recognised and acted upon. EVIDENCE: Policies and procedures are in place to ensure that service users are protected from abuse and any complaints/concerns are recognised and acted upon. There have been no complaints made to the home and only one received by the Commission for Social Care Inspection that was found to be unsubstantiated. Policies and procedures on Adult Abuse and Whistle Blowing are in place in line with Department of Health Guidance, `No Secrets’. Staff are expected to conform with the Code of Conduct issued by the General Social Care Council and their expected level of performance is always discussed at induction. At induction a form has to be signed by all new staff instructing them to not to accept gift from service users or be instrumental in assisting with the drawing up of wills. Staff spoken to were aware of issues regarding the abuse of vulnerable adults and had received some training on the subject. The Old Vicarage DS0000009853.V295893.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome group was good. The home has been improved and extended providing safe and comfortable accommodation for both service users and staff. EVIDENCE: Since the last inspection a large extension has been completed that provides an additional 7 bedrooms with en-suite facilities, a large lounge and a smaller lounge and an extra bathroom. The new extension provides good facilities for any one in a wheelchair as the corridor and all the doorways are very wide. Service users and a relative spoken with appreciated the new bedrooms with their bright pleasant aspect. A comment was raised by a service user that there were no call alarms within the new lounge; the inspector was able to establish that there was a call alarm on one wall. The inspector discussed the merits of having a portable call alarm available; the manager said that a member of staff was always present in the lounge.
The Old Vicarage DS0000009853.V295893.R01.S.doc Version 5.2 Page 16 As well as the above there is a new patio area that can be accessed by all service users, the gardens have been landscaped. The office is now close to the entrance hall with a staff room created out of the old office. There is also a new sluice room and a dedicated room for medication storage. As previously mentioned the home was experiencing problems with the electrical supply on the day of the site visit and some parts of the home were inaccessible. Generally the home was clean, warm and there were no unpleasant smells. The Old Vicarage DS0000009853.V295893.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome group was good. The staffing levels have been increased and are sufficient to meet the needs of the current service users. Staff receive training that assists them to care for vulnerable service users. EVIDENCE: The number of staff has risen in order to accommodate the increase of service users and the staffing rota ensures that there are sufficient staff on duty at all times. There are now 23 care staff and 6 ancillary staff; 5 staff have an NVQ qualification in Care and a further 9 staff are in the process of obtaining an NVQ qualification. The registered manager has recently qualified to assess staff on moving and handling. A mandatory training programme that all staff have to complete as well as NVQ includes: First Aid, Food Hygiene, Fire Safety, Infection Control, Health & Safety, Moving & Handling, Dementia Care, TOPSS, Abuse Awareness, Customer Care, and Medication Training. Staff had been recruited appropriately with suitable checks undertaken with the Criminal Records Bureau. Some recommendations were made about how the pro-forma for the recruitment of staff could be improved. The Old Vicarage DS0000009853.V295893.R01.S.doc Version 5.2 Page 18 New staff spoken with confirmed that they have been provided with an induction and were working alongside more experienced staff until familiar with all the service users and procedures. A key worker staff system of working is now in operation. The Old Vicarage DS0000009853.V295893.R01.S.doc Version 5.2 Page 19 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, 33, 35 & 38 Quality in this outcome group was good. The service users and staff are led, protected and cared for by a manager who has lengthy experience in care and the management of staff. EVIDENCE: The current manager has recently been registered by the Commission for Social Care Inspection having had lengthy experience in the provision of care. Evidence is to be provided of an appropriate management qualification at the first opportunity to the Commission. The manager has made numerous improvements to the home since commencement and has strengthened the existing policies and procedures. All staff are now receiving one to one individual supervision and staff meetings take place on a regular basis. Service users all hold regular meetings and the manager intends to invite relatives to the next meeting.
The Old Vicarage DS0000009853.V295893.R01.S.doc Version 5.2 Page 20 Staff and service users expressed their satisfaction with the current manager and the support they received. The area manager for Aegis Residential Care Homes Ltd supports the manager. Regular Audits are carried out within the home including a Quality Assurance Audit and a Medication Audit. The area manager undertakes regular visits to the home to ensure that standards are being met and the information is fed back to the Commission for Social Care Inspection. Staff confirmed that basic training in all aspects of health and safety is provided and was evidenced through induction documentation. Risk assessments are carried out on all safe working practices. The Old Vicarage DS0000009853.V295893.R01.S.doc Version 5.2 Page 21 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Old Vicarage DS0000009853.V295893.R01.S.doc Version 5.2 Page 22 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 OP28 Good Practice Recommendations Staff should continue to obtain a qualification at NVQ level 2. The Old Vicarage DS0000009853.V295893.R01.S.doc Version 5.2 Page 23 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
© 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 DS0000009853.V295893.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!
