CARE HOMES FOR OLDER PEOPLE
The Old Vicarage Weekly Village Kettering Northants NN16 9UP Lead Inspector
Fiona Stephenson Unannounced Inspection 30th January 2006 10:45 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 DS0000062531.V280027.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 DS0000062531.V280027.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Old Vicarage Address Weekly Village Kettering Northants NN16 9UP 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) 01536 484378 01536 485168 admin@theoldvic.co.uk Royal Bay Care Homes Jill Catherine Lambert Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38) of places The Old Vicarage DS0000062531.V280027.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. No one falling within the category of OP may be admitted into the home for nursing care where there are 38 persons in the category of OP already accommodated within the home with nursing needs. No one falling within the category of OP may be admitted into the home for personal care where there are 38 service users accommodated in the home No person under the age of 65 years of age may be admitted to the home. No service user requiring nursing care may be accommodated in the rooms 2a, 7 and 10 on the first floor 15th June 2005 Date of last inspection Brief Description of the Service: The Old Vicarage care home is situated in the village of Weekley, close to Kettering in Northamptonshire. The building is a listed building that has been adapted to meet the needs of the nursing and residential clients living there in. The home has both single and shared bedroom accommodation with all rooms having en-suite facilities. There is a variety of communal rooms for residents’ use, and a well tended, pleasant garden and patio area for use when the weather permits. The Old Vicarage DS0000062531.V280027.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection commencing at 10:45am and finishing at 3.45pm. It was the second statutory inspection for the home for the year 2005-2006, and as such the inspector focused on the care standards not covered in the previous inspection, and checked the actions required from the home as a consequence of the previous inspection. To support the inspection process the inspector ‘case tracked’ four residents living at the home. This means that the residents were spoken with, as well as staff involved in their care; their care records were checked, and staff records checked; and the areas of the home they used were also checked. What the service does well: What has improved since the last inspection?
Care plan records and pre-admission assessments have improved since the last inspection, with records providing accurate information about care being provided, and demonstrating involvement with the resident themselves, and where appropriate, their relatives. The provision of activities has improved, with an activities co-ordinator attending the home for 2.5 days per week. Residents also have the opportunity to attend yoga on a fortnightly basis, and a ‘yesteryear’ quiz once a month. An external company also comes into the home on a regular basis to provide activities such as singing and exercises to residents who wish to participate. The Old Vicarage DS0000062531.V280027.R01.S.doc Version 5.1 Page 6 Records relating to pressure ulcers have been up-dated and the manager has instigated a file with good practice information about the care of pressure ulcers. The provision of specialist equipment and staff training has improved. The equipment has had a positive impact on the care of residents, and staff have benefited from the training provided as this has improved their understanding of issues relating to care and health and safety. Good attention has been given to dietary needs. The cook and care staff have worked together in identifying, and implementing ways in which the vitamin and calorie intake of residents can be improved. 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 DS0000062531.V280027.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 DS0000062531.V280027.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): Not checked on this occasion. EVIDENCE: The Old Vicarage DS0000062531.V280027.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): 7,8,10. Residents’ are treated with respect, and their needs are well supported. EVIDENCE: The inspector checked the care files of the resident’s case tracked and found them to be in good order with documentation supporting the care required for each resident. On one occasion, changes to care, although recorded in the care notes, was insufficiently detailed – for example, the care plan documented that the resident now needed assistance with bathing – but didn’t make clear what type of assistance was required. The inspector noticed residents being treated with respect in the way that staff spoke with them, and noted that doors were knocked before staff went into resident’s bedrooms. The Old Vicarage DS0000062531.V280027.R01.S.doc Version 5.1 Page 10 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 Resident’s life style at the home satisfies their expectations and preferences. EVIDENCE: The inspector noted that there was now an improved social programme for those residents wishing to participate in social activities, although not all residents wished to become involved in social events. All residents spoken with at the home were very happy with the care they received from staff and with living at the home in general. The inspector observed that residents chose whether to stay in their rooms, and if they wished to go into communal areas, they also chose which areas to sit. Residents chose whether to have their dinner in the communal areas or whether to have meals in their own rooms. The inspector also observed that some residents had chosen to stay in bed. During the inspection the inspector talked to the cook and observed some of the meal preparation and was impressed with the quality of food on offer to residents. Residents themselves also informed the inspector of their satisfaction with the menus provided to them. The Old Vicarage DS0000062531.V280027.R01.S.doc Version 5.1 Page 11 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. Complaints are listened to, taken seriously and acted upon. Satisfactory measures are in place to protect residents from abuse, although these could be improved. EVIDENCE: Residents informed the inspector that if they were not happy with any aspect of the home, they could talk to staff and it would be sorted out. The inspector checked the complaints log in the home and found that formal complaints had been taken seriously and acted upon well. Staff have information about what constitutes ‘elder abuse’ in the policies and procedures file, however it is not clearly set out in the induction process, and not clearly linked to the Protection of Vulnerable Adults (POVA) procedures. The inspector was not clear that the POVA procedures in the file were the most recent ones. The Old Vicarage DS0000062531.V280027.R01.S.doc Version 5.1 Page 12 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): 19,20,21,22,23,24,25,26. Residents live in a safe, and well-maintained environment. EVIDENCE: The inspector checked the communal areas, kitchen, bathrooms, and the bedrooms of residents who were case tracked. All were found to be in a very clean and tidy condition. Although the building is listed, sufficient provision has been made to ensure that the home has suitable adaptations to support residents moving around the home. The inspector noted that residents case tracked, had use of specialist equipment to ensure their comfort and where possible to maximise their independence. Bedrooms reflected the personalities of those residing in them, having their own possessions in them. The back garden is well tended and very pleasant to look out on in the winter. Staff informed the inspector that residents enjoy using it in the warmer weather, and tea parties are held there in the summer. The Old Vicarage DS0000062531.V280027.R01.S.doc Version 5.1 Page 13 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 The needs of residents are met well by the number and skill mix of staff. EVIDENCE: The inspector checked the staffing levels and found them to be sufficient to meet the needs of residents living at the home. Care staff are supported by sufficient numbers of domestic staff that undertake the cleaning and laundry duties of the home. Residents informed the inspector that they felt there was always enough staff on duty to support their needs when required. Staff informed the inspector that opportunities for training had increased over the last year, and the training file, which showed that staff had undertaken good training in relation to care, and health and safety issues, evidenced this further. The home now has 40 of non-nursing staff that are trained to National Vocational Qualification Level 2 in Care. There are sufficient nursing staff on duty to support the nursing needs of residents living in the home requiring nursing care. The inspector noted that Criminal Records Bureau disclosure had been received for all staff, and checked other staff records and found them to comply with regulatory requirements. The application form requests candidates to say whether they are married, divorced, or single; and the inspector was not clear as to why this information was useful in determining a persons capacity to undertake a job. The Old Vicarage DS0000062531.V280027.R01.S.doc Version 5.1 Page 14 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): 32,33,38. The home has recently experienced a change of manager, however this has had no detrimental impact on the care received by residents. EVIDENCE: The current registered manager has recently left the home, and a new manager has been appointed and is awaiting her ‘fit person’ interview by the CSCI. The new manager and her deputies demonstrated good understanding of their responsibilities and were observed as having good rapport with residents and staff. The Old Vicarage DS0000062531.V280027.R01.S.doc Version 5.1 Page 15 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 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 4 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 X 3 3 X X X x 3 The Old Vicarage DS0000062531.V280027.R01.S.doc Version 5.1 Page 16 None 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 3 Refer to Standard OP29 OP7 OP18 Good Practice Recommendations Consider the appropriateness of requesting a person’s marital status on the job application form. Improve recording of changes to care plans to ensure that the changes are recorded in sufficient detail to make it clear to staff what the new instructions entail. Improve staff induction training to include Protection of Vulnerable Adults procedures and whistle blowing procedures. Ensure the POVA procedures in the staff policy file is the most recent document, and link this more effectively with the other information about elder abuse held in the file. Consider implementing a ‘medication care plan’ to support care staff in their knowledge and understanding of the medication prescribed to each resident, and the reasons for it prescription. 4 OP7 The Old Vicarage DS0000062531.V280027.R01.S.doc Version 5.1 Page 17 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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