Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: The Old Vicarage 15 Naze Lane Freckleton Lancashire PR4 1RH The quality rating for this care home is:
two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Dale
Date: 0 4 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home
Name of care home: Address: The Old Vicarage 15 Naze Lane Freckleton Lancashire PR4 1RH 01772635779 01772633269 old.vicarage@arc-homes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Lorraine Anne Mynott Type of registration: Number of places registered: Aegis Residential Care Homes Ltd care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: 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). Date of last inspection Brief description of the care home 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 older persons 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 Care Homes for Older People
Page 4 of 28 Over 65 35 0 0 3 Brief description of the care home persons with a physical disability; the new extension includes 7 bedrooms with ensuite facilities and 2 lounges. A large patio area with seating has also been incorporated and the gardens landscaped. All parts of the building and grounds can be accessed via a lift and various ramps. Care Homes for Older People Page 5 of 28 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The site visit was unannounced and focused on key standards. The views of the people who use the service, relatives and staff at the home were taken into account. Records were examined belonging to the people living at the home and staff recruitment, training and supervision records. Surveys were sent prior to the site visit, four were returned from the people living at the home, one from a relative and six from staff. All the responses were positive and any comments have been incorporated into the report. A tour of the premises took place. The fees at the home are currently at the lowest three hundred and forty six pounds and at the highest, five hundred and sixty five pounds. The last inspection on this service took place on the 9th October 2007. Care Homes for Older People
Page 6 of 28 Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? At the initial assessment, in line with the Mental Capacity Act, a new capacity questionnaire has been developed to ensure that the home will meet the needs of the person being assessed. All staff are being trained in Palliative Care and following the principles laid down by the Gold Standards Award. This ensures that individual wishes are recognised and Preferred Priorities of Care are recorded and followed by staff. A diary is being kept of any falls as well as an Accident Form completed to look for any patterns emerging. An information box with details of individual health conditions such as Strokes, Dementia or Parkinsons Disease, is kept in the staff room for the staff to access when they wish. A new fridge has been purchased for medication and a new stand up hoist. Risk assessments are now being completed about locks on bedroom doors and individual wishes and capabilities over the use of locks. Relationships are continuing to improve with district nursing staff who attend the home daily to administer insulin. A meeting has taken place recently with the Community Care Homes for Older People Page 8 of 28 Matron over the care of one the persons living in the home. The home has won an Excellence in Food award initiated by Fylde Borough Council. Following a risk assessment, a Hydrant has been provided to some of the people living at the home. The Hydrant protects against dehydration which equally is thought to lessen the risk of falls and provide a general benefit towards good health. An advocate provided by the Independent Mental Capacity Advocacy Service (IMCA) has been sought for one of the persons living in the home. Residents forums are being held every six weeks to obtain their views and the recording of complaints has been changed to a more concise format. Staff are being encouraged to improve their report writing skills with written tests on the use of grammer. Staff are now attending Skills for Care training and a comprehensive training programme is in place with more specialised training in for example, Tissue Viability and understanding cataracts. The manager is one of the finalists in the National Care Manager of the Year Awards that takes place in London on the 13th November 2008. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Up to date information is available about the home and the services provided. A person considering living at the home can be sure that the assessment process ensures the care provided will be suitable for their needs. Evidence: The Statement of Purpose and Service User Guide have been altered in line with the change of ownership by Pearl Care; both documents provide detailed information about the services provided by the home and are available in different languages or braille if necessary. Any person considering whether to live at the home is able to have a trial visit and stay for a maximum of four weeks to sample the services provided. A full assessment is carried out to ensure that their individual needs can be met by the home. The assessment takes into account the individuals mental capacity before they are
Care Homes for Older People Page 11 of 28 Evidence: admitted. A part of the process also looks at the Deprivation of Liberty of the person concerned and their feelings about being admitted to residential care. As part of the initial assessment process any risk connected with the environment are looked at and assessed including a room risk assessment. A checklist is completed to ensure that the room is ready for the new occupant. The home does not provide Intermediate Care. Care Homes for Older People Page 12 of 28 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A plan of care is devised that all physical, emotional and health requirements and is delivered by staff in a sensitive manner that respects privacy. Evidence: The initial assessment leads to a plan of care that is recorded on a standex system and is kept under review. The standex system does not allow for very many details to be recorded and the manager has overcome this by devising some additional documents and the details have been expanded where there is a need for a more detailed care plan. The background and previous social history is now being obtained and recorded by the key worker in a Life Mapping exercise where possible to ensure a more rounded picture of the individual concerned. Signatures had been obtained for the care plan and at each review. Care plans are reviewed each month and families are involved in the review if they wish. Staff are aware of the need to promote equality and diversity and individual wishes are recognised with regard to whether a male of female carer is preferred and religious or
Care Homes for Older People Page 13 of 28 Evidence: cultural requirements are recorded and implemented. A staff member made the following comment on a survey: The service caters well for all service users regardless of their gender, ethnicity, sexual orientation and faith. Some staff have been trained in Palliative Care and the home has adopted the Gold Standard approach in order to ensure that individual wishes are recognised. A Preferred Priority of Care legally binding document is devised and kept in the bedroom of the individual concerned. Hearing aids are checked on a daily basis and spectacles are cleaned once a week. A diary is kept of any falls and an accident form is completed each time for analysis as part of a care review. Liaison has taken place with a private dentist because of the difficulties of finding a National Health Service Dentist; the cost is passed on to the people who use the private dentist. The care plans seen covered all areas and a separate record is kept for any visits by health professionals. Good liaison takes place with District Nurses who attend the home once a day for insulin injections. A record is kept of baths and showers, weight and continence. A handling plan is devised and recorded for each individual and the details are kept in the bedrooms. A staff information box has been put in place that gives details about individual illnesses that the staff can access at any time. A new fridge has been purchased for the storage of any medication. Policies and procedures are in place that ensures the storage and provision of medication meet the standard required. A record is kept of the medication provided including any controlled drugs and the details were found to be correct. The manager completed an audit once a week and there was recently an audit carried out by a pharmacist which gave an excellent report. Staff are provided with certificated medication training. It was observed that staff treated the people receiving the service with respect and their privacy and dignity was respected.
Care Homes for Older People Page 14 of 28 Evidence: There were some comments from the people being cared for in the home: I really enjoy living here and I am very happy. The staff are very nice and do a good job. A relative commented: The home is excellent and always keeps me fully informed on my mothers care. A staff member commented, Care plans are done twice a day and we do written and verbal hand overs twice a day. Care Homes for Older People Page 15 of 28 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides activities that meet the expectations and capabilities of the people living in the home and visitors are made to feel welcome at all times. The people living at the home are provided with nourishing meals that offer choice at regular intervals. Evidence: At the initial assessment a record is made of hobbies and interests and a comprehensive daily programme of activities is in place with the help of a dedicated activities co-ordinator. Activities include Tai Chi, Karaoke, biscuit making, crafts, barbecues and regular outings. There has recently been a Halloween Party and a Firework display with Hot pot. There have been trips out including one to the Tower Ballroom in Blackpool for some dancing. Some of the people who live at the home who are not able to fully participate in the activities enjoy hand massage or taken out for a walk to the pub or church. A mini bus is available and transport is provided for any person wishing to attend church; local clergy visit the home on a regular basis. Photographs are provided to relatives of any trips out and an album is kept in the
Care Homes for Older People Page 16 of 28 Evidence: entrance hall of the home featuring photographs of the persons who enjoyed the activities. Permission is sought for the people featured in the album before any photographs are taken and displayed. Each month a news letter is devised and distributed. The newsletter is available to all visitors within the home. The details include the life story of one the persons living in the home and this has been perceived as a very positive. One of the persons living within the home is a poet and she has been able to make contributions to the newsletter. Visitors are made very welcome and a relative made the following comment: I came, often unannounced and she was always cared for and content. This meant a great deal to me because I could see that she was happier than before she came to the home. Meals are provided within a very attractive dining room; the meals provided offer a choice of menu and cater for special diets. A nutritionist has been contacted as necessary for advice and a record is kept of individual weight gain or loss. The home has won an award from Fylde Borough Council called Food for Life for its standard of excellence. Some of the persons living in the home have been provided with a Hydrant that provides drinking water at any time; its use is thought to improve the levels of hydration and thereby lessen falls and lower the risk of dehydration. A drinks machine is available within the lounge and jugs of water and juice are available at all times. Care Homes for Older People Page 17 of 28 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The policies, procedures and training of staff ensure that the people living in the home are protected from harm. Any complaints and concerns are recognised and acted upon to ensure that a good standard of care is maintained. Evidence: Complaints/concerns are recognised and acted upon. There is a new format for recording complaints which is more concise and allows for easier tracking of any concern raised. Verbal concerns are also recorded and the manager and residents forums are held every 6 weeks where any concerns can be raised. Staff are expected to conform to the Code of Conduct issued by the General Social Care Council and their expected level of performance is always discussed at induction. Any allegation that may have to be considered under Safeguarding Procedures have been correctly reported to the Local Authority and the Commission. All staff have been provided with training on how to recognise Adult Abuse and the reporting procedures; the training is updated once a year. There was evidence that new staff are checked on the Protection of Vulnerable Adults (POVA) Register prior to commencement at the home. Care Homes for Older People Page 18 of 28 Evidence: Policies and procedures are in place with regard to the financial affairs of the people living in the home with up to date records being kept. The manager has also made use of the advocacy service where necessary including a representative from IMCA the Independent Mental Capacity Advocacy. Care Homes for Older People Page 19 of 28 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides luxurious, safe accommodation for both the people living in the home and staff. Evidence: The home provides luxurious accommodation since it was extended and refurbished with attractive communal rooms as well as individual bedrooms. The corridors are wide and spacious and make easy access for wheelchair users. Some of the rooms have patio doors that open onto the gardens. The large communal lounge has a kitchen area for use by staff and the people living in the home able to make a drink or snack. There is easy access to the patio and gardens where there is a Gazebo to provide cover in inclement weather; currently consideration is being given to purchasing a water feature. Risk assessments are now being undertaken over locks on bedroom doors following some concerns by relatives; all bedroom doors can be opened from the inside and staff hold keys. Care Homes for Older People Page 20 of 28 Evidence: A new stand up hoist has been purchased and one of the rooms has been fitted with a nursing bed for a particular individual. A tour of the home took place and all parts of the home were found to be warm, clean and sweet smelling. Care Homes for Older People Page 21 of 28 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels are sufficient to meet the needs of the current people living in the home. Staff are recruited appropriately and receive training that protects the health and safety of the people being provided with care. Evidence: There were sufficient staff on duty at the time of the site visit and the surveys received indicated that there are sufficient staff on duty at all times. There are currently 24 care staff and 7 staff have a National Vocational qualification (NVQ) in Care at level 2 or above. Ten staff are in the process of completing their Skills for Care training. The registered manager is an NVQ Assessor and also an Internal Verifier for NVQ. A mandatory training programme is in place that includes, First Aid, Food Hygiene, Fire Safety, Infection Control, Health and Safety, Moving and Handling, Dementia Care, Abuse Awareness, Customer Care, Choice Dignity and Diversity and Medication. More specialised training is to be provided in, Care of the Dying, Dementia, Diabetes, Promotion of Continence and Tissue Viability. Care Homes for Older People Page 22 of 28 Evidence: There was evidence of training certificates on the staff files examined also evidence that staff understand the homes policies and procedures. Training has also been provided in report writing to ensure that any written record can be understood. Staff comments include: Training is given every few months on all mandatory training. I was given a handbook and explained my job right at the beginning of my employment. Supervision, appraisals we have on a regular basis. Staff had been recruited appropriately with suitable checks undertaken with the Criminal Records Bureau (CRB) and the Protection of Vulnerable Adults (POVA) Register. Care Homes for Older People Page 23 of 28 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who are provided with a service are led, protected and cared for by a manager who is qualified and experienced in care and the management of staff. Evidence: The registered manager has undertaken various courses to assist her in the management of the home and continues to undertake new training. Currently the manager is a finalist for the National Care Managers Award which takes place in London on the 13th November 2008. Qualifications already obtained include the Registered Managers Award, NVQ 4 and NVQ 5 in Care and Management, NVQ assessor and NVQ Internal Verifier and Moving and Handling Trainer. The manager is also about to undertake a new training course called Prepare to Teach in the Lifelong Learning Sector (PTLLS) in order to continue training the staff in the future. Care Homes for Older People Page 24 of 28 Evidence: There is constant striving to improve standards within the home and the manager has made a very positive contribution to raising standards. Staff confirmed that the manager is approachable and supportive and a team approach is taken at all times. All staff are taught to record any care provided in detail and the importance of maintaining all records such weight , baths and activities. There was evidence that all staff are provided with training in Health and Safety and risk assessments are carried out on all working practices. Staff meetings take place every 6 weeks with a separate meeting for senior staff and one to one supervisory are held with all staff. Annual surveys are sent out to families and the results are analysed and the manager draws up an action plan. The home has Investors in People Award. Regular audits are carried out in the home including a Quality Assurance Audit and a medication audit. The Area manager undertakes regular visits to the home to ensure standards are being met and the information is fed back to the Commission for Social Care Inspection. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations
These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - 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!
