Inspection on 06/09/07 for The Old Vicarage

This inspection was carried out on 6th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Old Vicarage 11/02/09

The Old Vicarage 12/02/08

The Old Vicarage 20/02/07

The Old Vicarage 05/06/06

The Old Vicarage 18/10/05

The Old Vicarage 26/10/04

The Old Vicarage 11/05/04

The Old Vicarage 25/11/03

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Old Vicarage Warren Road Hopton On Sea Great Yarmouth Norfolk NR31 9BN Lead Inspector Mrs Judith Last Unannounced Inspection 6th September 2007 11:50 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 DS0000027487.V351821.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 DS0000027487.V351821.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Vicarage Address Warren Road Hopton On Sea Great Yarmouth Norfolk NR31 9BN 01502 731786 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) Estateband Limited Mrs Jill Chaplin Care Home 20 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (20) of places The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Twenty (20) older people of either sex may be accommodated. Two (2) older people who have dementia and are named in the Commission’s records may be accommodated. The total number of people accommodated shall not exceed twenty (20). 20th February 2007 Date of last inspection Brief Description of the Service: The Old Vicarage is a two storey detached Georgian house that provides residential care and accommodation for up to twenty older people. The home stands in its own grounds of approximately two acres, there is parking to the front of the home and the gardens are mainly laid to lawn and are accessible by wheelchair from the main front door. People living at the home have the use of a passenger lift to the first floor and communal use of three lounges, a dining room, two bathrooms containing adapted bath, washbasin and toilet on each floor, two toilets on the ground floor and one toilet upstairs. There are nineteen single and one double bedroom. The home is situated in the village of Hopton-on-sea, between the coastal towns of Great Yarmouth and Lowestoft and is surrounded by caravans and sited in the centre of a holiday caravan village that is densely populated at certain times of the year. There are local amenities and the beach within walking distance of the home and a public transport service that provides a link to the main towns. The manager and a director told us that the fees are from £338 to £370 per week, with additional charges for private chiropody, hairdressing, newspapers or personal spending. There is an additional charge for some outings. The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups that look at how well a provider delivers outcomes for people using the service. We have rules to follow to help with this, which people can see on the Internet. We made two unannounced visits to the home, and spent thirteen and a half hours there. We got information from written comments from 7 people living at the home and from three relatives. We spoke to four people living at the home and six relatives. Where appropriate, their comments are included in the report. We also spoke with the manager and one staff member as well as looking at and listening to the things that were going on in the home. We got other information from the records the home keeps and from the selfassessment of the home sent to us by the manager. We take into account what has been happening at the home since we last visited. Although some things have improved and the manager has been working hard, overall, the home continues to deliver a poor service. This is primarily because of concerns about how people’s health care needs are being met, particularly about the way medication is managed. Some enforcement action has been taken about this and further action is actively being considered. What the service does well: There has been investment in decorating and carpeting the home and rooms that have been empty have been refurbished. This means that it looks a more pleasant and better kept environment for people to live in. The manager has clearly worked hard to prioritise work in this area and been supported by maintenance staff and cleaning staff to improve things. The home is generally kept clean. People like the food that is on offer, and say that they get a choice. When people need help from staff to eat their food they are given this. This chef now in post has increased the use of fresh vegetables. The home has recently been given five stars for good food hygiene practices by the district council’s Environmental Health Department. The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 6 People or their relatives say they know how to complain about the service if they need to. Staff have a good understanding of the basic care needs of people living at the home. What has improved since the last inspection? What they could do better: There are 17 things that need to happen to comply with the law and to improve the service. The list below does not represent each individual requirement. The information that follows is a summary and the manager can supply a full list of requirements in the report. The guide for service users has not been updated since 2005. It needs to be revised so that it contains all the information set out in revised regulations, particularly about fees. This is so people or their representatives have all the information they need to help make a decision about whether they wish to use the home or not. Assessments need to be completed accurately and kept up to date if needs change or are found to conflict with information obtained previously. Care plans cannot be set up properly with detailed information about how people’s needs are to be met, if underpinning assessments are not right. Residents and their representatives need to be involved in routine reviews. The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 7 There remain serious concerns about the management of medicines. This includes failing to give people the medication that has been prescribed and failing to keep accurate records of what has been received or given. People cannot be confident that they will receive the treatment they need at the time that they need it. This area has presented serious concerns since May 2006 and specialist pharmacy inspections have taken place four times, in addition to the check as part of this inspection. We are actively considering further legal action because of concerns for the welfare and safety of people living at the home and the failure of the home to improve this area sufficiently to lessen those concerns. Although activities have improved as have records to do with these, the records are not routinely incorporated into individual notes so that keyworkers and the manager can monitor whether everyone living at the home is receiving the social and recreational stimulation and support that they need. The manager needs to consider how she will develop this area further. Staff need to improve their performance in relation to the dignity of service users. Although this has been considered as promoted at previous inspections, concerns have been expressed about the way staff speak to people living at the home and responses around requests for help. The way people perceive how staff respond is important, even if staff have not intended to be abrupt or offhand. The owners of the home are not adequately supporting and funding staff training. People doing National Vocational Qualifications have been able to access funding from other sources and so work towards these. However, it is unacceptable that staff have had to fund, (whether wholly or in part), other training they need to be able to understand and meet people’s needs competently and safely. Staff are also not receiving proper supervision to support them in their roles (although there is some practical overseeing of tasks). Although the manager has surveyed some of the “stakeholders” in the service for their views, (for example, staff, relatives and some residents), she has yet to analyse the results and include them in an overall audit and plan for improving the standard of service at the home. The people who run the home are also not monitoring the service sufficiently regularly and supplying reports on service quality to the Commission. The manager needs to ensure that the records the law says must be kept are maintained and that these are all up to date and accurate. 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 summary of this inspection report can The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 8 be made available in other formats on request. The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 9 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 DS0000027487.V351821.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This represents a decline in this area of the home’s performance. People who may use the service and their representatives are not provided with all the information needed to choose a home and set out in law. More attention is needed to the accuracy and consistency of assessments so people can be sure their needs have been properly and assessed otherwise they cannot be sure they would be wholly met. The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 11 EVIDENCE: The Service User Guide available in people’s rooms and made available to prospective service users is dated 2005. All of the 7 people living at the home and completing written comments say that they received enough information to enable them to decide whether it was appropriate. However, one person completing written comments says they do not have a contract or statement of terms and conditions, and one relative for another person says the person they visit does not have one either. The Service User Guide does not contain the information required following a change in the Care Homes Regulations 2001, made in 2006, particularly in relation to fees. More transparency is needed to make sure people are clear about charges and arrangements for these to be revised. A requirement has been made. Files for two people recently admitted were checked. These contained information about a variety of needs as set out in standards. However, the information on the home’s paperwork was not wholly consistent with information from other sources including other professionals. For example, information about one person’s mobility was not consistent with information from the placing authority that indicated the person had deteriorating mobility and a medical condition that affected this. However, we were pleased to note that the home had completed a risk assessment that did recognise mobility difficulties and problems with balance. The file for another person, admitted some time ago, showed that the initial assessment was inaccurate and yet it had not been reviewed. A requirement has been made. There has been some work to develop life histories for people so that staff can understand and relate to them when they are using the service. This is good practice. The service does not offer rehabilitation facilities. Key standard 6 is not therefore applicable. The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There remain serious failings in the management of medicines. This currently fails to both protect service users and to ensure they receive treatment as prescribed. This is an ongoing concern and represents a failure to improve this area of the service sufficiently. There is some concern that people are not fully involved in planning and updating their care needs. Also, that they are not treated at all times with the dignity and respect to which they are entitled. These areas represent a decline in the performance of the service. EVIDENCE: Given inconsistencies in the assessment process and the failure to update inaccurate assessments conducted for people who have been at the home for some years, health and personal care needs cannot be wholly seen as met. However, staff spoken to had a general understanding of the support people need. The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 13 The way care plans set out the detail of how personal and health care needs are to be met can be improved. For example, one person has information supplied by the placing authority indicated that the service would “need to manage diet and food intake” and there is an underlying condition relating to this. However, there is no clear guidance for staff to follow in the plan the home has generated. However, although care plans might not clearly set out how needs are to be met - where this issue is identified as of concern - daily records show that both fluid and diet is monitored for some people with separate fluid intake charts where appropriate. 6 of the 7 people completing comment cards say they always receive the care and support from staff that they need (86 ). One says they receive this “sometimes”. People spoken to say that staff help them with things they find difficult. There are risk assessments setting out where people need additional support with their mobility due to both real risks and a lack of confidence on the part of people who may have fallen in the past. This is good practice. Service users sign some records where they are able, which is good practice. However, relatives and residents were not able to confirm they are involved in regular updates of care plans between formal reviews with social workers. One person said they had not been consulted since the initial assessment some years ago. A requirement has been made. People’s weights are inconsistently recorded. For one person the need to monitor this is noted because of poor nutrition at the point of admission and pressure area problems. Staff are aware of the need to monitor skin condition and what they should be looking for. However, the person was in residence for four weeks before any weight was recorded in order for the person’s condition and progress to be properly monitored. Not all records are signed to show who is accountable for their completion. Daily records contain some gaps where entries have been missed and staff have left space for them to be completed retrospectively, or where they have left lines between consecutive entries. This is poor recording practice. A recommendation has been made. However, there are some detailed records of what support people have had at night, including when they have used their call bells for assistance and what with. This shows support to be provided flexibly in terms of times for going to bed, getting up, using the toilet, and having drinks etc through the night time. We were able to see from this that one person received assistance at night that a relative was unsure was available. The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 14 Only 4 of 7 people (57 ) writing to us feel they always get the medical support they need. One relative responding in writing says, in response to the question about what the home does well, that they can’t think of anything the home does well and adds that care is adequate. They recognise the communication has improved. The manager was not able to demonstrate the home had complied with previous requirements made by the pharmacist inspector including a statutory requirement notice or following interviews under caution. Although improvements had been noted over time these had not resolved the issues and the same difficulties resurfaced at this inspection. The medication administration record (MAR) charts we saw had only been in use since 3rd September. We first visited on the 6th. Medication has been out of stock for two people at the start of the cycle – one was without the prescribed treatment for three days. One person did not have medication as prescribed given for one teatime dose, although the medication was available. This meant that they had only half of the drug prescribed. The same person had medication signed for administration on a date when they were not living at the home. Records of administration or refusal are not accurate. One person had two entries for the same medication on the chart. Both had been signed by staff, one correctly for alternate days as prescribed and the other signed every day, even though the medication was neither available nor prescribed for every day. The MAR chart for one person recorded three doses of medication had been given, and one refused (Thursday). The monitored dosage system contained medication for both Tuesday and Thursday, indicating it had not been given on the Tuesday despite the record of administration being signed. There was no record of receipt of one medication. There was one entry in the register for controlled drugs that had been made in pencil. The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 15 Requirements about medication have been made previously, and some of the same problems were noted at this inspection, meaning that the home has remains in breach of regulations. The requirements in this report represent simplified and repeated requirements that have been outstanding for between one and four previous specialist pharmacy inspections taking place over the last 15 months or so. See outstanding requirements. The home has previously had a good record with regard to the standard for treating people with dignity. However, information came to light during the inspection that this may not always be the case in that staff had been heard raising their voices at someone with mobility difficulties and using an inappropriate nickname for another service user. A similar concern about residents being spoken to inappropriately was raised in February 2006. After our visit we received information from a social worker that one person had complained of verbal aggression from staff and rough handling. One person commented that people were not always assisted to use the toilet when they requested and that this caused some distress. A visitor had overheard staff commenting that a person who had buzzed did not really need the toilet. One person confirmed not being assisted to the toilet as and when requested. The person’s care plan makes clear that they know when they need to use the toilet and will ask. They are also prescribed diuretic tablets, which mean the person may need to go to the toilet more often or with increased urgency. Staff are expected to assist according to instructions listed in the care plan. A requirement has been made. The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use services can make some choices about their life style. Although improved, the service cannot yet show that social, cultural and recreational activities meet the expectations and needs of each person. EVIDENCE: One relative commented that activities seemed to have improved recently, with sessions like bingo or people doing puzzles. We did see records showing that some people had been involved in a cooking session, making flapjacks and cookies. Some people had been on an outing to the Time and Tide Museum. Five people living at the home, who sent us written comments, say that there are always activities they can join in (71 ) and we saw one session of bingo and one of cards during each of the two afternoons we were present for. One person feels there are usually activities they can take part in and one says sometimes. The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 17 Three relatives sending us comments said that there could be more activities and more stimulation for people living at the home – one commented that this was the worst thing about the home. The manager recognises this area could improve, in her self-assessment of the service. There has been some improvement – recognised by a relative we spoke to, and showing in records, although there is room to develop this further. A requirement has been made. Notes and observation show that people who have relatives willing and able to visit, receive regular visits. People who visited the home and who we spoke to told us that they were welcomed in the home and did not need to make appointments. We saw that some people received visitors in one of the lounges, and that other people received visitors in their own rooms. One person’s file we saw, recorded that they did not want to see one particular person and that staff were to respect this. The Manager, staff and residents confirmed that they were able to bring in personal possessions, and some have brought small pets. One relative said that a person managed their own money and kept small amounts in their room to cover personal expenditures. The manager has introduced tea and coffee making facilities in lounges with thermal jugs for hot water. She says they are refilled regularly to make sure people can make a decent drink. This is a welcome facility. However, feedback from relatives suggests that sometimes refilling the jugs is overlooked. They did tell us care or catering staff will make drinks on request. People spoken to say that they like the food on offer, and 5 out of 7 people submitting written comments say they like the food (71 ). One person said in written comments that there was a good choice with regular changes and that they would always accommodate the person’s choice if they wanted something different. One person told us they like to have a cooked breakfast and this is provided. We spoke to a member of the catering staff who confirms that use is made of fresh vegetables and we saw that fresh fruit was available in the dining room on each of the two unannounced visits we made. We heard staff checking what people would like for their tea. Most meals are taken in the dining room, although when we visited two people preferred to take those in their rooms. We saw that people who needed assistance were given this by staff who sat to the side of them while helping them eat, meaning that the process was more pleasant and less threatening. Napkins and tablecloths are provided, as well as a selection of condiments. The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know how to raise their concerns and are generally satisfied they would be appropriately dealt with. There are measures in place to try and help protect people from abuse, although training could be improved in this area. EVIDENCE: Written comments from 7 people living at the home show that 5 people know how to make a complaint. One person does not and one person did not answer the question. We saw that a copy of the service users guide is put in each person’s room and this contains information about how to complain. However, a supplementary question as to whether people knew who to speak to if they had concerns about their care shows that only 4 people are sure that they always know who to speak to about such issues (57 ). A recommendation has been made. All the relatives we spoke to say they would talk to the manager if they had concerns, and felt that she would take these seriously. Written comments from two relatives say that they both know how to complain and that the service “usually” responds appropriately. One person commented to us that they felt that staff or the manager may avoid them if they felt they wanted to raise a concern. The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 19 The manager has a record book to record complaints and concerns. We discussed the content and purpose of this and the need for clarity about issues that should be in it or what should be in individual service user files. The record includes the actions she has taken to address any concerns. Staff have had some training in protecting vulnerable adults and being aware of abuse issues, but this is not recent for some of the longer standing staff members. Those with National Vocational Qualifications (NVQ) or training cover this issue during their courses. We had some concerns that refusal to assist people with toileting at their request (see health care section) could be seen as abusive practice and raised this with the manager, as well as that of staff being heard to shout. We are aware that an allegation of verbal aggression and rough handling has had an appropriate immediate response to protect service users and been referred to the relevant people. Discussion showed us the manager is aware of the need to balance risks to prevent harm and has avoided using bed rails as a safety restraint where these might increase risk of harm. Alternative methods, such as pressure mats, are in use. The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the 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 manager has a programme of continued improvement for the premises and an examination of previous inspection reports shows that this has improved considerably, so it is better able to meet the needs and expectations of those living there. The home is clean and hygienic so helping minimise the risk of infection for people. The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 21 EVIDENCE: Investment in the décor and furnishing of the home has continued, and over time has resulted in an improvement to the standard of the home. People told us they were satisfied with their rooms. The manager has an ongoing development plan for the service, with estimated costs and completion dates for further work considered necessary or desirable to enhance the environment for people living in, working at, and visiting the home. During our first visit, action was being taken to rectify a problem with boilers and heating. The home was comfortably warm, and areas seen were clean. One relative responding in writing commented that the home was always kept very clean. Six out of seven people living at the home say it is always kept clean (86 ) and one says it is usually kept so. There is protective clothing and hand wash gel provided where there are concerns about infection. Staff are aware of the measures that need to be in place and the manager is arranging infection control training. Food safety has been inspected by the district council officers since our last inspection and found to be of good quality. The home has been awarded five (out of a maximum of five) stars for good food safety practices. This is commendable and the requirement for food safety training has not therefore been repeated, as the environmental health officer responsible was satisfied with arrangements. There are no sluice cycles on the washing machines, but the manager says they do not have difficulties with linen that has been badly soiled. This needs to be kept under review to see whether alginate bags or sluicing facilities are needed. There is clear guidance about managing the laundry where there are concerns about acquired infection. The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At present there are sufficient care staff to support the people who use the service, but recently this has not always been the case. Training arrangements are poor in that staff are funding relevant courses in whole or part. Where this is required training in the interests of maintaining safety, or relates directly to service users needs and so informs good practice, this is unacceptable. It is the responsibility of the registered persons, (including the manager and the providing organisation), to provide training that staff require in order to help them meet people’s needs effectively, competently and safely. The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 23 EVIDENCE: Two relatives told us that they have concerns about the skill mix of staff on shift. They were anxious that sometimes inexperienced or younger staff were left in charge and that the mix was not appropriate. We discussed this with the manager. She says that there is always a senior or team leader on shift. Duty rosters support this except on a few occasions where there are holiday commitments. The manager says that when occupancy levels have dropped there have been two staff on rather than the usual three. We saw rosters confirming this. We saw that two people needed staff to help to feed them and one person needed supervision and assistance to cut up food. One person is currently unwell and in bed and needs assistance with meals in their own room. Several people need supervision from staff with their mobility. Where catering cover is not available then there would be insufficient staff to meet these needs. Additionally, there is a risk of cross infection. The care staffing tool developed by the residential forum shows that, for the reported dependency of service users there should be a minimum of three care staff on shift between 7am and 10pm. The current shift arrangements provide cover from three staff between 8am and 8pm. However, in written comments six people living at the home said that there were always staff available when they needed them, one said they were usually available. Four people spoken to say staff respond to call bells quickly. However, one person said in their comment card that sometimes it could take staff time to get to them due to other people needing staff at the same time. One relative spoken to was concerned that staff did not respond promptly to the call bell in the night and that the person living at the home was reluctant to use it. There was however, evidence in night reports that the person concerned made regular use of the call bell during the night. There were also records of the care given by night staff at those times. On balance, given the variety of comments received we did not conclude that staffing was inadequate at present, but it has been in the recent past. Information supplied by the manager in the self-assessment indicated that 90 of staff already had NVQ qualifications to the required level. This is not accurate. At the time of our visit there were 14 staff employed. The manager told us that of these, five staff have NVQ level 2 or above, confirmed by certificates. This is less than the required 50 . However, 4 staff are currently working towards it. A requirement has been made. The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 24 No staff have been recruited since the last key inspection. At that inspection records for three people newly recruited were checked and the process found to provide for robust checking to make sure unsuitable staff are not recruited and statutory records are kept. This standard was not therefore inspected, but is deemed met. All staff have completed the required induction training and have certificates for this. There has been additional training in Dementia and moving and handling. There is a need to continually update training. One relative considers the service could improve in ensuring staff are qualified and also that training updates needed are delivered appropriately. One person has not had moving and handling training certificated since 2004, but staff say training is currently taking place and infection control is planned to follow. Training in the awareness of abuse of vulnerable adults needs updating. Staff say the company pays for training twice a year, normally mandatory training, and that staff pay some or all of the cost of other training and some refreshers. We were told that they have paid towards moving and handling training or food hygiene themselves in the past. The manager confirms that staff pay for some of the training they undertake either in whole or in part. A requirement about training has been made. We asked the manager how she would address concerns about conduct or performance which led to disciplinary measures in an open and even handed manner, given she employs three relatives. One visitor to the home raised this as of concern. She says that the majority of their shifts are worked with other staff rather than each other, and that she is confident they would report any concerns about conduct and she would be able to deal with them as she would for other staff. The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is actively working towards completing her qualifications so that she has the underpinning knowledge to help her run the home in the best interests of those who live there. There is room for improvement in the development of systems for monitoring safety and also the quality of the service so that people can be confident their views on standards will result in action to continue to improve the service. The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 26 EVIDENCE: The manager showed us confirmation that she has a place to complete the Registered Managers’ Award starting in September, and says that, given her NVQ level 4 in care she only needs to complete two units to top this up. She anticipates, with the tutor, that this will be complete by Christmas. The requirement to comply with adequate training is therefore repeated as outstanding, but with the timescale indicated as achievable based on discussion with the manager and evidence she has the place. A requirement has been made. At our second visit we found that the manager had already attended one of the college sessions to achieve her qualification. The manager has carried out a survey of views of staff as required at the last inspection. However, she has not yet analysed the information to see what it tells her about the service and how she might improve it. Neither has she used any other means of objectively auditing the performance of the home. The home is also operated by a limited company. Reports on service quality are not being submitted regularly to the Commission by any of the company’s representatives as required by law. Requirements have been made. The manager does not act as appointee for service users. She does handle amounts of personal monies that relatives bring in for people living at the home, where necessary. She keeps this in a locked tin and says only she has access. Relatives speak of other people handling their own money and never having had any concerns about its safety, whether or not they had a lockable facility for it. We did not check individual records and balances but the home has consistently met this standard. Staff are not receiving supervision as set out in standards. Records show that, when it is delivered, it primarily constitutes observation of practice and some use of questionnaires. It does not provide for formal recording of discussion with the agenda and frequency set out in standards. Staff describe their understanding of supervision as being mostly practical check ups on what they have done by someone more senior. One person we spoke to says this happens about 3 times a year. Records show for one person, one supervision in July this year and the previous one in August last year. Another had two recorded observations of practice in July this year, but the last one was in 2005. The observation is important and shows that the manager actively monitors the performance of staff, but is part of routine monitoring on a dayto-day basis, and not of supervision as set out in standards. A requirement has been made. The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 27 There are shortfalls in the accuracy of records, including those to do with medication and referred to elsewhere. We also identified that the register of admissions and discharges is not up to date, with some people having no date of discharge, death or transfer from the home, yet not being in residence. A requirement has been made. We checked a sample of records related to health and safety, predominantly to do with fire safety. These show that detection, emergency call points, and fire fighting equipment is maintained and tested. The manager says that she walks round and checks the safety of the building on a regular basis and the maintenance programme and schedule shows that she arranges for issues to be addressed promptly. We saw no immediate health and safety hazards. However, the information provided before the inspection shows no evidence that wiring circuits in the home had been checked for safety. A requirement has been made. Records of monthly wheelchair checks show two consecutive concerns about foot rests in May and April. There were no subsequent records on the chart to show the repair had been effected in the interests of safety, but the manager says this had been done. There were no records that the chair had been checked at all since May. A random check of some portable electrical equipment showed that these were checked with dates corresponding to the information on the self-audit. The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 28 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 2 2 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 1 2 2 The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES 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 OP1 OP2 Regulation 5 Requirement Timescale for action 30/11/07 2. OP3 3. OP7 People who live at the home or who are thinking about moving there, must have the information the law says they need. This is so they or their representatives can make an informed choice about moving into the home. It is also so they can be sure of the arrangements for charges or increases in these. 14 Proper and accurate assessments of people living at the home must be obtained. If assessments are not accurate the home cannot show that it is able to meet the needs of people living there. 14.2, 15.2 Assessments and care plans must be kept under review involving people living at their home and their representatives (family members particularly) if they wish. This is so people are involved in planning their care and their changing needs or wishes are better recognised. 31/10/07 31/12/07 The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 30 4. OP9 5. OP9 6. OP9 7. OP9 12.1,13.1, Outstanding requirement for 13.2. two previous inspections. The registered person must ensure prescribed medicines are always available so that residents receive timely administration of the treatment their medical practitioner considers necessary. Previous two timescales are unmet. 13.2,13.4 Outstanding requirement from the last pharmacy inspection There must be full and accurate records for medicines scheduled for regular administration. This is to comply with the law and to protect people from potential over or under medication. 13.2,13.4, Outstanding from the last 17.1(sche four pharmacy inspections d 3) Medicines must be administered in line with their prescribed instructions and this must be demonstrated by record-keeping practices at all times. This is so the home can show that people have been given medicines at the appropriate times and on appropriate days. 13.2,13.4 Outstanding requirement from the last pharmacy inspection There must be full and accurate records for the nonadministration of medicines scheduled for regular administration. This is so there is a means of following up any concerns about persistent refusal, and so records show a safe procedure has been followed that helps reduce the risk of error and therefore harm to service users. 31/10/07 31/10/07 31/10/07 31/10/07 The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 31 8. OP10 9. OP12 10. OP28 11. OP30 12. OP31 13. OP33 12.1, Requests for assistance to use 12.4, 12.5 the toilet or commode, or with mobility, must be responded to appropriately. This is so people are treated with dignity at all times. 16.2.m&n Everyone living at the home must be consulted about recreational and social opportunities and the home must provide a programme that suits people’s interests and abilities. This is so the service can show how each person’s recreational and social needs are being addressed. 18.1 At least half of the care staff must achieve NVQ level 2 or above, so that people living at the home are cared for by staff who can show they are competent do meet their needs. 10.1,12.1, The registered providers must 13.4supply appropriate training for 6,18.1 staff so they can meet people’s needs competently and safely. 10, 18.1 Outstanding requirement The manager must complete her registered managers’ award. This is so she has the underpinning knowledge to effectively run the service in the best interests of those who use it. 24 The views of stakeholders must be incorporated into an audit of service quality and a plan for its improvement. This is so people can be confident the service is being monitored and will improve, and that their views will be taken into account in the process. 31/10/07 30/11/07 30/06/08 28/02/08 31/01/08 31/01/08 The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 32 14. OP33 26 15. OP36 16. OP37 17. OP38 A representative of the registered providers must complete reports monitoring the service quality and supply these to the Commission and the company. This is so people can be confident someone other than the manager makes regular and structured checks on the quality of the service and the views of people living and working in it. 18.2.a Staff must receive supervision with the agenda and frequency set out in national minimum standards. This is so the management team can be sure that people understand their roles, work effectively with service users and can identify shortfalls or training needs at an early stage. 17, Sch 3 The manager must keep the and 4 records the law says she must have, and must keep these up to date. This is so people are protected by the accuracy and adequacy of record keeping systems. 13.4,23.2. The manager must supply b, 23.4.a evidence that the wiring circuits in the home are safe. This is so people are protected and that risks are minimised. 31/10/07 31/12/07 31/01/08 31/12/07 The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 OP37 Good Practice Recommendations Staff should be given guidance on good practice in record keeping. This is so people are protected by policy and record keeping systems and alterations or entries cannot be made retrospectively. The manager needs to know who is responsible for making the record, Regular residents meetings should be held so people are encouraged to discuss the running of the home and are supported and encouraged as to how they should raise concerns and who they should speak to. 2. OP16 The Old Vicarage DS0000027487.V351821.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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