Inspection on 12/12/08 for The Old Vicarage [Antony]

This inspection was carried out on 12th December 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Old Vicarage [Antony] 30/01/07

The Old Vicarage [Antony] 15/08/05

The Old Vicarage [Antony] 27/04/05

The Old Vicarage [Antony] 24/11/04

The Old Vicarage [Antony] 19/07/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Old Vicarage [Antony] Antony Torpoint Cornwall PL11 3AQ     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: Mandy Norton     Date: 1 6 1 2 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 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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 24 Information about the care home Name of care home: Address: The Old Vicarage [Antony] Antony Torpoint Cornwall PL11 3AQ 01752812384 01752812816 antony@torcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Anne Marina Hetherington Type of registration: Number of places registered: Torcare Limited care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Old Age, not falling within any other categories (OP) - maximum 22 Service users may include up to 1 adult aged over 65 years with a mental illness (MD(E)). Service users may include up to 4 adults aged over 65 years with Dementia (DE(E)). Date of last inspection Brief description of the care home The Old Vicarage provides care for older people, some of whom may have a mild dementia or mental health problem. It is, as its name implies, an old building in the village of Antony near Torpoint. It is part of Torcare Homes Ltd with its sister homes being approximately five miles away in Torpoint. There are a number of linked sessions Care Homes for Older People Page 4 of 24 Over 65 4 1 22 0 0 0 Brief description of the care home for training etc between the two homes. Accommodation in The Old Vicarage is on three floors connected by a shaft lift and stairs. The majority of rooms are for single occupation and a few are en suite. There is a large sitting room and a dining room on the ground floor. Service users choosing to live at The Old Vicarage have reasonable mobility as there are slopes (with handrails) which have been put in to overcome steps and changes in level. Staff are however always willing to assist anyone who may need to rely on a wheel chair to cover longer distances. Exernally the home is surrounded by a sheltered garden and although some is sloping, there is a sitting area by front door. Access to the car park is via a steep slope or steps but there is an alternative rear entrance where a vehicle can pull up. Both publicly and privately funded people are welcome at the home following an assessment of their needs. The current fee level is 430 pounds per week. Contracts are issued to each person once an agreed settling in time has been achieved. Care Homes for Older People Page 5 of 24 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: This unannounced inspection took place from 10:50am to 12:30pm on 12th December and from 13:00 am to 1:30 pm on the 16th December 2008. The inspection was conducted with the senior carer on duty on the first day and the manager on the second day. A tour of the home was carried out and people who live at the home and care staff were spoken to and observed during the inspection. There were 15 people living at the home on the day of the inspection. Care Homes for Older People Page 6 of 24 What the care home does well: What has improved since the last inspection? 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 7 of 24 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 8 of 24 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. People who use this service have up to date information about the home in order to make an informed decision about whether the service is right for them. The personalised needs assessment means that peoples diverse needs are identified and planned for before they move to the home. Evidence: The manager said that people are always assessed prior to moving into the home to ensure their needs can be met. If people are to be admitted they and their representatives are given as much up to date information about the service as possible. They are written a personal letter detailing the services the home can offer and invited to look around and spend some time at the home and ask any questions they may have. The manager said she can arrange for a person to be picked up from their current setting to come and spend time at the home. Following the visit the staff Care Homes for Older People Page 9 of 24 Evidence: group have a meeting to decide if they think the home can meet their needs. A Service User Guide and the previous CSCI inspection report is displayed in the downsatirs hallway for people to read at any time. The manager said new staff are also expected to read the documents as aprt of their induction. Care Homes for Older People Page 10 of 24 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. The practice regarding the planning and delivery of care means that people can be sure that their health and personal care needs will always be fully met. Evidence: The care plans seen contained a lot of relevant information about the person and their health, personal and social care needs. The care staff complete evaluation records about a persons welfare and detail what care has been provided, this is completed at least once every three days if there are no changes. The key workers complete the care plans and carry out regular reviews with the client where at all possible. The manager said she checks all of the care plans to ensure they are accurate and up to date. Information was included about visits made by health care professionals such as GPs, district nurses, opticians and dentists. A tour of the home showed that equipment necessary for the promotion of tissue viability and prevention of pressure sores is available to meet peoples current needs. The manager said that any specialist equipment is provided by the community nursing Care Homes for Older People Page 11 of 24 Evidence: services as required. The home uses a blister pack system for administration of medicines. They are kept in a locked wall mounted cupboard. Any creams or eye drops that neeed to be kept in the fridge are kept in the door of the kitchen fridge and do not come into contact with foodstuffs. The fridge temperature is regularly checked and recorded. All of the care staff who administer medicines have had training in medicines administration (certificates seen in staff fiels examined). The medication administration records (MAR) sheets seen were completed as required. The procedure for receipt, storage and disposal of unwanted medicines was explained and is in accordance with laid down legislation. The manager was advised that the people who self medicate should be asked to sign the care plan to indicate that they agrre with the procedures in place around self administration. Staff were heard and observed interacting with people appropriately and providing care and support in a discreet manner. Staff were knocking on doors before entering and doors remained closed whilst personal care was taking place. People were being called by their preferred name and staff were heard explaining to new staff the likes and dislikes people have with their drinks, including what they like to have and whether it is in a cup or a mug. This showed that the staff know the clients well and provide personalised care. Care Homes for Older People Page 12 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of activities within the home and the local community mean that people have opportunities to participate in stimulating and motivating activities. Meals and mealtimes are not rushed and staff are available to help make them an enjoyable and social occasion for people. Evidence: The manager and carer, who was available for the inspection on the first day, said that people are encouraged to exercise choice in how they spend their time and activities are offered individually or in groups and are facilitated by the care staff. The staff said that music and movement takes place on a Sunday afternoon and on Saturday afternoons they watch a movie (on DVD) and have tea and cakes. As it is near to Christmas most of the clients are going out to a local garden centre for a Christmas meal in the near future and visiting the local Royal Navy base for the annual Christmas lunch and entertainment. Visitors are welcomed at anytime and a number of people regularly go out with friends or relatives. Independence and contact with the local community is actively encouraged by the manager and the care staff. There are large mature gardens around the home. There is level access to the gardens Care Homes for Older People Page 13 of 24 Evidence: where there is seating for people to use. There are plans to have a summer house and decking built in the near future. Following a bequest of money the manager asked the clients how they would like to spend it and the summer house was the most popular option. Most people have their meals in the dining room, which is spacious and at the time of the inspection was tastefully decorated for Christmas. It is a very social occasion (parts of 2 mealtimes were observed during the inspection) with the clients chatting with each other and care staff, who are on hand should anybody need assistance. The daily menu is displayed on a board in the dining room, but there is always an alternative available. People spoken to said the meals are very good and taste like home cooking. Drinks and snacks are available 24 hours a day. Care Homes for Older People Page 14 of 24 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. Formal complaints and safeguarding policies and procedures are in place and are available to staff at all times. All staff undertake safeguarding training. This means that people who live at the home are adequately safeguarded. Evidence: The complaints procedure was seen displayed in more than one place in the home, is included in the Service Users Guide and a copy is on the back of the door in each individual room. It is comprehensive and gives options about who to contact and timescales for responses to be made. There have been no complaints made to the Commission or the home since the last inspection. The training officer for Torcare ltd. has attended the County Council safeguarding training and trains all the staff in the home on safeguarding, they also have information about safeguarding when doing National Vocational Qualification (NVQ) training and during induction training. Care Homes for Older People Page 15 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a very comfortable, homely and safe environment in which to live. Evidence: The Old Vicarage is currently registered to take up to 22 people although due to double rooms the most they take is 18. On the day of the inspection 15 people were resident at the home. It is owned by Torcare Ltd. who have 2 other homes in the local area. Accommodation is provided on three floors and although there is a lift that stops at each floor there are also stairs. A tour of the home showed that peoples rooms are personalized with furniture and momentos they bought in with them. People spoken to said they were happy with their current accommodation. People who are self medicating have lockable space in their rooms to keep their medicines in. Communal space consists of one lounge and one dining room both of which are situated on the ground floor. The mature grounds are accessible to people and are well used during good weather. There are a number of assisted bathrooms and toilets on each floor and due to upgrading work carried out in 2008 majority of the rooms have en-suite facilities. Care Homes for Older People Page 16 of 24 Evidence: The home was clean, tidy, hygienic and very homely on the days of the inspection. Policies and procedures around infection control are up to date and available to staff at all times. Training on the importance of infection control is routinely offered to staff. Domestic laundry is done in house using a domestic washing machine. Towels, sheets and draw sheets are sent out to a commercial laundry where they are washed at required temperatures. Some rooms have been upgraded since the last inspection and rooms continue to be decorated when they become vacant. There are handrails throughout the home and in the grounds where there are slopes. Radiator covers have been fitted throughout and hot water outlets fitted with thermostatic control valves to prevent people from burning or scalding themselves. Care Homes for Older People Page 17 of 24 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 and skill mix are satisfactory meaning peoples needs are being met at all times. The robust recruitment procedure means that people who live at the home are being looked after by appropriate staff and their welfare is not at risk. Evidence: The manager and care staff are supported by catering and domestic staff within the home and administrative staff, a training officer and maintenance staff who work for Torcare Ltd but are not based at the home. The manager and the duty rota seen confirmed that there are 2 care staff, one of whom is usually a senior, plus the manager , who is often supernumerary, on duty during the day and overnight there are 2 care staff. one awake and one who can sleep. This is seen as sufficient for the number of people who currently live at the home (15) and is based on their dependency levels. Torcare Ltd. ensure that all new staff have a 2 day induction that covers health and safety, fire safety, safeguarding and person centred care. They continue to work with experienced staff until they are confident and competent to work alone. There was a new staff member working during the inspection. She was being offered support and Care Homes for Older People Page 18 of 24 Evidence: not being asked to do things that she was not confident about. Training opportunities were seen displayed in the staff area in the kitchen during the inspection. Staff spoken to said that training is always available and they are encouraged to attend. Torcare Ltd. have a robust recruitment procedure that includes 2 written references and a CRB check (it was confirmed with the administrator that CRB checks are not transferable between jobs even if they are less than a year old). The staff files are kept at the administrative office based at one of the sister care homes in Torpoint approximately 5 miles away. The staff files seen contained all of the required information. The manager said she interviews prospective staff and the administrative part of the process is carried out by the Torcare Ltd. administrative team. Care Homes for Older People Page 19 of 24 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 systems and procedures in place are designed to meet the needs of the current clients and to continually improve the service the home offers to them. The attitude to health and safety shown by the providers, care and ancillary staff means that people live in a safe and well maintained environment. Evidence: The Registered Manager has been in post for approximately 3 years. Before that she was employed at the companies sister home in Torpoint for 10 years. She holds an NVQ level 3 qualification and is also a NVQ assessor and has recently achieved an NVQ 4 and Registered Managers Award. Staff meetings and supervision sessions with staff are recorded. Evidence of this was seen when examining staff files. She said she likes to involve the care staff and clients in decisions made in the home so that they can affect the way in which the service is run. Such as the decision documented earlier in the report about the use of money from a bequest. This is noted as good practice. She Care Homes for Older People Page 20 of 24 Evidence: now has an office on the first floor that allows her to hold interviews and supervision and appraisal sessions in private. The company operates an internal quality assurance group known as the Care Standards Committee. This group comprises of representatives from management, staff at all levels, service users, relatives and other interested persons. There role is to advise on the quality of care being provided. A questionnaire is also given to clients and their families in order to get their views on the services provided by the home. Clients finances are managed from the administration base at the companies home in Torpoint and were not directly inspected on this occasion. However they have been found to be in order in the past. The manager said that all staff have statutory training that includes health and safety, first aid (when examining the staff files 2 first aid certificates were found to be out of date), lifting and handling and food hygiene. A number of routine servicing and maintenance documents and the fire log book were examined and found to be up to date. The Environmental Health Office carried out a routine assessment of the kitchen in May 2008. Some recommendations were made which have since been carried out. The manager said that the fire officer has made an appointment to carry out a routine visit in January 2009. The maintenance team are told about entries in the defect book and carries out repairs as requested. They also carry out ongoing in house and outdoor routine maintenance tasks. There was some painting ongoing during the inspection and electrical work underway to fit key pads to some of the outside doors. The current residents cannot access areas of the home where building work is ongoing due to security key pads being place. Areas of the home where refurbishment is ongoing and residents are living are continually subject to risk assessments to ensure the ongoing health, safety and welfare of them. Once the building work is completed an outside organisation will be asked to carry out a full health and safety assessment Care Homes for Older People Page 21 of 24 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 22 of 24 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 1 2 3 9 38 38 The manager should ensure that all pots/ tubs of cream in use have an opening date written on them. The manager should ensure that there is a qualified first aider on duty 24 hours a day. The manager should ensure that risk assessments are carried out to ensure safe working practices are maintained. Care Homes for Older People Page 23 of 24 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. 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