Inspection on 18/08/08 for The Old Vicarage (Askam)

This inspection was carried out on 18th August 2008.

CSCI found this care home to be providing an Poor 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 (Askam) 26/01/09

The Old Vicarage (Askam) 24/10/07

The Old Vicarage (Askam) 17/07/06

The Old Vicarage (Askam) 29/11/05

The Old Vicarage (Askam) 18/07/05

The Old Vicarage (Askam) 19/01/05

The Old Vicarage (Askam) 01/07/04

The Old Vicarage (Askam) 18/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Sunny Bank (P.R.S.) Ltd

Ruskin Lodge

Bushell House

Ashwood Court Unit 1

Clover House

Langrigg House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/11/2008.

CARE HOMES FOR OLDER PEOPLE The Old Vicarage (Askam) Ireleth Road Askam In Furness Cumbria LA16 7JD Lead Inspector Marian Whittam Unannounced Inspection 18th August 2008 09.00 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 (Askam) DS0000048089.V370079.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 (Askam) DS0000048089.V370079.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Vicarage (Askam) Address Ireleth Road Askam In Furness Cumbria LA16 7JD 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) 01229 465189 tov.askam@btopenworld.com Vicarage Care Ltd Mr Carl Terence Raine Care Home 30 Category(ies) of Dementia - over 65 years of age (12), Learning registration, with number disability (1), Mental disorder, excluding of places learning disability or dementia (3), Old age, not falling within any other category (26) The Old Vicarage (Askam) DS0000048089.V370079.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The home is registered for a maximum of 30 service users to include: up to 26 service users in the category of OP (Old age, not falling within any other category) up to 12 service users in the category of (DE(E) (Dementia over 65 years of age) up to 3 service users in the category of ME (Mental disorder, excluding learning disability or dementia) 1 service user in the category of LD (Learning disability) 24th October 2007 Date of last inspection Brief Description of the Service: The Old Vicarage, Ireleth, is a residential care home providing care for people with a range of care needs. The home is in a residential area on the edge of the village of Ireleth. It is within walking distance of the local shops and a public house and the small town of Askam with more shops and a post office. The home is in a large detached house and is on two floors with a single storey extension and a conservatory to one side of the house. There is a stair lift to provide access to the first floor for less mobile residents. There is a secure garden area at the side of the home with seating for service users. The grounds are well maintained, have seating for residents and are wheelchair accessible. There is also a sheltered inner courtyard patio area with seating close to resident’s rooms. Information is available to prospective residents in the Statement of purpose and service users guide; this is available in the home. The fees charged by the home range from £386.00 to £449.00 per week as at the date of the inspection. An additional charge is made for personal toiletries and cigarettes, newspapers, magazines, and any personal travel expenses. The Old Vicarage (Askam) DS0000048089.V370079.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This site visit forms part of a key inspection carried out at The Old Vicarage. We (The Commission For Social Care Inspection, CSCI) were in the home for a total of seven hours during which an ‘expert by experience’ accompanied us for a period of time during the visit. The CSCI pharmacist inspector also visited as part of this key inspection and assessed the handling of medicines through inspection of relevant documents, storage and meeting with the manager, other staff and residents. The pharmacy inspection took four hours. Information about the service was gathered in different ways: • An Annual Quality Assurance Assessment document completed by the manager, identifying what the service does well and what could be improved. • The service history. • Observations made by us in the home during the visit. Also an expert by experience visited with us and spent time with, observing and talking with people living there. • Completed questionnaire survey forms from people living in the home and from the staff working there. • Interviews with residents, visitors and staff on the day of the visit. • Information provided by people coming into contact with the service and from General practitioners who have patients living in the home. We looked at care planning documentation to ensure the level of care provided met the needs of those living in the home and made a tour of the building to inspect the environmental standards. Staff personnel and training files were examined and a selection of the service’s records required by regulation. The registered manager was not in the home on the day of the visit and a member of the management team whose role is Administration represented the service and made information available to us. What the service does well: Residents are provided with a clean, homely and comfortable place to live. Staff members are aware of people’s individual needs and are familiar with these and particular personal interests although these are not always recorded. The Old Vicarage (Askam) DS0000048089.V370079.R01.S.doc Version 5.2 Page 6 This can help staff as they support people in their daily lives and in maintaining any outside interests and contacts in the community people may have. People who are able to go out into the community and follow their own interests are supported to do so. The service works well with other agencies to try to get help and support for people when they identify the need. Feedback from people living there was generally positive and comments such as, “The manager is helpful” and “I am quite happy here, I get on alright with the staff” were made. The service has effective recruitment processes to help safeguard people living there. This ensures all staff have the appropriate security checks and references taken before they work in the home. What has improved since the last inspection? What they could do better: The Statement of Purpose should include the full range of services and support the service gives to residents with dementia including staff training. Records must be kept of the original pre admission assessment done by the service and the information gathered prior to someone coming into the home. Records should be kept saying who did the assessment and when it was done and the individual’s perspective and wishes. This way the service can demonstrate how they have undertaken the assessment and people coming into the home can be assured that all their individual needs and expectations have been recorded, assessed and the service is sure it can meet them. The manager should also consider looking at ways to make the assessment and admission process more personalised to the individual rather than just a process. The Old Vicarage (Askam) DS0000048089.V370079.R01.S.doc Version 5.2 Page 7 The care plans should always be updated when reviewed and as changes occur and as noted in the daily notes to ensure care plans always accurately reflect a person’s needs and condition and so staff always have up to date information. Risk assessments should be reviewed and updated as changes occur so information available to staff is an up to date reflection of the risk to people. Nutritional, psychological and behavioural needs and conditions need to be consistently monitored where a risk has been identified so prompt action can be planned and taken to meet people’s needs and keep them safe. Care plans should be in place for the disguising of medication in food to show that this is done in the best interests of the person, and to include discussions with people involved in their care. Regular audits should also be carried out on care plans to monitor their accuracy and effectiveness and on medication to identify discrepancies quickly. Care plans should be developed along more person-centred lines and include people living there in their care plan’s development and review. Records for the administration and disposal of medicines need to be improved and must be accurate to prevent errors that could affect the health of the people who live there and so that all medicines can be accounted for. It is recommended that the management of high risk medicines and blood tests is improved and discussed with the department responsible for issuing results so that staff are notified of changes to medication without delay. It is recommended that night carers receive training in the safe handling of medicines so that they can administer medication competently when necessary. Medicines administration records should be signed at the same time that medicines are given to prevent errors being made. The manager should make sure that people living in the home have the opportunity to take part in or attend religious meetings and services of their choice. We also recommended that particular consideration be given to developing the opportunities for stimulation through recreational activities for people with dementia and other cognitive impairments to suit their individual preferences and capabilities. The Provider must review the systems and support available for those who wish to raise concerns through whistle blowing and grievance procedures and the keeping of records of this. This will help ensure resident’s best interests are promoted and promote good professional relationships. The manager and responsible individual should act promptly to any staff concerns raised with them to promote good personal and professional relationships between themselves, staff and people using the service. An annual staff training and development programme and forward planning is needed to make sure that the care staff always get the right training they need to do their jobs and fulfil the home’s stated aims and be able to meet the changing needs of people living there, such as dementia care and challenging behaviour. The manager should make sure that all care staff have the opportunity to have formal supervision that includes all aspects of practice, the philosophy of care in the home and career development needs. The Old Vicarage (Askam) DS0000048089.V370079.R01.S.doc Version 5.2 Page 8 The management should look at ways to improve ventilation in the smoker’s lounge and people using this room should have appropriate supervision to minimise health and safety risks. An effective quality assurance and quality monitoring system, using appropriate tools, must be put in place so the service can objectively measure success in meeting the aims, objectives and statement of purpose of the home, to measure success in meeting the home’s aims and the views and expectations of people using the service. Satisfaction surveys completed by residents should be analysed and collated and the results made available to current and prospective users of the service. We recommend that the service review its fire risk assessments in light of changing fire regulations and for those residents using the smoker’s lounge. 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 be made available in other formats on request. The Old Vicarage (Askam) DS0000048089.V370079.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 (Askam) DS0000048089.V370079.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, 2, 3 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information about the home is available to inform prospective residents. There is an assessment process for people coming to live there but poor recording of the initial assessment may affect care planning to ensure individual needs can be met. EVIDENCE: A combined statement of purpose and service user guide is available for prospective residents and their families and included the home’s complaints procedure. This can be made available in large print if requested. The service is registered to provide care and support for people with dementia and the Statement of Purpose needs to make clear what the specialised services and support provided for this client group are in detail. We discussed this with a member of the management team and recommended this be done to make sure that people thinking of using the service know what is available to meet the individual needs of people with dementia, including activities and The Old Vicarage (Askam) DS0000048089.V370079.R01.S.doc Version 5.2 Page 11 recreation. People living in the home told us they knew about the home before they came in and felt they had information about it and their survey responses supported this. We looked at the contracts/ terms and conditions of residency that people are given. These included people’s rights and responsibilities and the complaints procedure and what is included in the fees. Survey responses supported the receipt of contracts by people. A member of the management team who is a registered nurse completes the pre admission assessments used by the home. The member of the management team told us that they take notes on the daily living skills form during the assessment and put on the computer on their return to the home for the care plan. We could not see a record of the assessments done prior to admission, where it was done, when or by whom and who was involved in the initial information gathering. Dates in the plan are the dates of admission to the service. We discussed this with the service representative and that records must to be kept of the original assessments and the information gathered, who did the assessment and when it was done and the individuals perspective on their admission. This way the service will be able to demonstrate how they have undertaken the assessment and people coming into the home can be assured that all their individual needs and expectations have been assessed, recorded and the service is sure it can meet them. The manager should also consider looking at ways to make the assessment and admission process more personalised to the individual. Where assessments had been done by a social worker through care management arrangements the home had a copy on file. Prospective residents and/or their families are invited and encouraged to visit, to speak with the manager and staff and other people living in the home. The service does not provide intermediate care. The Old Vicarage (Askam) DS0000048089.V370079.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): NMS 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of residents are being assessed and planned for but health care issues are not always adequately recorded and medication is poorly managed and these shortfalls may place resident’s health at risk. EVIDENCE: All people living in the home have an assessment of daily living needs and a care plan. People living there have access and to health care services. We could not examine the original pre admission assessments from which the plans were developed, as these were not available. During the visit we looked at a sample of four care plans in detail. We found that care problems and assessments in the care plans are being recorded as being reviewed although the care plans had not always been updated to reflect a noted change in condition, objective or need that had occurred or noted in daily records. For example for one person their wound did not have a care plan for staff to refer to. One person who had been identified as high risk of skin damage had no The Old Vicarage (Askam) DS0000048089.V370079.R01.S.doc Version 5.2 Page 13 accompanying plan for staff on managing and minimising this risk to them. On occasions certain residents had their medication crushed and administered in food. There were no care plans in place to show that this was done safely or in the best interests of the person and that relevant people involved in their care had taken part in making this decision. This was also contrary to the services own policy on the disguising of medication. Care needs to be taken to make sure all assessments are done to identify risks. Some people did not have nutritional assessments and psychological and behavioural assessments and plans despite having had problems in these areas. The care plans are working records and must always be updated as conditions, objectives and individual care needs alter to ensure care plans always accurately reflect a person’s needs, goals and condition and so staff always have up to date information to work from. Care plans did not reflect an individualised person centred approach to care planning and delivery including what individuals wanted or expected from their care and the support they wanted to live their own lives and what goals they aspired to. There were gaps in daily progress sheets and assessments did not always reflect what was recorded on a daily basis such as a person with increasing numbers of falls and bruising in daily records. The moving and handling assessment in the plan indicated that this person was independent and needed no assistance and no action was being taken to manage their risk of falls. There were some risk assessments in place for challenging behaviour directing staff to policies and training. From what we could see in training records staff had not yet had training in managing challenging behaviour. Challenging and unpredictable behaviour was not always being well monitored in the care plans or using monitoring sheets and evaluations of management of the behaviour. Where an incident involving residents had occurred it was not always well recorded and appropriate action planned to manage this. All staff need to be aware of incidents affecting people and the care planned to support them and safe guard other residents. People did have life histories in place that gave a good insight into their lives and interests but were not being put to good use in developing activities on an individualised basis. Observing staff going about their duties and talking with residents during the day we could see that they were polite and generally respected individual’s wishes and privacy. Surveys from people living there indicate that staff listen to them and act on what they say. Records for receipt of medication were satisfactory however records for administration and disposal were poor placing people at risk from errors. Records of administration of medicines were not always signed so that it was not possible to tell if they had been given and this could result in medicines being duplicated or missed altogether. In some cases there were many gaps for particular medicines rounds, for example, none of the lunchtime medicines were signed for administration on the day before the pharmacy inspection. The Old Vicarage (Askam) DS0000048089.V370079.R01.S.doc Version 5.2 Page 14 Where medicines were given four times in a day sometimes doses were given too close together. The handling of high-risk medication that required regular blood tests was checked. On occasions the home was not notified of changes to medication for a couple of days after the test was done and this delay could place the health of the person at risk. On one recent occasion a resident was given the wrong dose. Some medicines, such as those that were persistently refused by people, could not be accounted for. We also counted a sample of medicines and checked them against records. These were mostly in order with some occasional discrepancies. We were told that senior carers who worked during the day had received training in the safe handling of medicines. However, night carers had not received this training though they had been trained in the services medication policies. It is recommended that night carers are also trained in the safe handling of medicines so that they can competently administer medicines such as painkillers if they are needed. There were no regular checks, or audits, of medication handling and systems being done within the service so that discrepancies and poor practice can be identified and dealt with promptly to keep people safe. However the owners said that they had recently obtained an audit package and had plans to run this. The Old Vicarage (Askam) DS0000048089.V370079.R01.S.doc Version 5.2 Page 15 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): NMS 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The more able people who use this service are able to make choices about their lifestyles and access the community but a lack of organised activities to meet specific dementia needs and capacities means that some people may not have the same opportunity for stimulation through recreation. EVIDENCE: The routines in this home are generally flexible to meet the needs of those living there who wish to go out or pursue their own hobbies and interests. For example one person with an interest in gardening had been allowed to use some land by their room to grow vegetables and herbs. They told us that the cook prepared them for them to eat. Useful work has been done on getting ‘pen pictures’ of people and better information of people’s backgrounds, social and recreational expectations. It was not evident from the activities being provided that this personal information was being used in developing individualised activities planning for people or groups of people with cognitive impairments. We recommended that particular consideration be given to developing the opportunities for The Old Vicarage (Askam) DS0000048089.V370079.R01.S.doc Version 5.2 Page 16 stimulation through recreational activities for people with dementia and other cognitive impairments to suit their preferences and capabilities. Several people did not have their religious preferences and needs recorded so people may not be having this aspect of their lives fully addressed and needs met. Some people we spoke with commented on this telling us that they did not have access to church services or religious meetings and they would like to attend. The daily activities on offer are displayed on the notice board. Some residents told us that these did not always happen. One person told us there was not much to do and another that they did not know about the activities. Members of staff asked by the ‘expert by experience’ did not appear to know what activities were on in the afternoon and this was borne out by the residents. Some said there had been outings, but could not remember when. Some residents go into the village for newspapers and to collect their pensions and personal shopping items. Residents also go into Barrow in Furness to Social Services/Benefit Office on local public transport. Other people went out for walks and one person told us they enjoyed their walks especially down to the local beach. The resident’s notice board indicated that the activity for the afternoon was a Manicure and Pedicure but we did not see this taking place during the visit. The residents have a choice of meal at each mealtime and there is a 4 week menu in place. Residents have been asked to comment on meals at the last residents meeting. On the day of the inspection for lunch it was shepherds pie or sausage and mashed potatoes with vegetables and to follow was apple crumble with ice cream. Opinions expressed about the food indicated people “usually” liked it. Observations in the dining room indicated that people were assisted with their meals where they had difficulty feeding themselves. However some people struggled but did not always get the help they needed quickly so meals and drinks could go cold. We observed that a lot of food went back to the kitchen and people were not asked if they wanted anything else. One person commented that the meal was “too wet”, another that they did not like the sausage. One resident was offered a cheese sandwich as an alternative because they did not eat the sausage. The Old Vicarage (Askam) DS0000048089.V370079.R01.S.doc Version 5.2 Page 17 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): NMS 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are complaint, whistle blowing, bullying and adult protection procedures in the home to promote the interests of people living there. Staff reluctance to ‘whistle blow’ could undermine the robustness of such systems to protect people. EVIDENCE: There are procedures in place for dealing with complaints and this has been reviewed. The complaints policy and procedure is part of the guide for the people using this service and there was also a copy on display. The management representative said that there had been no complaints made to them since the last inspection. CSCI has received two complaints/concerns about the service and these were also referred to the appropriate agencies for investigation. Survey responses and comments from most people we talked to support that overall people living there felt they would be listened to if they were not happy with something. Staff surveys indicated that staff were aware of what they should do if they had concerns about a resident’s welfare. Staff have been given training on safeguarding vulnerable adults. The service has policies and procedures for the Protection of Vulnerable Adults (POVA) and for referral to the POVA register and a copy of the Department of Health guidance ‘No Secrets’. There is also a procedure for staff on reporting incidents of bullying. The manager has already completed a training course, The Old Vicarage (Askam) DS0000048089.V370079.R01.S.doc Version 5.2 Page 18 run by social services, on protecting vulnerable adults so this training can be given to staff. Updates on this training with staff are planned for the 15.9.08. The services procedures do however need to make it clear that any suspicions of abuse must always be reported to Social Services in line with multi agency guidance. There has been one safeguarding adults referral concerning the service made to social services and this was investigated by the appropriate agencies. The management of the home worked well with other agencies during the investigation to safeguard and promote the interests of residents. Staff survey responses and comments made to us by staff did however differ significantly in the views expressed about confidence in using the services whistle blowing procedures on reporting colleagues practice and behaviour. Some staff comments indicated that when practice concerns had been raised by staff they felt the manager has not acted upon them and investigated thoroughly. There are basic whistle blowing procedures in place and on display in the staff office for staff to report concerns about colleagues and practice and these have been reviewed this year. We have also received information raising concerns about staff teamwork and poor working relationships within the home and some dissatisfaction with the management response was clear from some staff views. From survey responses, letters received and from talking to staff there was some evidence of a general reluctance on their part to use ‘whistle blowing’ systems to report poor practices. This reluctance could potentially have an adverse effect upon the care people receive especially if the professional relationships between staff in the home are not good. There is inconsistency and quite apparent differences in opinions expressed by staff in their surveys with some being very negative. Such inconsistent findings suggest that there may be a lack of teamwork and also robustness in whistle blowing processes. The Provider must review the support available for those who wish to raise concerns through whistle blowing and grievance procedures to ensure they feel able and safe to report practice matters. There were no records of any concerns under whistle blowing procedures having been brought verbally or in writing. We recommended to the management representative that the manager and responsible individual should act promptly to promote good personal and professional relationships between themselves, staff and people using the service and record any matters brought to them under this process. The Old Vicarage (Askam) DS0000048089.V370079.R01.S.doc Version 5.2 Page 19 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): NMS 19, 20, 21, 22, 24, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The premises are being maintained and updated and are kept to a satisfactory standard of cleanliness. EVIDENCE: Some internal redecoration has been completed since the last inspection in bedrooms, communal areas. We made a tour of the premises and it was evident that routine redecoration and maintenance is being done. Two bedrooms were in the process of being redecorated. There are two large lounges with a large conservatory and dining areas on the ground floor and a smaller lounge/dining area on the first floor. There is also a ‘study’, used as a smoker’s room and an internal courtyard entrance that several people were seen to use and sit in. The smoker’s room door opens The Old Vicarage (Askam) DS0000048089.V370079.R01.S.doc Version 5.2 Page 20 onto the main corridor and there was a smell of cigarette smoke on the corridor and very heavy within the room. We did not see evidence of people using the smokers room being supervised especially those with dementia. There were soft furnishing in this lounge and we saw one resident lighting a cigarette with a lighter right in the well of a chair this could be dangerous as the residents are by themselves and it could lead to them setting fire to the furnishings or themselves. The two other lounges were not always well supervised by staff. We discussed this with the management representative about the need for better ventilation of smoke and better staff supervision of those using the room. The management should look at ways to improve ventilation in the smoker’s lounge and people using this room should have appropriate supervision to minimise health and safety risks There are three bedrooms that are shared but this is only with the agreement of the people using this service. Curtains are provided for privacy and dignity when delivering personal care in 2 of the shared rooms but one has a heavy wooden screen that is difficult to move around quickly and easily and provides only limited screening. We recommended that as in the other rooms curtains or more effective screening is provided. Residents are encouraged to personalise their rooms and have done so with pictures, ornaments and photographs. The home is generally clean and tidy, although there was a slight smell of urine noticeable in some areas. There is a range of equipment and adaptations in the home to help residents make the most of their independence and to get about the home. Over half the bedrooms have en suite facilities and there are sufficient toilets, assisted baths and showers for people to use. The laundry is small but was organised, clean and tidy. Staff attend to the laundry as part of their duties. Staff were seen following appropriate infection control procedures, using gloves and appropriate protective clothing. COSHH substances were locked away for safety. The Old Vicarage (Askam) DS0000048089.V370079.R01.S.doc Version 5.2 Page 21 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): NMS 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service uses appropriate recruitment procedures to protect residents but the lack of annual planning for staff training needs means some staff may miss out on training they need to do their jobs. EVIDENCE: During this visit we looked at samples of new staff recruitment records and found them to be in order. Prospective staff complete an application form, supply referees and attend for interview. Special checks such as Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) first are undertaken prior new staff to starting work. This helps to ensure the safety and protection of those living in the home. Staff rotas were checked and found to be adequate for the current number and needs of people living there. There were four care staff on duty during the busy morning period and a supervisor but numbers dropped between 2pm and 4pm rising again after 4pm. The person working 8am until 4pm is responsible for ensuring activities take place in the afternoons but this is a time when staff numbers are lowest. We did not see any organised activities taking place during the afternoon of visit. The service has 2 domestic assistants and 2 cooks covering the week. There are 2 waking night staff on night duty, they are also required to do some cleaning duties in addition to the domestic assistants. The Old Vicarage (Askam) DS0000048089.V370079.R01.S.doc Version 5.2 Page 22 Some work has been done on providing more staff training and keeping records. We could see that staff had induction training records. Training records had information on what training staff had done and when but there was no annual training and development plan in place. This is to make sure that mandatory training needs and training relevant to residents needs is always done and up to date. It also allows that training needs identified at supervision to be taken forward and provided within the timescales set by the manager. Forward planning is needed to make sure that the care staff always get the right training they need to fulfil the home’s stated aims and be able to meet the changing needs of people living there, such as dementia care and challenging behaviour. The management is aware that there are some gaps in the in the training programme and a lack of overall planning to ensure staff have the training and updates. They have begun to address this but need to monitor its effectiveness to ensure they are able to meet the changing needs of people living there. Consequently it was difficult to assess the evidence on what training and development each member of staff had done, asked for or needed to do or update. Supervision records show that it had been recognised that some staff had not done their moving and handling training and asked for this. It was identified as a training need and a timescale put on it but no system of planning or monitoring to ensure the timescales were met. Records of moving and handling training having been done and fire training had been kept separately and these were current. Training dates had been given for September for dementia training and safeguarding vulnerable adults. Staff did tell us that they had access to NVQ training and several had completed this and others were enrolled on it. The service has achieved over 50 of care staff with NVQ level 2 in care or above. The Old Vicarage (Askam) DS0000048089.V370079.R01.S.doc Version 5.2 Page 23 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): NMS 31, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lack of an overall systematic quality monitoring process may affect quality assurance and monitoring in the service so potentially undermining systems to support the welfare and interests of those living in the home. EVIDENCE: The service has a registered manger, Mr Carl Raine, who has the relevant qualifications and experience to run the home. The management team consists of Mr C Raine and his two brothers who undertake different roles in running the home. There are staff and residents meetings and the home has used a system of annual satisfaction surveys to get feedback from people. Minutes from the last residents meeting in April this year show what was discussed and what actions The Old Vicarage (Askam) DS0000048089.V370079.R01.S.doc Version 5.2 Page 24 needed to be taken. The management representative told us that the management has an “open door” policy for staff and residents. From staff surveys, comments made to us by staff and concerns raised with us there was evidence to suggest that some staff do not feel there is an open, positive and inclusive management approach in the home. We talked with staff in the home and their general comments, survey responses and information to us indicated that, amongst some staff, their experiences with aspects of the management approach was not entirely positive. Some did not have confidence in using the formal process for raising practice or workplace concerns. We were concerned from comments and information given to us that the running of the home may not always be open, transparent and supportive of the individual. Staff do have a grievance process and policies and procedures on bullying to use. There were evident differences in the opinions being expressed in some surveys that were more positive about the management. One staff survey commented, “The manager is always there when needed if we ever want to talk he is very happy to sit with us”. We discussed these matters with the management representative and that the service must address this as a matter of urgency and review the systems and support available for those who wish to raise concerns through whistle blowing and grievance procedures. This may help to create a more open and positive environment and resolve poor staff relationships. The registered manager needs to present a clear sense of direction and strong leadership to staff and people living in the home. The manager and responsible individual should act promptly and appropriately to team and workplace issues to promote good personal and professional relationships between themselves, staff and people using the service. They should also record any such concerns brought to them. The service has carried out reviews on some policies and procedures to bring them up to date and has used surveys to ask residents their views. We recommended that the results of such surveys are analysed and collated and the results and actions made available to current and prospective users of the service. The quality assurance systems have not continued to be developed to include a systematic approach of planning, action and review, using appropriate tools, to measure success in meeting the home’s aims and the views and expectations of people using the service. There was no evidence of annual audits of systems to ensure quality or regular audits of medication practices and care planning or to ensure good outcomes for people. We recommend that an internal audit of systems be done at least annually as part of quality monitoring. Regular audits should also be carried out on care plans to monitor their accuracy and effectiveness and on medication to identify discrepancies quickly. The home takes care of a small amount of money on behalf of some residents. This is used to pay for hairdressing newspapers and toiletries. Individual records are kept of each transaction. The Old Vicarage (Askam) DS0000048089.V370079.R01.S.doc Version 5.2 Page 25 There are records in staff files of some staff supervision having been done but some staff have no record of this. One showed a staff member who had not received any formal supervision during 16 months of employment. Staff survey comments indicated that some people have not been given formal supervision on a regular basis. The manager should make sure that all care staff have the opportunity to have formal supervision that includes all aspects of practice, the philosophy of care in the home and career development needs. Records did show that fire training had been given to staff. We recommend that the service review its fire risk assessments in light of changing fire regulations and those residents using the smoker’s lounge. Discussions with the management representative, observations and records confirmed that safety checks are being and emergency equipment is being maintained and serviced. Overall the standard of recording in the home is not consistent. The Old Vicarage (Askam) DS0000048089.V370079.R01.S.doc Version 5.2 Page 26 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 3 2 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 X 2 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 2 2 2 The Old Vicarage (Askam) DS0000048089.V370079.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 (1) (2) Requirement Timescale for action 30/09/08 2. OP7 15(2) 3. OP9 13 (2) Records must be kept of the original pre admission assessment and the information gathered, who did the assessment and when it was done and the individuals perspective and wishes. This way people coming into the home can be assured that all their individual needs and expectations have been recorded, assessed and the service is sure it can meet them. The care plans must always be 30/09/08 updated as conditions, objectives and individual care needs alter to ensure care plans always accurately reflect a person’s needs, goals and condition so staff always have up to date information. Records for the administration 30/09/08 and disposal of medicines must be accurate to prevent errors that could affect the health of the people who live there and so that all medicines can be accounted for. The Old Vicarage (Askam) DS0000048089.V370079.R01.S.doc Version 5.2 Page 28 4. OP18 12 (1) (5) 5. OP33 24 (1) (3) The Provider must review the 30/09/08 systems and support available for those who wish to raise concerns through whistle blowing and grievance procedures and the keeping of records of this. This will help ensure resident’s best interests are promoted and promote good professional relationships. An effective quality assurance 30/10/08 and quality monitoring system, using appropriate tools, must be put in place so the service can objectively measure success in meeting the aims, objectives and statement of purpose of the home, to measure success in meeting the home’s aims and the views and expectations of people using the service RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP1 OP3 OP7 Good Practice Recommendations The Statement of Purpose should include the full range of services and support the service gives to residents with dementia including recreational opportunities. The manager should also consider looking at ways to make the assessment and admission process more personalised to the individual. Care plans should be developed along more personcentred lines and include people living there in their development and review with more information to reflect individual perspectives, expectations and support needs. Risk assessments must be reviewed and updated as changes occur so information available to staff is an accurate reflection of the risk to people. Nutritional, psychological and behavioural support needs and conditions need to be consistently monitored where a DS0000048089.V370079.R01.S.doc Version 5.2 Page 29 4. 5. OP7 OP8 The Old Vicarage (Askam) 6. 7. OP9 OP9 8. OP9 9. 10. OP9 OP12 11. 12. 13. 14. OP12 OP18 OP24 OP25 15. OP30 16. 17. OP33 OP33 risk has been identified so prompt action can be planned and taken to meet people’s needs and promote safety. It is recommended that night carers receive training in the safe handling of medicines so that they can administer medication competently when necessary It is recommended that the management of high risk medicines and blood tests is discussed with the department responsible for issuing results so that staff are notified of changes to medication without delay. Care plans should be in place for the disguising of medication in food to show that this is done in the best interests of the person, and to include discussions with people involved in their care. Medicines administration records should be signed at the same time that medicines are given to prevent errors being made. We recommend that particular consideration is given to developing the opportunities for stimulation through recreational activities for people with dementia and other cognitive impairments to suit their preferences and capabilities The manager should make sure that people living in the home have the opportunity to take part in or attend religious meetings and services of their choice. The services policy and procedure on reporting abuse should make it clear that all suspicions of abuse must be reported to Social services. We recommend that in all the shared rooms effective, easily used screening be provided. This will promote privacy during care. The management should look at ways to improve ventilation in the smoker’s lounge and people using this room should have appropriate supervision to minimise health and safety risks. An annual staff training and development programme and forward planning is needed to make sure that the care staff always get the right training they need to do their jobs and fulfil the home’s stated aims and be able to meet the changing needs of people living there, such as dementia care and challenging behaviour. Satisfaction surveys completed by residents should be analysed and collated and the results made available to current and prospective users of the service. We recommend that regular audits should also be carried out on care plans to monitor their accuracy and effectiveness and on medication to identify discrepancies quickly. DS0000048089.V370079.R01.S.doc Version 5.2 Page 30 The Old Vicarage (Askam) 18. OP36 19. OP38 The manager should make sure that all care staff have the opportunity to have formal supervision that includes all aspects of practice, the philosophy of care in the home and career development needs. We recommend that the service review its fire risk assessments in light of changing fire regulations and those residents using the smoker’s lounge. The Old Vicarage (Askam) DS0000048089.V370079.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North West Region 3rd Floor Unit 1 Tustin Court Port Way Preston PR2 2YQ 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. Extracts may not be used or reproduced without the express permission of CSCI The Old Vicarage (Askam) DS0000048089.V370079.R01.S.doc Version 5.2 Page 32 - 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. 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