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Inspection on 18/07/05 for The Old Vicarage (Askam)

Also see our care home review for The Old Vicarage (Askam) for more information

This inspection was carried out on 18th July 2005.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents spoken to liked the staff and spoke well of them and the care they received. Staff members spoken with were aware of the resident`s individual needs and were familiar with these and particular behaviours and interests. Residents said the staff "worked hard for them" and "took time with them". Staff supported residents well in maintaining outside interests and contacts in the community.

What has improved since the last inspection?

The home was improving some of its accommodation for residents by reducing the number of shared rooms and developing additional single rooms with en suite facilities.

What the care home could do better:

The home must make sure that resident`s care plans are updated as changes occur in residents health, personal and social care needs to make sure thatthey reflect the actual situation and do not lag behind. The updated plans must record changes and state in detail the action to be taken by care staff to make sure that all health, personal and social care needs are met. All residents must have a plan of care developed with them on admission to the home for staff to work to, and not rely too much on the daily records for information. The home must make sure that it informs the CSCI when it significantly alters the premises and apply for any necessary variations to registration. The home must provide window restrictors on first floor bedrooms based on an assessment of the vulnerability of and risk to residents using the rooms and so minimise risks to their safety. The home should get residents views on adding variety to the menus and also keep a record of the activities residents have taken part in and enjoyed.

CARE HOMES FOR OLDER PEOPLE The Old Vicarage Ireleth Road Askam in Furness Cumbria LA16 7JD Lead Inspector Marian Whittam Unannounced 18 July 2005 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 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 F58 F10 s48089 old vicarage askam v232539 180705 ui stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Old Vicarage Address Ireleth Road Askam in Furness Cumbria LA16 7JD 01229 465189 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Vicarage Care Ltd Allister Raine Care Home 29 Category(ies) of OP - Old Age registration, with number DE(E) - Demential over 65 of places LD - Learning Disability MD - Mental Disorder The Old Vicarage F58 F10 s48089 old vicarage askam v232539 180705 ui stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19 January 2005 Brief Description of the Service: The Old Vicarage, Ireleth, is a residential care home providing care for 29 people with a range of 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 public house and the small town of Askam with 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 by a stair lift to the first floor. There is a secure garden area at the side of the home with seating for service users. The grounds are well maintained, had seating for service users and were wheelchair accessible. There is also an inner courtyard patio area providing a seating area area close to service user rooms. The home has 4 shared rooms. The Old Vicarage F58 F10 s48089 old vicarage askam v232539 180705 ui stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 18th July 2005. The inspector looked at a number of care plans, looked around the home and spoke with residents and staff members. The manager was not on duty on the day of the visit so some records and documentation was not available for inspection and will be looked at during the next inspection. What the service does well: What has improved since the last inspection? What they could do better: The home must make sure that resident’s care plans are updated as changes occur in residents health, personal and social care needs to make sure that The Old Vicarage F58 F10 s48089 old vicarage askam v232539 180705 ui stage 4.doc Version 1.40 Page 6 they reflect the actual situation and do not lag behind. The updated plans must record changes and state in detail the action to be taken by care staff to make sure that all health, personal and social care needs are met. All residents must have a plan of care developed with them on admission to the home for staff to work to, and not rely too much on the daily records for information. The home must make sure that it informs the CSCI when it significantly alters the premises and apply for any necessary variations to registration. The home must provide window restrictors on first floor bedrooms based on an assessment of the vulnerability of and risk to residents using the rooms and so minimise risks to their safety. The home should get residents views on adding variety to the menus and also keep a record of the activities residents have taken part in and enjoyed. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Old Vicarage F58 F10 s48089 old vicarage askam v232539 180705 ui stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Old Vicarage F58 F10 s48089 old vicarage askam v232539 180705 ui stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4 The system of assessment before admission relies heavily on other agencies, including specialised services, for information on residents needs and preferences. EVIDENCE: Individual care plans showed that resident’s needs had been assessed before admission; social services care management plans, hospital discharge information and individual information from other care settings rather than the home’s own assessment. Following admission individual care plans had been developed from this and the homes daily living skills assessment. The staff said the home manager also did an individual assessment of needs to ensure that the home could meet needs before residents came to live there. However these pre admission assessments were not available for inspection or included in the care plans in use. Specialised services had been involved for residents with particular needs to give information and support before and after admission. Staff had received training that was relevant to the care and welfare of the residents and were familiar with their individual needs and preferences. The Old Vicarage F58 F10 s48089 old vicarage askam v232539 180705 ui stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 and 10 The care planning system was not consistent in updating and reflecting changes to personal and healthcare needs of residents. As a result the information in the care plans did not always reflect the current situation for residents. Personal support was being offered in a way that promoted resident’s dignity and independence. EVIDENCE: Residents had individual plans of care and some risk assessments had been done following admission. However, one recently admitted resident had been in the home 12 days and had not had a care plan detailing the actions that needed to be taken by staff to ensure needs are met. This was despite the pre admission information highlighting that this person had dementia, communication difficulties, a tendency to self neglect, wandering, place objects in their mouth, double incontinence and the need to prompt with food and drinks. Changes in needs and in behaviour were not consistently monitored in care plans so changing needs and situations were not quickly identifiable for staff to take appropriate action. Several assessments were out of date or incomplete in The Old Vicarage F58 F10 s48089 old vicarage askam v232539 180705 ui stage 4.doc Version 1.40 Page 10 plans. Although care plans had been reviewed changes were not always updated in the plans or assessments to reflect an accurate current picture of needs. This was evident with one resident where the daily records over a period of time showed changing skin conditions, pressure areas requiring dressing, confirmation of MRSA, bruising to limbs, swollen feet and decreasing mobility. These progressive changes and the actions staff must follow to meet and monitor the changes and actions taken were not evident in the plan of care or assessments that should provide an up to date picture of changing needs and instructions for staff to follow. The daily progress sheet provided information to follow events on a daily basis but not the actions staff needed to follow. Staff should not rely so much on the daily records as these do not give a full picture. Senior care staff did a daily chart that told staff what jobs to do and was valuable for carers given that changing needs could not be found in the care plan. That this had to be done each day suggests that the care plans were not being used as dynamic and changing individual records of care reflecting changes. Residents spoken with could not recall being involved in drawing up their care plans, discussing changes or being involved with their development. Care plans seen did not indicate that they had been drawn up with the residents where possible. Discussion with staff suggested that they were familiar with residents needs and preferences and that needs were being addressed even though there was a lack of clear up to date care plans. The approach being taken depends heavily on staff memory and care staff having good informal communication systems, with senior staff passing changes onto staff at each shift rather than updating changes and actions needed into care plans for all staff to use. Residents are at risk of not having their health and personal needs met if this informal system breaks down. Residents spoken with said that they felt they were being well cared for and that they were treated with proper respect by staff, with their wishes respected. Residents said that they saw health care professionals in their own rooms and saw their visitors when they wanted to and could come and go as they wanted, as long as staff knew. The Old Vicarage F58 F10 s48089 old vicarage askam v232539 180705 ui stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 The home provides limited social activities and staff supported residents to maintain outside contacts and interests as they chose. Links with the community are good and improve resident’s social opportunities. Dietary needs of residents were being catered for with a nutritious menu that offered choice to residents. EVIDENCE: The home provided some regular activities, recorded resident’s hobbies and interests and organised periodic social events. These were advertised on a board in the foyer. A senior carer coordinated and organised the activities on offer but did not keep a record of what had been done and by whom. Resident’s said that they could come and go as they pleased and see who they wanted to. One resident told the inspector about a holiday to Blackpool they were going on from the home. One group of residents was going to a local pub the next day for a drink and a game of pool. One resident told how they enjoyed going out to get their hair done and go shopping. Residents spoken with said they enjoyed their food and that it was important to them, although one resident felt it was a “bit boring” and another that it was “nice but all the same”. Menus showed a nutritious diet that offered a choice. The Old Vicarage F58 F10 s48089 old vicarage askam v232539 180705 ui stage 4.doc Version 1.40 Page 12 Some residents preferred to remain in their rooms and not join in and were glad that staff respected this. The Old Vicarage F58 F10 s48089 old vicarage askam v232539 180705 ui stage 4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The home has a satisfactory complaints system in place. There were procedures in place to protect vulnerable adults and for whistle blowing these were available for staff in the home. EVIDENCE: The home has a complaints procedure and the procedure was available to residents and on display. Residents spoken to said they thought that the manager would deal with any complaints they made. No one spoken to said they had made a complaint using the procedure. Staff spoken with had received instruction in house on abuse and dealing with aggression to promote resident’s safety and well being. Training records were not available to confirm this and will be looked at during the next inspection. Staff were not aware of any recent complaints having been received and the log was not available as the manager had responsibility for this and was not in. This will be looked at during the next inspection. The CSCI had not received any complaints about the home. The home did not deal with any resident’s personal finances only small amounts of spending money. The Old Vicarage F58 F10 s48089 old vicarage askam v232539 180705 ui stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20 21,22,23,24 and 26 The standard of decoration in the home was satisfactory overall with evidence of recent improvements and more planned to improve the environment for residents. The home was tidy, homely and adequately maintained for residents and had the equipment they need to promote mobility and independence. EVIDENCE: The home was adequately maintained and decorated to provide comfortable and homely surroundings for residents. Resident’s bedrooms seen by the inspector had locks for privacy, satisfactory decoration and had suitable lighting and furnishings. Many rooms had residents own possessions and this made them more personal and homely. Shared rooms had screening in place. The home and the laundry facilities that were clean and procedures were in place for cleaning commodes in the absence of a sluice. The Old Vicarage F58 F10 s48089 old vicarage askam v232539 180705 ui stage 4.doc Version 1.40 Page 15 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. The owners have started a series of improvements to increase the number of single rooms with en suite facilities. One of these bedrooms was now completed and occupied, the resident said that he liked his new room and was pleased with the improvements. However, the owners had not give notice in writing to the CSCI of their proposal to significantly alter the premises of the care home and apply for a variation to their existing registration to make sure that the new bedroom meets the regulations and the requirements of other agencies before it is used. The Old Vicarage F58 F10 s48089 old vicarage askam v232539 180705 ui stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 The numbers and skill mix of care staff on the rotas and on duty during the visit were adequate to be able to meet resident’s needs. EVIDENCE: Staff rotas were satisfactory and observation during the visit suggested that the home had a stable staff group providing continuity for residents and enough staff on duty to provide adequate care during the day and night. There were adequate catering and domestic staff in post. Staff spoken with enjoyed their work and team work and morale was good. Senior staff were on call during the night to support staff if needed. Residents said that care staff were “caring” and “friendly”. There was evidence from observation and from speaking with residents of a good rapport and support between staff and residents with friendly banter and good humour during interactions. The formal training and recruitment records were not available during the visit and will be looked at during the next inspection. However, there was evidence The Old Vicarage F58 F10 s48089 old vicarage askam v232539 180705 ui stage 4.doc Version 1.40 Page 17 from talking with staff and notices to staff that relevant training was being offered and updated and that NVQ training was well established and supported. The Old Vicarage F58 F10 s48089 old vicarage askam v232539 180705 ui stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33 and 38 Resident’s views are sought from time to time but consultation systems must be improved if residents are to affect the way their care and services are delivered. Risk assessment systems for the provision of window restrictors must be improved to safeguard residents. EVIDENCE: There were regular staff meetings and seniors meetings and staff spoken with said they were included in policy making and their opinions were sought. Staff were clear about their roles and responsibilities and lines of accountability were clear in the home. Staff said that residents meetings were not well attended when they had been held. Residents spoken with could not recall there being a residents meeting and one said that “ the owners don’t take much notice”. The home must find ways of making sure that resident’s views are asked for and acted upon as part of its own quality assurance systems. The results of any resident surveys should be made available in the home for anyone who wants to see them. The Old Vicarage F58 F10 s48089 old vicarage askam v232539 180705 ui stage 4.doc Version 1.40 Page 19 There was evidence that staff supported residents who wanted to in their personal interests and development. Windows on the first floor did not have restrictions on opening and there was no evidence of an assessment of this risk to residents based on individual vulnerability or a record kept of the assessment outcome and any restrictors provided based on the assessments. The Old Vicarage F58 F10 s48089 old vicarage askam v232539 180705 ui stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION x 3 3 3 2 3 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 2 x x x x 2 The Old Vicarage F58 F10 s48089 old vicarage askam v232539 180705 ui stage 4.doc Version 1.40 Page 21 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 (1) (2) Requirement All residents care plans and assessments must be reviewed and updated to reflect changes in condition and needs and the actions to be taken by staff. This was to have been met 31.1.05 All residents must have a plan of care drawn up on admission to the home. Care plans must be drawn up with residents wherever possible. The registered person must give notice in writing to the CSCI if they intend to significantly alter the premises and apply for a variation to ensure the alterations meet the required standards. Residents views must be sought as part of the homes quality monitoring. Window restrictors must be provided, based on assessment of vulnerability of and risk to residents Timescale for action 13.9.05 2. 3. 4. OP7 OP7 OP 23 15 (1) 15 (1) 39 (h) 13.9.05 13.9.05 30.8.05 5. 6. OP33 OP38 24 (1) (3) 13 (4)(a) (c) 13.9.05 30.8.09 The Old Vicarage F58 F10 s48089 old vicarage askam v232539 180705 ui stage 4.doc Version 1.40 Page 22 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. 4. Refer to Standard OP15 OP7 OP12 OP33 Good Practice Recommendations The home should consult with residents to get their ideas on more variety on the menu. The daily records should not be relied on too heavily for information and monitoring. Records should be kept of the activities that residents take part in. The results of any residents surveys should be available for anyonme who wants to see them. The Old Vicarage F58 F10 s48089 old vicarage askam v232539 180705 ui stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith, Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 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 F58 F10 s48089 old vicarage askam v232539 180705 ui stage 4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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