CARE HOMES FOR OLDER PEOPLE
The Old Vicarage (Askam) Ireleth Road Askam In Furness Cumbria LA16 7JD Lead Inspector
Marian Whittam Unannounced Inspection 26th January 2009 10:00 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.V373835.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.V373835.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.V373835.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). 18th August 2008 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 residents’ rooms. Information is available to prospective residents in the Statement of purpose and service users guide; this and the latest inspection report are 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.V373835.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 1 star. This means the people who use this service experience adequate quality outcomes. This site visit forms part of a key inspection carried out by two inspectors at The Old Vicarage on 26th January 2009. We (The Commission For Social Care Inspection, CSCI) were in the home for a total of five hours. 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 and a half 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. All providers of registered services provide this self assessment annually. The service history. Observations made by us in the home during the visit and during the time we spent talking with people living there. Interviews with residents, visitors and staff on the day of the visit. Information we have about any complaints made about the service. • • • • 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. What the service does well:
The people living at the Old Vicarage have a well maintained, homely and comfortable place to live. We found the home to be generally clean and tidy, and people living there had been able to bring in some of their own things and make their rooms more personal and familiar with pictures, ornaments, photographs and some small items of their own furniture. The Old Vicarage (Askam) DS0000048089.V373835.R01.S.doc Version 5.2 Page 6 Staff members are aware of people’s individual needs and are familiar with these and particular personal interests and how they want to be supported. 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, District Nurses and GP’s to try to get help and support for people when they identify the need. Regular checks or audits of medication are done to monitor the management of medicines and to help keep people safe. Feedback from people living there was generally positive about the staff and the food provided and comments such as; “I get on well with the staff” and “I like living here”, were received. 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. People are encouraged to handle their own affairs and supported to be as independent as they can be. What has improved since the last inspection?
Since the last inspection the management and staff have been working towards meeting the requirements and recommendations made to improve the service. They have been effective in achieving several changes to improve outcomes for people living in the home. The service has improved its pre-admission assessment process and clear records are now kept of the initial assessment before the decision is taken for the person to come to live there. 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. Greater involvement of the prospective resident in this assessment helps to make the process of admission more personal and consider their feelings and expectations rather than just as part of a process. The Old Vicarage (Askam) DS0000048089.V373835.R01.S.doc Version 5.2 Page 7 The care plans have been improved and we could see that they were being updated when reviewed and changes made to plans when they occurred. A sample is also being audited for quality monitoring. Risk assessments were being reviewed and updated as changes occur so information available to staff is more of an up to date reflection of the risk to people. Nutritional, psychological and behavioural needs and conditions are being assessed and monitored where a risk has been identified so prompt action can be planned and taken to meet people’s needs and keep them safe. A thorough review of the care plans has resulted in the introduction of a much more individualised and person centred approach to planning the care and support people need and want. The manager has now begun including a section in the care plans for recording professional visits from doctors and other healthcare professionals so that the information is easily accessible for reference. This follows a recommendation made by our Pharmacy Inspector at their recent visit. Regular audits are now being carried out on medication records and care plans to improve the monitoring of their accuracy and effectiveness and to identify discrepancies quickly. The owners of the home have discussed the safe management of blood-thinning medication with the haematology department at the hospital where blood is tested. This has helped to improve the way this medication is handled. The Provider has looked at the support available for those who wish to raise concerns through whistle blowing and grievance procedures to try to help ensure they feel able and safe to report practice matters. Improvements have also been made to the efficiency in reporting any concerns the management have about safeguarding issues to social services to protect the interests of people living there. Improvements have continued in redecorating and refurbishing bedrooms and en-suite bathrooms to improve the environment for people living there. As part of this, improvements have been made to screening in one of the double rooms to promote greater privacy during care. Improvements have been made in the development of a consistent quality assurance and quality monitoring system, so the service can objectively measure its success in meeting the aims, objectives and statement of purpose of the home. Improvements have been made to the way staff training is planned and monitored. There is now an annual staff training and development programme and improved forward planning was evident 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. The Old Vicarage (Askam) DS0000048089.V373835.R01.S.doc Version 5.2 Page 8 What they could do better:
The manager should make sure that the information given to people is clear about the specialised services and support provided for people with dementia. People considering coming to live at the home who have dementia and their representatives supporting them need to know what is on offer to meet their needs, including opportunities for activities and recreation to suit their needs. Although most records for administration of medication are being well completed, staff should take care to avoid omissions and ensure that medication is administered as prescribed so that people receive the correct treatment. When people spent time away from the home the staff packed their medicines into cassettes for family to administer. This is called secondary dispensing. It is recommended that the home discuss secondary dispensing of medication with the pharmacy to identify safer ways of supplying medication for periods of leave. Staff do support people, who are more able, to be independent and join in the local community. However for those who are less physically able or have greater cognitive impairments, there are still fewer opportunities for them to take part in doing things that have meaning to them. We recommend that particular consideration be given to developing the opportunities for stimulation through meaningful recreational activities for people with dementia and other cognitive impairments to suit their preferences and capabilities. The manager should continue the work, already started on trying to do this. The manager should also make sure he continues the work started on maintaining a more open culture in the home so staff can have confidence they will be well supported by an organisation that has people’s protection and safety as a priority. A copy of reports made by a member of the organisation under Regulation 26 should be kept and be available for inspection. This will help ensure that someone other than just the registered manager is monitoring the effective and efficient running of the business. As part of its overall quality monitoring the manager should make sure there is a system for making clear when policies and procedures have been reviewed and changed, and when reviews are due to make sure none get overlooked. Improvements have been made generally to the maintenance of a pleasant environment in the home but to improve the environment and people’s safety, we recommend that the manager makes sure that that the arrangements for ventilating the smokers’ room meets local authority guidance to be sure people’s health and safety are promoted. The management team and staff have been working to develop the service and improve it for people living there. They need to make sure they maintain the improvements and continue to build upon them to further improve the home and the services it offers to people.
The Old Vicarage (Askam) DS0000048089.V373835.R01.S.doc Version 5.2 Page 9 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.V373835.R01.S.doc Version 5.2 Page 10 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.V373835.R01.S.doc Version 5.2 Page 11 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): NMS 3, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Assessments of people’s needs are done before they come to live in the home to make sure they can be met and relevant information is provided to help people make an informed decision about living there. EVIDENCE: A combined statement of purpose and service user guide is available for prospective residents and their families and this includes the home’s complaints procedure. This has been reviewed and information updated and can be made available in large print if requested and a summary of the last inspection report is included in the information for people. The Old Vicarage (Askam) DS0000048089.V373835.R01.S.doc Version 5.2 Page 12 The manager should make sure that the information given to people is clear about the specialised services and support provided for people with dementia. People considering coming to live who have dementia and their representatives supporting them need to know what is on offer to meet their needs, including opportunities for activities and recreation to suit them. We looked in detail at the pre-admission assessments for five people living in the home, including new residents, to make sure that a full assessment of their needs had been done by an experienced member of staff before the decision was made to offer them a place and that the individual had been involved in this assessment. Involving the person in this process makes it less impersonal and allows for their feelings on this change to be considered. We found that the people had pre admission assessments in place. Individual care plans showed that before coming to live in the home people had their personal, health and social needs assessed to make sure the home was able to meet an individual’s needs. The pre-admission assessments we looked at contained sufficient information from which to develop an individual care plan. This information ensures the staff are aware of the level of care required to meet the different needs. Where assessments had been done by a social worker through care management arrangements the home had a copy on file. The home has a settling in/trial period followed by a review to make sure needs are being met and the home suits the resident. We looked at the records of these reviews done with the individual, their family and people involved in their care to make sure the home was meeting their needs and expectations. 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.V373835.R01.S.doc Version 5.2 Page 13 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 adequate. 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 extra care is needed to ensure medication records are always complete and accurate to fully protect the health of the people who live there. EVIDENCE: All people living in the home have an assessment of their daily living needs and a care plan setting out the care they need and generally their preferences. During the visit we looked at a sample of five people’s care plans in detail. We found that improvements had been made to the way people’s care plans were developed with them and their needs identified and recorded. The plans were more focussed on the individual’s perspective than at the previous visit with more individualised information and plans based more upon what kind of support people wanted. The Old Vicarage (Askam) DS0000048089.V373835.R01.S.doc Version 5.2 Page 14 The care plans we looked at were person centered and showed sensitivity to helping new people to settle in and meet particular needs and preferences. For example, one person’s view of how their condition can affect them was made clear and what they wanted staff to do and be aware of when they showed that particular behaviour. Observing staff going about their duties and talking with residents during the day we could see that they were polite and respected individuals’ privacy. From records being kept we could see that people living there have access and to health care services and support agencies. Overall, we found that medicines were being managed adequately. The receipt of medication was well recorded. The service had a system of checking medicines for disposal against medicines administration records so that discrepancies can be identified and addressed as a means of improving the handling of medicines. Visits by, and information from, doctors were well recorded in residents’ care records so that changes to medication could be tracked. The manager was in the process, following the recent pharmacy inspection, of improving the records of professional visits to make this easier to monitor quickly and tell at a glance why medications had been changed. We looked at medicines administration records and these continued to include some errors that could leave residents at risk from inappropriate treatment. We found some records that had not been signed and we could not tell if medication had been given or not. Other records were signed in error when medicines had not actually been given. Medication changes were not always dated so we could not always tell what was administered on a given date. We saw a new dose of a medication that had not been accurately transcribed from one administration record to another at the start of the new month. We counted a sample of medicines and compared them with records. In most cases, these were in order and showed that medicines were mostly given in the correct dosage. However, occasional discrepancies were found when odd tablets were missing and could not be accounted for. The owners of the home had discussed the safe management of blood-thinning medication with the haematology department at the hospital where blood is tested. This has helped to improve the way this medication is handled. However, residents’ booklets where blood tests and dosage recommendations are recorded are sometimes not available for staff to refer to, as they are updated by haematology and then posted back. We recommend that the home review records kept in the home for this medication so staff are able to refer to them at all times. The Old Vicarage (Askam) DS0000048089.V373835.R01.S.doc Version 5.2 Page 15 When people spent time away from the home the staff packed their medicines into cassettes for family to administer. This is called secondary dispensing and is not a recommended practice as errors can occur. It is recommended that the home discuss alternative ways of managing this with their pharmacy to reduce the risk of dispensing errors and to ensure medicines are properly labelled. Since the last pharmacy inspection most night staff have received training in the safe handling of medicines. We were told that there is always trained staff on duty so that residents can receive their medication safely at all times of the day. The home also does regular checks, or audits, of medication to check for discrepancies that can be dealt with promptly to keep people safe. The Old Vicarage (Askam) DS0000048089.V373835.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Many people living at the Old Vicarage are able to make choices about their lifestyles and access the community but people with cognitive impairments may not always have the same organised or individually supported opportunities for stimulation through recreation. EVIDENCE: The routines in this home are generally flexible to meet the needs of those living there that wish to go out or pursue their own hobbies and interests and maintain their contacts and friendships outside the home. For example, we saw on pre-admission information that one person wanted to maintain contacts with friends in a nearby town and he had been able to do this and they had been accompanied to meet with these friends on the day of the visit. Discussion with staff confirmed this person was able to go out daily as stated as their preference in the care plan. The Old Vicarage (Askam) DS0000048089.V373835.R01.S.doc Version 5.2 Page 17 There are regular visits to the home from a qualified hairdresser or people can continue with their own arrangements if they want. The home does not have in-house religious services but will arrange for people to attend their own religious services if they want or for their own clergy or priests to visit them and their religious preferences or requests are recorded. Staff do support people, who are more able, to be independent and join in the local community. However for those who are less physically able or have greater cognitive impairments, there are still less opportunities and individual support for them to take part in doing things that have meaning to them or based on their capabilities. There was no evidence of any individualised recreational planning for this in the care records or information on recreational facilities for specialised dementia care in the Statement of Purpose. We recommend that the manager continue the work, already started on trying to improve recreational opportunities, to ensure they can offer and support meaningful opportunities that suit the capabilities of the people with dementia and other cognitive impairments such as sight, hearing and learning disabilities. The work that had been done at the last inspection on getting ‘pen pictures’ of people and better information of people’s backgrounds, social and recreational expectations has been developed further. As part of the more individualised assessments and care planning, there is more information for staff about people, their previous occupations, families and what was important to them. This kind of information should help staff to support individuals to do things that hold meaning for them. The daily activities on offer are displayed on the notice board. People told us they had watched a film the day before and the activity that afternoon was manicure and hand massage held in the conservatory for those who were interested. There is now a carer designated for activities to help ensure people are supported more in the home to take part in recreational opportunities if they want to. The more able residents go into the village for newspapers and to collect their pensions and personal shopping items and some attend a local pensioners club. Residents also go into Barrow in Furness to Social Services/ Benefit Office on local public transport. Other people went out for walks in the village and down to the local beach. One person with an interest in gardening was able to grow some vegetables in the gardens. The people living in the home have a choice of meal at each mealtime and there is a four-week menu in place. People we spoke to confirmed they had a choice of food at meal times and we received only positive comments on the quality and variety of food provided. The service catered for special diets such as diabetic. The Old Vicarage (Askam) DS0000048089.V373835.R01.S.doc Version 5.2 Page 18 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 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 and adult protection procedures in the home to help promote the safety and interests of people living there but a lack of staff understanding of the investigations and actions taken could undermine people’s confidence in the system. 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 registered manager said that there had been no complaints made to them since the last inspection. We examined the complaints log and there had been no complaints logged since 2006. We were told during the visit about a complaint that had recently been made by a staff member about a work matter. We discussed this with the Manager who confirmed they had spoken with the people concerned and the management were currently monitoring the team situation. This complaint was on a matter of employment and staff interaction and did not involve anyone living in the home. The Old Vicarage (Askam) DS0000048089.V373835.R01.S.doc Version 5.2 Page 19 There was a brief personnel record made of this complaint being raised and investigated under the service’s procedures and notes had been made. We also discussed with the manager how they maintained confidentiality when investigating concerns raised by staff and issues between staff. The manager had found that some staff felt team differences should be settled in a public way that could compromise confidentiality. We recommended that he continued the work he was doing to make staff aware of the need to maintain people’s confidentiality during any investigation of workplace issues. The management team was continuing to address this issue through raising staff awareness and understanding around confidentiality at staff meetings and at supervision. The manager has reviewed the support available for those who wanted to raise concerns through whistle blowing and grievance procedures to try to help ensure they felt able to report any poor practice to the manager. The management team should continue with its efforts to maintain this more open and transparent culture as part of the service’s long term development. 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 in the workplace to the management. The manager has done a training course, run by social services, on protecting vulnerable adults and gives this training to staff and most staff have had this training. Updates on working with people with challenging behaviour and safeguarding adults are also planned as part of the new training programme. The home had the new multi agency adult protection procedures that, the manager confirmed, will be introduced at the planned staff meeting the next day. The manager had prepared an informative handout for staff highlighting their main responsibilities in protecting people from abuse. We discussed this with the management team who had decided this was needed because, although staff had training on how to report concerns and to whom, they needed more in depth training regarding possible scenarios they may encounter in their work. The manager was following correct procedures for safeguarding referrals and had appropriately referred such an instance to Adult Social Care on the morning of the visit to promote the safety and welfare of people living there. The management of the home worked well with other agencies during the previous investigation of a concern to safeguard and promote the interests of residents. Improvements and changes have been made by the management team in dealing with complaints and working with staff to ensure people living in the home are safe. The challenge for the management team now is to make sure The Old Vicarage (Askam) DS0000048089.V373835.R01.S.doc Version 5.2 Page 20 these improvements are robustly maintained as part of their continued development. The Old Vicarage (Askam) DS0000048089.V373835.R01.S.doc Version 5.2 Page 21 The Old Vicarage (Askam) DS0000048089.V373835.R01.S.doc Version 5.2 Page 22 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, 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 Old Vicarage is being maintained and updated and the premises are kept to a satisfactory standard of cleanliness. EVIDENCE: We made a tour of the premises and we could see that routine redecoration and general maintenance of the home is being done maintenance and servicing records are kept. Internal redecoration has continued and more bedrooms have been redecorated and refurbished to improve the environment for people living there. One person living there showed us the new bathroom in their room and new furniture and they said they were pleased with these improvements. The Old Vicarage (Askam) DS0000048089.V373835.R01.S.doc Version 5.2 Page 23 Overall, the home was clean and comfortable although there was a slight smell of urine noticeable in one area, for which the reason was known and being addressed. People living there are encouraged to personalise their rooms and we saw that many have done so with pictures, ornaments and photographs. 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, including a stair lift. Over half the bedrooms have en-suite facilities and there are sufficient toilets, assisted baths and showers for people to use. People’s bedrooms are fitted with locks for their use, if they choose, and we found several people used this and locked their rooms when they went out of the home. The home has 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 smokers’ room on the ground floor and an open internal courtyard smokers can use, with seating and plants. The smoking room is only used by those people living in the home that wish to smoke and not by other non-smokers living there. There is no extraction system for removal of smoke from the smoking room and natural ventilation is provided to remove smoke by opening the windows. The manager has updated the home’s fire risk assessments and in line with changes in fire regulations. Staff do check the smokers lounge when it is in use to promote people’s safety and make sure no one is at risk. However, as the smoke from the room can ventilate into the foyer of the home, we recommended that the manager made sure that that the arrangements for ventilating the smokers’ room meet local authority guidance. This will help to make sure people’s health and safety are promoted in line with relevant guidance. There are three bedrooms that can be shared but this is only done with the agreement of the people using this service. Curtains are now provided in all the shared rooms for privacy and dignity when delivering personal care. We looked at the home’s laundry facilities, which although small, were well organised, clean and tidy. Care staff attend to the laundry as part of their duties during the day. The home has infection control procedures in place and the staff were seen to be following appropriate procedures, using gloves and appropriate protective clothing for personal care and these were available in bathrooms and toilets as well. COSHH substances, these are substances that may be hazardous to people, were locked away for safety. The Old Vicarage (Askam) DS0000048089.V373835.R01.S.doc Version 5.2 Page 24 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 good. This judgement has been made using available evidence, including a visit to this service. The people living at the Old Vicarage are protected by a thorough recruitment process and supported by sufficient experienced staff who know them well. EVIDENCE: During the visit we looked at staff recruitment records and found them to be in good order. Prospective staff had completed an application form, supplied referees and attended for interview. Security checks, such as Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) first had been done prior to new staff to starting work. This helps to ensure that the right staff are employed and the safety and protection of those living in the home is promoted. We looked at staff rotas and observed the use of staff in the home during the visit and found these to be satisfactory for the current number and physical needs of the people living there. There were five care staff on duty during the busy morning period and a supervisor and four carers and a supervisor during the afternoon. One person working 8am until 4pm is responsible for ensuring activities take place in the afternoons and the service has two domestic assistants and two
The Old Vicarage (Askam) DS0000048089.V373835.R01.S.doc Version 5.2 Page 25 cooks covering the week. There are two waking night staff on the rota to support people at night. The management team has been continuing to develop and formalise staff training plans and records. We examined the annual training plan displayed on the wall in the office showing that all mandatory training is planned for this year. Infection control was the next planned to take place the following month and Moving and Handling training had already been done with some staff as updates and for all new starters. The manager is now using better forward planning to make sure that the care staff consistently 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. We could see that updates on working with people with challenging behaviour and safeguarding adults training were also scheduled on the plan. Consequently, we were, at this visit, more easily able to assess the evidence on what training and development each member of staff had done, asked for or needed to do or update. The challenge for management is to ensure these improvements in planning and training are maintained in the long term and carried out as planned. We discussed the improvements made with the manager who expressed an understanding of this need and a good level of commitment to achieving it. The new multi agency adult protection procedures were due to be introduced at the main staff meeting next day. The manager has done a useful handout for staff highlighting their main responsibilities in this to update them. We could see that staff had induction training records and there was information on what training staff had done and when it had been done. One person’s induction record could not be found when asked for and the manager said the staff member must still have it. We talked to staff members about the training they received and their comments were positive and that they had better access to training and felt supported to undertake courses. They told us that they had access to NVQ at levels 2 and 3 training and several had completed these courses and others were enrolled on it. The service has achieved over 50 of care staff with NVQ level 2 in care or above. We spoke with one staff member who said they enjoyed their work and thought they were a “good team”. The Old Vicarage (Askam) DS0000048089.V373835.R01.S.doc Version 5.2 Page 26 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. Procedures are in place at the Old vicarage to safeguard residents’ financial interests and promote their health, welfare and safety. 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 the registered manager and his two brothers who undertake different roles in the management team running the home. The Old Vicarage (Askam) DS0000048089.V373835.R01.S.doc Version 5.2 Page 27 There are staff meetings being held in the home to allow staff and management to discuss practices and care issues affecting the way the home is operating. The last staff meeting was in August last year and the next is planned for the day following our visit. Supervisors meet more frequently with the management team and they last met earlier this month which covered medications, activities and safeguarding. They do not produce formal minutes of these meetings but keep a record of what was discussed in a book specifically for meetings. The manager told us that the management team has an “open door” policy for staff and residents. We talked with staff in the home and their general comments indicated that the manager was accessible and one person said they were “always happy to listen”. Staff have a grievance process and policies and procedures on bullying to use if they feel they need to. However, despite this, some staff, whilst finding the management team “friendly” and “good lads”, did not have total confidence in them to deal with difficult complaints and concerns effectively. From the changes already made on complaints and whistle blowing procedures it was evident that the management team are working to raise staff understanding and awareness around raising concerns and confidentiality. We discussed all these matters with the manager who has already reviewed the systems and support for whistle blowing and keeping staff informed within the boundaries of confidentiality. The manager accepts the management team have to maintain their efforts to promote openness and transparency in managing and running the home to help gain staff confidence and that this will take time to achieve fully. Staff did confirm that they were receiving supervision and there were records on file signed by staff and the person carrying out the supervision. There is now a supervision rota in place to try to ensure staff receive this support as planned. Some staff told us they would probably be more likely to raise any concerns about practice issues or colleagues at supervision now as it was a less public forum than meetings. Most people handle their own money or with help from their representatives but 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. Records are kept of each transaction in people’s individual records and we checked some of these and they were being accurately recorded. The manager has carried out reviews on some policies and procedures but should make sure they have a system for making clear when this is done and reviews due to make sure none get overlooked. The manager has improved quality monitoring by buying in a quality monitoring system and tools supporting them to do quality assurance audits across the service. There was evidence that audits were now being carried out in some areas, such as medication practices and care plans. We advised they continue this work to
The Old Vicarage (Askam) DS0000048089.V373835.R01.S.doc Version 5.2 Page 28 implement the system fully to be able to assess success in meeting their aims and identifying areas they need to improve. The manager has used periodic surveys to ask residents and relatives for their views. We asked to see records of visits required under regulations by a member of the organisation other than the registered manager where they speak with residents, their representatives and staff to get their views and form an opinion of the standard of care being provided. These have not been done formally and a written report should be prepared and kept for inspection. This can also be useful in assisting in their overall quality monitoring. We looked at accident records and these were being completed and kept securely. Records did show that fire training had been given to staff on both day and night duty at appropriate times, including a written test this year. Discussions with the management, observations and records held confirmed that safety checks are being done and emergency equipment is being maintained and serviced to protect people’s safety. The Old Vicarage (Askam) DS0000048089.V373835.R01.S.doc Version 5.2 Page 29 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 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 3 3 X X 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 3 2 3 The Old Vicarage (Askam) DS0000048089.V373835.R01.S.doc Version 5.2 Page 30 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 OP9 Regulation 13 (2) Requirement Records for the administration and disposal of medicines must be accurate to prevent errors that could affect the health of the people who live in the home. Timescale for action 20/02/09 The Old Vicarage (Askam) DS0000048089.V373835.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The Statement of Purpose should include the full range of services and support the service gives to residents with dementia and other cognitive impairments, including recreational opportunities. It is recommended that the home discuss secondary dispensing of medication with the pharmacy to identify safer ways of supplying medication for periods of leave. We recommend that particular consideration be given to developing the opportunities for stimulation through meaningful recreational activities for people with dementia and other cognitive impairments to suit their preferences and capabilities. We recommended that the manager continue to make staff aware of the need to maintain people’s confidentiality during any investigation of workplace issues and that the management team continue with its efforts to maintain an open and transparent culture as part of the service’s long term development. We recommended that he manager should continue the work started on building a more open culture in the home and continue to maintain and develop the improvements made in handling complaints and safeguarding issues. We recommend that the manager makes sure that that the arrangements for ventilating the smoker’s room meets local authority guidance to make sure people’s health and safety are promoted. The manager should make sure there is a system for making clear when policies and procedures reviews are done and when reviews are due to make sure none get overlooked. A copy of reports made by a member of the organisation under Regulation 26 should be kept and be available for inspection. This reporting will help ensure that someone other than just the registered manager is monitoring the effective and efficient running of the business. 2 3 OP9 OP12 4. OP16 5. OP18 6. OP25 7. OP33 8. OP37 The Old Vicarage (Askam) DS0000048089.V373835.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection NW Regional Office Unit 1, 3rd Floor 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
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