CARE HOMES FOR OLDER PEOPLE
The Old Vicarage (Askam) Ireleth Road Askam In Furness Cumbria LA16 7JD Lead Inspector
Marian Whittam Unannounced Inspection 29th November 2005 10:30 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.V259630.R01.S.doc Version 5.0 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.V259630.R01.S.doc Version 5.0 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 Care Home 29 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 (25) The Old Vicarage (Askam) DS0000048089.V259630.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th July 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 with seating close to service user rooms. The Old Vicarage (Askam) DS0000048089.V259630.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on 29th November 2005. The inspectors looked around the home and spoke with residents and staff members. Staff records, training records and care plans were examined and a selection of records required by regulation. The pharmacy inspector did an inspection at the same time looking at medicine handling and practice with the senior carer. A full report on the findings of the pharmacy inspector is available from CSCI Penrith office. What the service does well: What has improved since the last inspection?
Residents were signing their care plans, where possible, and where they wanted to. This was to reflect their acknowledgement of the contents of their plans. All residents who have been recently admitted to the home have a care plan done when they come into the home. The home’s owners are continuing to develop the home and provide 3 more single bedrooms with en suite facilities, reducing the number of shared rooms and improving the standard of accommodation. One of the new rooms is occupied and others are nearing completion. The home has assessed the risk to residents and restricted the opening on windows in some bedrooms. The manager has applied for registration with the CSCI and has done the NVQ level 4 manager award.
The Old Vicarage (Askam) DS0000048089.V259630.R01.S.doc Version 5.0 Page 6 Since the previous inspection the manager had introduced a system for identification of residents for medicines administration. Clear records were kept for receipt and disposal of medicines. What they could do better: 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
The Old Vicarage (Askam) DS0000048089.V259630.R01.S.doc Version 5.0 Page 7 contacting your local CSCI office. The Old Vicarage (Askam) DS0000048089.V259630.R01.S.doc Version 5.0 Page 8 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.V259630.R01.S.doc Version 5.0 Page 9 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 the following standard(s): 3 and 4 An assessment for care planning is being done and information from other agencies is obtained to provide staff with the information they need to plan care and meet resident’s needs when they come in. EVIDENCE: Daily living skills assessments are done before admission and updated following admission and individual care plans are developed from this. 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 The home manager does an individual assessment of needs to ensure that the home could meet needs before residents came to live there. Specialised services had been contacted and 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 (Askam) DS0000048089.V259630.R01.S.doc Version 5.0 Page 10 The Old Vicarage (Askam) DS0000048089.V259630.R01.S.doc Version 5.0 Page 11 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 the following standard(s): 7, 8, 9 and 10 The care planning system was not consistent in reflecting changes to personal and healthcare needs of residents. As a result the information in the care plans did not always reflect all the current needs of residents. The systems for the handling of medication need to be improved to ensure that resident’s medication needs are safely met. 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. Some moving and handling assessments were not complete. Although care plans had been reviewed monthly changes noted over that month in the daily notes were not always updated in the care plans or assessments to reflect an accurate picture of individual needs and how they are to be met. Changes in psychological health and in behaviour were not consistently monitored for some residents so changing needs and situations were not recorded and monitored for staff to take appropriate action. This was evident with one resident where the daily records showed aggressive behaviour, affecting other residents, over a period of time but no plan of care
The Old Vicarage (Askam) DS0000048089.V259630.R01.S.doc Version 5.0 Page 12 and management had been developed to deal with this in either the short or long term. The behaviours being exhibited and the actions staff must follow and monitoring systems were not evident in the plan of care. No changes had been made to the initial psychological assessment done on admission to reflect the changes in behaviour or if other agencies were being involved to deal with this. Medication handling, record keeping, medication audit trails and liaison with prescribers and the pharmacy needed to be improved. Assessments for self medication need to be done and better multi disciplinary consultation and consent from residents on crushing medications for covert administration. Care plans had been signed by residents to acknowledge their involvement where this had been possible and where they wished to. Speaking with and observing staff suggested that they were familiar with residents needs and preferences and that needs were being addressed even though the care plans did not always state them clearly. Staff know the residents well and pass information on verbally to one another. This approach depends heavily on memory and care staff having good informal communication systems. Residents are at risk of not having all their health and personal needs met if this informal system breaks down. A resident spoken with said that they felt they were being well cared for and that they were, “treated properly” by staff. Residents said that they saw doctors and district nurses in their own rooms and saw their visitors when they liked and could come and go, as they wanted, as long as staff knew. The Old Vicarage (Askam) DS0000048089.V259630.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 12 and 15 The home provides social activities and staff support residents to maintain outside contacts and interests as they chose. Links with the community are good and promote resident’s social opportunities. Dietary needs of residents are being met with a varied menu that offered choice to residents. EVIDENCE: The home provided some regular activities, recorded resident’s hobbies and interests and organised social events from time to time. It was evident that staff viewed spending time with residents and helping them with their interests as a normal part of daily routines. A senior carer coordinated and organised the activities on offer a record is not kept of what activities residents had had been done. Resident’s said that they could come and go as they pleased and see who they wanted to. One resident spoke of the holiday they had been on to Blackpool. Some of the residents were going to a local pub for a drink and a game of pool and some of the female residents were going to the hairdressers during the afternoon of the visit. 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, Menus showed a nutritious diet that offered a choice and catered for
The Old Vicarage (Askam) DS0000048089.V259630.R01.S.doc Version 5.0 Page 14 special diets. The cook also helped residents with baking which several enjoyed doing. The Old Vicarage (Askam) DS0000048089.V259630.R01.S.doc Version 5.0 Page 15 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 the following standard(s): 16 and 18 The home has a satisfactory complaints system in place and available to residents and visitors. There were procedures in place to protect vulnerable adults and for whistle blowing these were available for staff in the home. However up to date training is needed to raise staff awareness and promote the safety of residents. EVIDENCE: The home has a complaints procedure available to residents and on display. Staff spoken with are aware of the home’s policies on abuse and aggression and multi agency guidelines. Some staff did not have recent training on adult protection and recognising abuse and some were not familiar with whistle blowing procedures. Although the staff spoken with were clear about what they as individuals would do if they suspected abuse this training must be brought up to date to promote staff clarity and resident safety. There is not a clear system for recording when training has been given to staff and what training is needed. The home has a system for recording, tracking and responding to complaints. There have been no complaints logged since the last inspection and CSCI has not received any complaints about the home. The home did not deal with any resident’s personal financial arrangements only small amounts of spending money. The Old Vicarage (Askam) DS0000048089.V259630.R01.S.doc Version 5.0 Page 16 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 the following standard(s): 19,20, 21 and 25, The standard of decoration in the home is satisfactory with evidence of continuing development to improve the environment for residents. Changes to the current smoking facilities would further improve the environment for residents. The home was clean, tidy and adequately maintained for residents and had the equipment they need to promote mobility and independence. EVIDENCE: The home planned for improvements to the premises for the coming year. The owners have started a series of improvements to increase the number of single rooms with en suite facilities. The dining and lounge areas were clean, well lit, comfortable and homely. There is a strong smell of cigarettes and cigarette smoke as people come into the home along the hallway and the ground floor corridors. This comes from the room used by smokers off that corridor that does not have a ventilation system to remove the smoke. The home must review and improve its facilities for smokers and consult with residents to make sure that provision is made for
The Old Vicarage (Askam) DS0000048089.V259630.R01.S.doc Version 5.0 Page 17 them in the home that does not affect the health and environment of other residents and visitors to the home. Resident’s bedrooms seen by the inspector had satisfactory standard of décor and furnishings. Many rooms had residents own possessions and this made them more personal and homely for residents living there. The home was clean and tidy and 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. Whilst the home was generally well maintained one resident had a broken and a loose window catch in their bedroom making the window loose, rattling, was creating a draft and it must be fixed. The Old Vicarage (Askam) DS0000048089.V259630.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 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. The procedures for the recruitment of staff are satisfactory and offer protection to people living in the home. Staff training was established in the home and induction and foundation training provided to promote a competent staff group to care for residents. However records of training must be clear to make sure staff are up to date. EVIDENCE: Staff rotas are satisfactory and observation and discussion with staff during the visit suggested that the home had a stable and motivated staff group providing continuity for residents. There were adequate catering and domestic staff in post. Training for NVQ Level 2 and 3 was well supported and over 50 of the staff had achieved this qualification. Staff had received induction and foundation training. However although it was evident that training was being provided relevant to the resident groups the training records were not clear regarding what had been done, when and what was needed for each staff member. The staff are clear about the training they had and were going to do. Satisfactory recruitment and selection procedures and criminal record checks had been followed for staff working in the home.
The Old Vicarage (Askam) DS0000048089.V259630.R01.S.doc Version 5.0 Page 19 The Old Vicarage (Askam) DS0000048089.V259630.R01.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36 and 38 Management is well supported by senior staff and are is aware of its responsibilities towards residents and staff. Procedures and practices are in place which safeguard resident’s financial interests and promote their health, safety and welfare. EVIDENCE: The home is in the process of registering the manager with the CSCI. There are regular staff meetings and seniors meetings and staff spoken with said their opinions were sought. Staff receive regular supervision and staff spoken with felt supported in their work and development. Staff said that residents meetings were not well attended when they were held. A resident spoken with said they told staff if there was anything they did not like and felt that staff would “have a talk and listen to them”. Staff spoken with said that they felt they felt that residents made their own choices. Observation suggested that positive, supportive relationships have been formed between staff and residents.
The Old Vicarage (Askam) DS0000048089.V259630.R01.S.doc Version 5.0 Page 21 There was evidence that staff supported residents in their personal interests and development and in maintaining contacts and interests outside the home. Records showed that fire training had been given and emergency equipment is checked and appliances serviced. The Old Vicarage (Askam) DS0000048089.V259630.R01.S.doc Version 5.0 Page 22 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 X X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 X X X 2 X 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 2 3 3 X X 3 X 3 The Old Vicarage (Askam) DS0000048089.V259630.R01.S.doc Version 5.0 Page 23 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 reflect identified changes in condition and needs and state the actions to be taken by staff. Resident’s psychological health must be monitored regularly and care planned accordingly. To maintain accurate medicines administration records. This was to have been met by 01/10/05 To liaise with the supplying pharmacy to ensure that medicines are received in time for administration to take place at the start of the month Changes to medication must be clearly documented in care plans and easily to track. This was to have been met by 01/11/05 To confirm medication changes with the person prescribing for specific residents identified during the inspection. To undertake risk assessments for all residents who selfmedicate
DS0000048089.V259630.R01.S.doc Timescale for action 01/01/06 2. 3. OP8 OP9 13 (1) (b) 13 (2) 01/01/06 01/01/06 4. OP9 13 (2) 01/01/06 5. OP9 13 (2) 01/01/06 6. OP9 13 (2) 01/01/06 7. OP9 13 (2) 01/01/06 The Old Vicarage (Askam) Version 5.0 Page 24 8. 9. OP9 OP9 13 (2) 13 (2) 10. OP9 13 (2) 11. OP18 13 (6) 12. 13. OP19 OP25 23 (2) 23 (2) This was to have been met by 01/11.05. Medicines with limited expiry after opening must be marked with the date of opening Medicines must be administered as prescribed This was to have been met by 01.10.05. To ensure documentation of multi-professional discussions with respect to crushing of tablets and mixing with jam, and consultation with and consent from the resident where possible. This was to have been met by 01.11.05. All staff must have up to date training on adult protection and recognising and responding to abuse or neglect. This must be clearly recorded. The broken window catches in the resident’s room identified at inspection must be repaired. A review must be done on the smoking facilities to improve them for smokers and so they do not affect other residents and visitors to the home. 01/01/06 01/01/06 01/01/06 24/02/06 23/12/05 31/12/05 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. Refer to Standard OP7 OP9 Good Practice Recommendations The daily records should not be relied on too heavily for information and monitoring. It is recommended that the pharmacy be requested to Remove out-of-date entries for discontinued medicines
DS0000048089.V259630.R01.S.doc Version 5.0 Page 25 The Old Vicarage (Askam) 3. 4. 5. 6 OP9 OP9 OP12 OP30 To up-date MARs as soon as possible following dosage changes. Remove duplicate entries To obtain clarification on the dosage of “as directed” medicines To mark original packs with dates of opening to enable audit of use at future inspections. Records should be kept of the activities that residents take part in and enjoy. Training needs and records of training done by staff and planned for should be clear for each person. The Old Vicarage (Askam) DS0000048089.V259630.R01.S.doc Version 5.0 Page 26 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
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