Inspection on 12/07/05 for The Old Vicarage [Cannington]

This inspection was carried out on 12th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Old Vicarage [Cannington] 09/05/06

The Old Vicarage [Cannington] 08/12/05

The Old Vicarage [Cannington] 24/11/04

The Old Vicarage [Cannington] 23/06/04

The Old Vicarage [Cannington] 06/05/03

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 The Old Vicarage Brook Lane Cannington Bridgwater Somerset TA5 2HP Lead Inspector Judith Roper Unannounced 12th 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 D53 - D02 S31640 The Old Vicarage V235961 120705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Old Vicarage Address Brook Lane Cannington Bridgwater Somerset TA5 2HP 01278 653688 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) Somerset County Council (LD Services) Mrs Deborah Winter Personal Care Home Only 8 Category(ies) of Learning Disability registration, with number of places The Old Vicarage D53 - D02 S31640 The Old Vicarage V235961 120705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The bedroom that is below 10 square metres can only be occupied by fully mobile residents. 2. Registered for a total of eight persons with a learning disability. Seven of these persons may also have a physical disability. Date of last inspection 24th November 2004 Brief Description of the Service: The Old Vicarage is a large two storey building situated in the centre of the village of Cannington. The house is adjacent to the church and is close to a village pub. The home is within walking distance of the local amenities. The town of Bridgwater is five miles away. The Old Vicarage is a home run by Somerset Social Services. The registered manager is Mrs. Deborah Winter. The responsible individual for the service is Mr. David Dick. The Old Vicarage is registered with the Commission for Social Care Inspection to provide care for eight people with learning disabilities and physical disabilities. The Old Vicarage D53 - D02 S31640 The Old Vicarage V235961 120705 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 over one day between the hours of 10 am – 1.45pm. 8 residents were at the home on the day of the inspection. There are currently no vacancies at the home. The inspector was able to see and spend time interacting with the residents. No relatives were visiting the home at the time of the inspection. All staff on duty were able to give time to speak with the inspector. The registered manager Mrs. Winter was available for comment during the inspection. The inspector would like to thank Mrs. Winter and her staff for their time and hospitality shown to the inspector during her visit. The atmosphere at the home was relaxed and informal. Staff carried out their duties in a friendly and professional manner. It was a hot summers day and one resident went out and some others sat near the open front door. This is the first inspection using the new CSCI reporting format, which focuses on outcome statements for National Minimum Standards. The inspector’s aim on this inspection visit was to seek views on the quality of the service from as many service users as possible and to speak to staff and any visiting relatives. At The Old Vicarage residents all have impairment with speech and language skills. Communication includes other verbal sounds than words, gesturing, pictures/drawings or Somerset Total Communication signs/symbols. The inspector was able to find a common language for gaining the mood of most service users and observed non-verbal body language clues to how residents behaved with staff interactions. Records examined were care plans, staff recruitment files, the fire and complaints logs, Regulation 26 visit recordings on behalf of the provider, equipment servicing records, accident/incident logs and medication records; other records will be examined at subsequent inspection visits. This inspection has found that the home is providing sensitive individualised care for its residents. What the service does well: What has improved since the last inspection? One requirement was made at the last inspection. This was for the home to have a registered manager approved by the CSCI. Mrs. Deborah Winter applied for this and was successful. The Old Vicarage D53 - D02 S31640 The Old Vicarage V235961 120705 Stage 4.doc Version 1.40 Page 6 Since the last inspection the staff team at the home has been getting used to their new manager. She has focused on working with her staff team to further promote the ability of residents to be empowered to make more personal choices regarding their lives. The large shower room for residents is in the process of being upgraded. 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 contacting your local CSCI office. The Old Vicarage D53 - D02 S31640 The Old Vicarage V235961 120705 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection The Old Vicarage D53 - D02 S31640 The Old Vicarage V235961 120705 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3. There have been no recent admissions to the home. Information around the home for residents takes the form of written English, pictures and Somerset Total Communication symbols. This enables residents to understand the daily routines at the home. The staff team know resident’s needs well and are able to care for residents in a way that provides individualised care. EVIDENCE: The home has a Statement of Purpose and Service User’s Guide. These documents have been updated to reflect the change in management at the home. There have been no new admissions to the home since the last inspection. The residents at the home are settled and get on well. The staff team is established and very few shifts are covered by relief staff. Training is provided for staff to manage the complex needs of individual residents. All residents are placed by and funded through Somerset Social Services. The Old Vicarage D53 - D02 S31640 The Old Vicarage V235961 120705 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9,10. Care plans reflect current individual care needs. This enables staff to deliver care that meets needs. Residents are risk assessed for daily activities and safety action plans are in place. Resident’s are being given more opportunities at the home to participate with the day-to-day domestic management of the home. This is to give residents a sense of achievement and self-esteem. EVIDENCE: Two resident care plans were inspected in detail. The information in the plans is detailed and reflects person centred planning. Plans are critically reviewed monthly. Residents are unable to participate fully in their care planning process due to their complex disabilities. Care plans include clinical and environmental risk assessments. The registered manager is working with her staff team to increase the amount of choice and participation for residents in their daily life and daily routines, such as bed making, food preparation etc. The Old Vicarage D53 - D02 S31640 The Old Vicarage V235961 120705 Stage 4.doc Version 1.40 Page 10 Staff spoken with understood confidentiality issues relating to residents and information in the home relating to residents was handled and stored in accordance with safe storage good practice principles. The Old Vicarage D53 - D02 S31640 The Old Vicarage V235961 120705 Stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,13,14,16,17. Residents are being encouraged to actively participate in the home’s daily domestic routines. This provides structure and purpose to the day. Residents access the wider local community for leisure and shopping but this can be limited at times due to staffing levels. Staff support resident’s emotional and social needs with a professional kindness. This contributes to the air of calmness in the home. Meal times are unhurried and personal attention is given to residents by staff. EVIDENCE: Residents are being supported to manage their bedroom personal space more. Since the loss of day care services last year to residential home clients the residents spend more time at the home and have more time to be included in the daily domestic management of the home. Employment or educational opportunities are limited for the residents due to their physical, emotional or learning disabilities. This was discussed with the registered manager. The Old Vicarage D53 - D02 S31640 The Old Vicarage V235961 120705 Stage 4.doc Version 1.40 Page 12 The home is next to the village church. One resident choose to be a member of the local church congregation. Residents are given the opportunity to access the local and wider community as the home has suitable transport. However, due to the dependency level at the home when three staff are on duty and not four, this makes community access difficult for most residents as two staff are needed out on the mini-bus and two staff need to remain at the home for residents still in the building. (See Standard 33 for staffing level recommendation). Activities take place in the home on a daily basis and residents have part of their contract several ‘quality days’ per year or a short annual holiday, based on individual ability and preference. There were no visitors to the home on the day of the inspection. The manager reported that most residents have contact with visiting family members from time to time. Staff on duty were interacting with residents in a friendly and sensitive manner. Residents approached staff for social interaction on a 1:1 basis and staff gave this attention. Residents were free to move around the home in order to find alternative points of interest or to be alone. The gardens are pleasing and accessible but residents need supervision in the gardens. The manager has a plan to provide a safe space in the garden with non-toxic plants, as two residents are at risk of picking and then ingesting foliage. Meals are provided in the dining room. Most residents require supervision or assistance at meal times. The daily menu is flexible to choice. Meals are cooked on the premises. The kitchen is suitably equipped. The Old Vicarage D53 - D02 S31640 The Old Vicarage V235961 120705 Stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20. Personal support for residents is individual and sensitive to needs. Medication training for staff is not sufficient. Competency needs to be assessed by a trainer. EVIDENCE: All residents at the home need personal care support. Several residents need two staff to assist with these tasks. Suitable equipment is available in the home to assist staff with this. Community health care professionals are involved in the overall care management of residents on a continuing basis. Specialist community health care professionals also consult on health care matters for individual residents. Care plans reflected that health needs were anticipated and acted upon. Health issues that were not anticipated were also managed appropriately and effectively. The manager was following up dental and opticians routine visits that were now due. No resident in the home is able to manage his or her own medication. Staff administers medication. Medication records for the month were examined and the records were managed appropriately. The home has a system of asking staff to sign to say that they have read the home’s policies and procedures in the administration of medicine and two staff supervise one another in medication administration. In discussion with staff and the manager it was The Old Vicarage D53 - D02 S31640 The Old Vicarage V235961 120705 Stage 4.doc Version 1.40 Page 14 reported that not all staff that administer medication in the home have undergone formal medication training from a competent trainer. Staff medication competency in actively administering medications has also not been assessed by a competent trainer. (Only by staff having completed the off site training course). It is acknowledged that the home supervises staff administering medications by working in pairs and that staff to sign to say that they have read the policy on the administration of medicines and that medication training issues are discussed in staff supervisions. Nevertheless, staff must receive formal training in the administration of medicines by a competent trainer who must assess practical competency prior to staff in the home administering medications. The Old Vicarage D53 - D02 S31640 The Old Vicarage V235961 120705 Stage 4.doc Version 1.40 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23. There is an open atmosphere in the home for the raising of concerns. Residents are risk assessed for self-harm or neglect. Staff are aware of the signs of abuse and of how to report suspected abuse. Resident’s monies are audited fortnightly to detect any concerns for financial abuse. EVIDENCE: The home has a complaints procedure and the complaints/concerns log was inspected. The last complaint was in November 2004 and concerned and incident affecting a resident whilst away from the home on other Council premises. This complaint was dealt with properly. The home has received no complaints since the last inspection. Staff spoken with said that they found the home’s management approachable for any concerns they may have. Polices and procedures are available in the home for the protection of vulnerable adults. Staff spoken with had a good knowledge of how to handle abuse issues and whom to report concerns of abuse to residents to. Some staff did comment, however, that it had been several years since their last abuse training. This was reported to the manager for her to consider. The Old Vicarage D53 - D02 S31640 The Old Vicarage V235961 120705 Stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,29,30. The Old Vicarage is a character property providing spacious living areas for residents. Bedrooms are personalised and attractive. The home is clean and well equipped for the physical needs of residents. The home is awaiting a replacement carpet for the hallway and stairs, as there are pockets of lingering malodour here. EVIDENCE: The physical premises were inspected. Communal areas are spacious and accessible for residents. The home was clean to a good domestic standard on the day of the inspection. There were some areas of lingering malodour. The manager said that the carpet for the ground and first floor hallways and stairs was due to be replaced. The lounge carpets were also due to be deep cleaned. Residents have single bedrooms. They are spacious to meet resident physical needs, are personalised attractively and have equipment installed to meet handling needs of residents. Sensory equipment is also provided in bedrooms. The home has purchased a new replacement patient hoist since the last inspection. Bathrooms are sufficient to meet resident needs. One shower room is currently being upgraded. The laundry is equipped with industrial The Old Vicarage D53 - D02 S31640 The Old Vicarage V235961 120705 Stage 4.doc Version 1.40 Page 17 machines. Access to the laundry is not convenient for wheelchair users but residents can assist with folding their laundry if it is taken to the lounges. Staff demonstrated safe infection control practices in the home and staff have suitable facilities for hand washing between personal care duties. The Old Vicarage D53 - D02 S31640 The Old Vicarage V235961 120705 Stage 4.doc Version 1.40 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,36. Staff understand their roles and responsibilities. They are regularly supervised and their performance discussed. The staffing level at the home should be reviewed by Somerset County Council to take into account high dependency levels at the home and the ability of residents to access the community more frequently now that day care is being provided from the home base. EVIDENCE: The staff team is now settled and there is one care worker vacancy at the home. These shifts are covered in-house or occasionally by relief workers. The home is trying to work with a minimum of four staff during the day but this does not always happen. Often if the home has four staff and a sister home needs additional workers then a member of The Old Vicarage staff is seconded to a sister home for the day. The dependency at The Old Vicarage is high. Most residents need two staff to assist with physical needs. For outside trips two staff are usually needed and two staff must remain in the home to meet the needs of residents staying in the home. It is therefore recommended that the minimum staffing level in the home be four staff during the day to meet the needs of residents both in and out of the home. At night there is one waking and one sleeping-in night staff. Staff spoken with were clear about their job roles and expected responsibilities. The Old Vicarage D53 - D02 S31640 The Old Vicarage V235961 120705 Stage 4.doc Version 1.40 Page 19 Two staff recruitment files were inspected. As the provider Somerset Social Services recruits centrally and recruitment records are initially held centrally it is not possible to inspect all documentation to be held in accordance with Schedule 2 of the Care Homes Regulations at the home. The two staff employed recently were both already relief workers for Somerset Social Services. Relevant CRB/POVA checks were demonstrated. Individual staff supervision at the home is both formal and documented. Staff spoke to confirmed regular supervision sessions with their line managers. The Old Vicarage D53 - D02 S31640 The Old Vicarage V235961 120705 Stage 4.doc Version 1.40 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,41,42. The home is managed well and resident safety is risk assessed and managed. A recommendation has been made that bedrails safety checks are recorded monthly to demonstrate that bedrails in use do not put residents at risk of entrapment or injury. EVIDENCE: The registered manager is Mrs. Winter, she is experienced and enthusiastic and competent to manage the home. Staff said that they find her approachable and open in her management style. Records were stored in the home in a way that protected resident confidentiality. Health and safety and equipment servicing records were inspected. Paperwork was maintained in good order for equipment servicing. A network manager for social service who completes a report that includes a health and safety report inspects the home monthly. Staff fire training records were inspected. The The Old Vicarage D53 - D02 S31640 The Old Vicarage V235961 120705 Stage 4.doc Version 1.40 Page 21 home conducts staff training in fire safety three monthly. There were some gaps. The manager said that she is chasing this up and would record where staff were unable to attend due to sickness. Resident incident/accident records indicated no recent trends and that staff record ‘near misses’ and unexplained bruises for investigation. This is good practice. The home is not auditing bedrails for safety checks as per Department of Health guidance. This is recommended on a monthly basis. The Old Vicarage D53 - D02 S31640 The Old Vicarage V235961 120705 Stage 4.doc Version 1.40 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 N/A 3 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 4 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 x 3 3 x 3 3 Standard No 31 32 33 34 35 36 Score 3 3 2 3 x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Old Vicarage Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 x x 3 3 x D53 - D02 S31640 The Old Vicarage V235961 120705 Stage 4.doc Version 1.40 Page 23 No 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 YA20 Regulation 13(2) Timescale for action All staff administering medication 12/11/05 in the home must have received medication training given by a competent trainer. Staff need to be assessed as being competent to administer the medications. Requirement RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA33 YA42 YA23 Good Practice Recommendations It is recommended that the minimum staffing level in the home during the day is four staff. It is recommended that the manager devises a bedrail safety audit sheet to record that bedrails in use in the home have been safety checked at least once a month. It is recommended that care staff receive an update training session in the protection of vulnerable adults. The Old Vicarage D53 - D02 S31640 The Old Vicarage V235961 120705 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL 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 D53 - D02 S31640 The Old Vicarage V235961 120705 Stage 4.doc Version 1.40 Page 25 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!