Inspection on 08/12/05 for The Old Vicarage [Cannington]

This inspection was carried out on 8th December 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Old Vicarage [Cannington] 09/05/06

The Old Vicarage [Cannington] 12/07/05

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 The Old Vicarage Brook Lane Cannington Bridgwater Somerset TA5 2HP Lead Inspector Judith Roper Announced Inspection 8th December 2005 10:15 The Old Vicarage DS0000031640.V260638.R01.S.doc Version 5.0 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 DS0000031640.V260638.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 Adults 18-65. 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 DS0000031640.V260638.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Old Vicarage Address 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) The Old Vicarage Brook Lane Cannington Bridgwater Somerset TA5 2HP 01278 653688 Somerset County Council (LD Services) Mrs Deborah Winter Care Home 8 Category(ies) of Learning disability (8) registration, with number of places The Old Vicarage DS0000031640.V260638.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The bedroom that is below 10 square metres can only be occupied by fully mobile residents. Registered for a total of eight persons with a Learning Disability. Seven of these persons may also have a Physical Disability. 12th July 2005 Date of last inspection 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 DS0000031640.V260638.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over one day between the hours of 10 15 am – 2.15pm. Eight residents were at the home on the day of the inspection. There are currently no vacancies at the home and there have been no admissions since the previous inspection. The inspector was able to see and observe staff interactions with five residents; three were out during the inspection. No relatives were visiting the home at the time of the inspection but three relative feedback cards about the service were received at the CSCI prior to the inspection. The comments were positive regarding the care delivery at the home. Two cards indicated that they were not aware of the home’s complaints procedure, but that they had not had reason to raise a complaint. The home management said that they would explain the complaints procedure to the respondents at scheduled care reviews and address one comment regarding providing information required on updates regarding their relative’s ongoing care. The registered manager Mrs. Winter, her deputy and the service network manager were 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. This focus of this inspection visit was to monitor progress on the requirement and recommendations made at the previous unannounced inspection in July 2005, to also inspect Standards not inspected at that visit and to inspect other key Standards. Records examined were two care and support plans, medication administration records, the home’s policy on the protection of vulnerable adults and information provided by the home to the CSCI in the home pre-inspection questionnaire. At The Old Vicarage residents all have impairment with speech and language skills. Residents communicate using other verbal sounds than words such as gesturing, pictures/drawings or Somerset Total Communication signs/symbols. The staff at the home know the residents very well as the staff team is settled and the residents have lived at the home together for a number of years. This inspection has found that the home is providing sensitive individualised care for its residents. The Old Vicarage DS0000031640.V260638.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection? 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 DS0000031640.V260638.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection The Old Vicarage DS0000031640.V260638.R01.S.doc Version 5.0 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 the following standard(s): 1, 3, 5. Standards 2 and 4 are not currently applicable. 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. Each resident has a copy of the home’s Statement of Purpose (revised in 2005) and the Service User’s Guide (resident agreement and individual contract) held in the individual’s care and support plan. 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, including Resident Agreement and Contract. The Statement of Purpose has been updated to reflect the change in management at the home. There have been no new admissions to the home since the last inspection. Residents have all lived at the home together for several years. 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 DS0000031640.V260638.R01.S.doc Version 5.0 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 the following standard(s): 6, 9. Care and support plans reflect current individual care needs and are regularly reviewed. 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. The Old Vicarage is piloting a change in care and support plan documentation to provide a summary of resident current care needs in a shorter document form in addition to the full care and support plan. In this way it is hoped that relief staff will be able to refer to a synopsis of resident care needs in an easy to read shortened document. The Old Vicarage DS0000031640.V260638.R01.S.doc Version 5.0 Page 10 Care plans include clinical and environmental risk assessments. The inspector discussed with the management risk strategies for some specific care issues in the home and the home has thought through the management strategies and contingency planning for identified clinical risks for individual residents. 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, laundry skills and kitchen tidying. The Old Vicarage DS0000031640.V260638.R01.S.doc Version 5.0 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 the following standard(s): 11, 12, 13, 14, 15, 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 and the amount of opportunities for this has greatly increased since the last inspection as staffing levels have risen in order to facilitate this. Staff support resident’s emotional and social needs with a professional kindness. This contributes to the air of calmness in the home. Relatives reported satisfaction in the care delivery of the service in comment cards received to the CSCI prior to the inspection. Meal times are unhurried and personal attention is given to residents by staff. EVIDENCE: Residents are being supported to manage their bedroom personal space according to ability. Since the reduction in access to day care services last year to residential home clients the residents had been spending more time at the home. However, the home has addressed this by providing an increased The Old Vicarage DS0000031640.V260638.R01.S.doc Version 5.0 Page 12 staffing complement during the day to enable residents to attend leisure opportunities in the surrounding community. Employment or educational opportunities are limited for the residents due to their physical, emotional or learning disabilities. 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 adapted disabled transport. The management is considering a business case for requesting a second vehicle for community access. 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. This is being achieved. 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. Three feedback cards were received from relatives prior to the inspection. Comments were positive regarding care delivery. Two people indicated that they did not know how to raise a complaint to the home and one person said that they were not always kept informed of changes to their relative’s health. The management said that they would address such issues generally in scheduled care reviews to ascertain what information people needed. 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. This is planned for next Spring/Summer. 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. Fridge/freezer temperatures are recorded daily and cold stored food in use is labelled with use by date. There is a written cleaning schedule for the kitchen for staff to follow. There are good supplied of fresh fruit and vegetables at the home and this is offered daily. The Old Vicarage DS0000031640.V260638.R01.S.doc Version 5.0 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 the following standard(s): 19, 20, 21. Personal support for residents is individual and sensitive to needs. Additional medication training for staff has been provided since the last inspection after this was made a requirement. The management is improving ways to assess staff competency in the management of medication at the home. There have been no deaths at the home for many years. Staff are given training in caring for ill residents and bereavement counselling is available for the staff should a resident die. 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. Prior to the inspection one comment card from a community health professional was received at the CSCI. The comments about care delivery at the home and professional working relationship with the home was positive. The Old Vicarage DS0000031640.V260638.R01.S.doc Version 5.0 Page 14 Care plans reflected that health needs were anticipated and acted upon. Health issues that were not anticipated were also managed appropriately and effectively. No resident in the home is able to manage his or her own medication. Staff administer medication. Medication records for the month were examined and the records were managed appropriately. The inspector questioned the managers how staff identify, report and rectify the rare instances in medication recording that did not reflect best practice. The management were receptive to addressing this issue in order to further improve record keeping at the home. 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. There have been two reportable medication errors at the service in the last 12 months. A requirement was made at the previous inspection that additional training in medication administration was to be arranged. This took place on the 5th of December. Medication storage has also been re-sited in a secure manner to a more accessible place for staff following the medication errors to help prevent the type of medication errors occurring again. At the inspection there was a discussion with the management of improving the observed practice of medication administration by a competent assessor. The home has an action plan to meet this best practice issue in the safe administration of medication and this will be monitored at the next inspection. There have been no deaths at the home for several years. The Old Vicarage DS0000031640.V260638.R01.S.doc Version 5.0 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 the following standard(s): 22, 23. There is an open atmosphere in the home for the raising of concerns but tow relatives indicated that they were not ware of the home’s complaints procedure. The management said that they would address this by making all relatives aware of the process in care reviews. 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. Staff received an abuse training update following a CSCI recommendation in the last inspection report. EVIDENCE: The home has a complaints procedure. It is not displayed prominently in the home, as there is risk of this being taken or destroyed by residents. The home reports that they have not received any complaints in 2005. Two out of three relative feedback cards said they were not aware of the home’s complain procedures, but also that they had not had reason to raise a complaint. This was discussed with the management in finding the best way to make relatives aware of the home’s complaint procedure. Polices and procedures are available in the home for the protection of vulnerable adults. The policy is the multi-agency protocol for Somerset in the Protection of Vulnerable Adults. There has been a staff training update in the protection of vulnerable adults since the last inspection, as recommended by the inspector. The Old Vicarage DS0000031640.V260638.R01.S.doc Version 5.0 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 the following 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. There has been new laundry equipment, additional moving and handling equipment and new carpets to hallways, corridors and stairs since the last inspection. 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. The carpets for the ground and first floor hallways and stairs have been replaced. An additional stand aid has been purchased for the home to aid semi-independent resident transfers and laundry equipment has been replaced and upgraded. Residents have single bedrooms. They are spacious to meet resident physical needs, are personalised very attractively and have equipment installed to meet handling needs of residents. Sensory equipment is also provided in bedrooms. Bathrooms are sufficient to meet resident needs. One shower room has recently been upgraded and the large disability equipped bathroom has been decorated pleasingly since the last inspection to make a more homely space. Residents are also able to listed to music of their choice whilst bathing as a The Old Vicarage DS0000031640.V260638.R01.S.doc Version 5.0 Page 17 sound system speakers have been wired into the bathroom (a safe distance from wet areas). 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. The two communal lounges are showing some signs of wear and tear in places such as damage to paint work from wheelchair users but the communal spaces are utilised very well and provide sufficient space for residents to socialise. The Old Vicarage DS0000031640.V260638.R01.S.doc Version 5.0 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35. The staff team work well together and there is good investment in staff training. This means that residents receive care from skilled staff. Recruitment practices are sufficiently robust to protect residents. EVIDENCE: The staff team is settled and there are very few vacant shifts that need to be covered. If this is so, the shifts are covered in-house or occasionally by relief workers. The home is now working with a minimum of four staff during the mornings, which provides appropriate staffing support for the physical and emotional dependency levels of residents. At night there is one waking staff member and one sleeping-in night staff member on duty. Staff recruitment was inspected through the information provided to the CSCI in the pre-inspection questionnaire and discussing the information with the management team at the home. There is a volunteer worker who has been associated with the home for several years. This person needs to have a CRB check. The management said that they would arrange for this to be done. Staff training records were provided with the pre-inspection questionnaire. The recommendations for additional staff training in medication administration and protection of vulnerable adults have been taken up between inspection visits. This year there has been suitable staff training provided at The Old Vicarage, including support for staff to obtain NVQ awards in care. The Old Vicarage DS0000031640.V260638.R01.S.doc Version 5.0 Page 19 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 40, 41, 42, 43. The home is managed well and resident safety is risk assessed and managed. Quality assurance processes are both formal and informal. Somerset Social Services Community Directorate runs the service. Somerset County Council was recently awarded a maximum three stars in its annual inspection. EVIDENCE: Health and safety equipment servicing information was supplied in the preinspection questionnaire. This was cross-checked against servicing labels on equipment in the home. A network manager for social service completes a monthly health and safety/quality assurance check (Regulation 26 reports). The home carried out a quality assurance questionnaire for relatives this year and the results are going to be forwarded to the CSCI office, as requested during the inspection. As recommended in the previous inspection report the home is now auditing bedrails monthly as part of health and safety checks. The Old Vicarage DS0000031640.V260638.R01.S.doc Version 5.0 Page 20 The home notifies the CSCI of reportable events. The home was reminded that these events should be on the CSCI Regulation 37 forms and forwarded without delay. Records were stored in the home in a way that protected resident confidentiality. The service is run by the County Council Social Services, who provide their own insurance for The Old Vicarage. The home uses both Council generic and service specific policies and procedures. The Old Vicarage DS0000031640.V260638.R01.S.doc Version 5.0 Page 21 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 N/A 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 4 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 3 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Old Vicarage Score X 3 3 3 Standard No 37 38 39 40 41 42 43 Score X X 3 3 3 3 3 DS0000031640.V260638.R01.S.doc Version 5.0 Page 22 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Old Vicarage DS0000031640.V260638.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street 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. 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