Inspection on 24/06/05 for The Old Vicarage Nursing and Residential Care Centre

This inspection was carried out on 24th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 Nursing and... 18/04/07

The Old Vicarage Nursing and... 25/10/05

The Old Vicarage Nursing and... 18/01/05

The Old Vicarage Nursing and... 03/08/04

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

CARE HOMES FOR OLDER PEOPLE The Old Vicarage Nursing & Residential Care Centre Fir Tree Lane Burtonwood Warrington Cheshire, WA5 4NN Lead Inspector Anthony Cliffe Unannounced 24th June 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Old Vicarage Nursing & Residential Care Centre F51 F01 S34659 Old Vicarage V231982 230605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Old Vicarage Nursing & Residential Care Centre Fir Tree Lane Burtonwood Warrington Cheshire WA5 4NN 01925 229944 Address 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) Cheshire Lifecare Ltd Joanne Goodwin (proposed) Care Home 35 Category(ies) of OP Old Age (35) registration, with number of places The Old Vicarage Nursing & Residential Care Centre F51 F01 S34659 Old Vicarage V231982 230605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 The use of bedrooms number 1,2,3,4,5,6a,6b,7,8 on the first floor is restricted as detailed in condition numbers 2, 3, and 4 2 Occupants must be able to access these rooms using the stair lift to ensure they enjoy freedom of movement commensurate with normal activities The needs of the service users must be regularly reviewed to ensure that these conditions are complied with at all times The stair lift must meet the appropriate health and safety requirements 35 Service Users may be in receipt of either personal care and/or personal care with nursing No more than 3 service users aged 55 to 64 requiring nursing care may be accommodated The registered provider must comply with the staffing notice dated 3 February 2000 issued by North Cheshire Health Authority 18th January 2005 3 4 5 6 7 Date of last inspection Brief Description of the Service: The Old Vicarage is a 35-bedded care home providing personal care with nursing. It was originally a Victorian residence, which has been converted and extended. Accommodation consists of 3 double bedrooms and 29 single bedrooms, 11 with en-suite facilities. There were 5 lounges, a dining room, a passenger lift and stair lift and special bathing facilities. The home has a large garden with patio area. The home is situated on the edge of Burtonwood village within easy access from the M62 and M6. There is a bus stop outside the home for buses to Warrington, St. Helens and Earlestown. The Old Vicarage Nursing & Residential Care Centre F51 F01 S34659 Old Vicarage V231982 230605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection on 24th June 2005 took, place over 7 hours. All parts of the home which accommodate residents were looked at, including residents’ care records and the home’s records. A number of residents’ and staff were spoken with. What the service does well: What has improved since the last inspection? The management of the home has improved since the recruitment of an experienced Registered General Nurse. The staff team have leadership, guidance and supervision. There is a positive working partnership between the registered provider and manager. Staff morale has further improved, with positive comments from staff about the manager and registered owner. Staff training has improved with staff having access to NVQ training. The conservatory has been redecorated in bright colours. Equipment to meet the needs of residents has been purchased, for example an electric profiling bed and air replacing mattresses. A monitored dosage system has been introduced for the management and administration of medicines. The Old Vicarage Nursing & Residential Care Centre F51 F01 S34659 Old Vicarage V231982 230605 Stage 4.doc Version 1.30 Page 6 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 Nursing & Residential Care Centre F51 F01 S34659 Old Vicarage V231982 230605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Old Vicarage Nursing & Residential Care Centre F51 F01 S34659 Old Vicarage V231982 230605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Assessments of needs are completed, before residents move into the home, to ascertain if their needs can be met. EVIDENCE: The records of two residents who had recently moved into the home were examined. A standard pre-admission form is completed as part of the preadmission assessment. The information includes the residents’ previous history, physical illnesses and current medication. The pre-admission form includes a skin integrity assessment and identified that one resident needed a profiling bed to meet their needs. This was purchased by the Registered Provider. One resident identified as being at risk of falling, both had a moving and handling assessment and a falls risk assessment. Copies of the care management assessment and care plan were obtained and an assessment for NHS funded care had been completed. The Old Vicarage does not provide intermediate care facilities and this standard is not applicable. The Old Vicarage Nursing & Residential Care Centre F51 F01 S34659 Old Vicarage V231982 230605 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Residents’ plans ensure that health and social care needs are identified and met. The procedures for managing medication could be improved to ensure residents’ are not at risk from not having prescribed medication. EVIDENCE: The care plans of three residents were examined. All plans had a wide range of assessment documents completed in full, with a care plan to address the identified needs of the residents. Evidence from care plans, and from conversations with residents, indicated that the health needs of residents were met. Residents’ care plans recorded that the dietician and speech and language therapist were contacted, for advice on the diet of a resident with swallowing difficulties, who was at risk of choking. One resident identified at risk of falling, had a moving and handling assessment completed, together with a falls risk assessment. After two of the three residents moved into The Old Vicarage with pressure ulcers, staff at the home contacted the tissue viability nurses regarding treatment. Equipment to reduce the incidence of further pressure ulcers was provided and the pressure ulcers had healed. An oxygen concentrator was provided for a resident with breathing problems. The Old Vicarage Nursing & Residential Care Centre F51 F01 S34659 Old Vicarage V231982 230605 Stage 4.doc Version 1.30 Page 10 One resident said that staff made sure he kept to his diabetic diet, ‘sometimes for devilment I go for the sugar bowl and they remind me, I don’t have sugar’. Another resident said ‘the staff are very good especially the nurses. I had a problem with a lump on my foot which kept bleeding. I was seen by a district nurse and the staff have dressed it. I was in pain with it but the staff were dressing it regularly. The pain has gone and I can walk without discomfort, that’s got to be a good thing’. Residents confirmed that their rights were respected. Two residents said they were independent and staff respected this. Another resident said ‘staff are very helpful, they don’t put upon you, they let you help yourself, they help me in my bedroom or toilet and make sure my privacy is respected’. Medication administration and recording has improved, with the introduction of a monitored dosage system. The monitored dosage system replaces the system of original packages of medicines supplied by the pharmacist and pre printed medicine administration sheets are used. These are carbonated and provide a accurate record of the management and administration of medicines. The home experienced some teething problems as the pharmacy were supplying medicine administration record sheets with incorrect details. The manager could demonstrate an audit system, which identified the errors on the medicine administration record sheets. The audit system identified that some signatures had not been recorded for the administration of medicines, but the manager could evidence that the audit had picked up these errors with action taken to address them. The audit system was only completed at the end of each month and did not use a document to record the audit findings. See recommendation 1. The Old Vicarage Nursing & Residential Care Centre F51 F01 S34659 Old Vicarage V231982 230605 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15. Residents are supported to make choices in their lifestyle and in meeting their social needs. Families and friends are welcomed into the home at any reasonable time. Residents have a good choice of meals in pleasing surroundings. EVIDENCE: Residents are free to move around within the home and were at ease in asking staff for help. A variety of sitting areas are available and a separate dining room. Staff were seen spending social time with residents and talking about their families and life history. Staff were knowledgeable about residents life history and shared their knowledge in conversation with residents. Morning activities were provided, with an art and craft group organised. Care staff also joined in a variety of activities with residents. A number of visitors throughout the day were made welcome and were clearly comfortable in approaching staff. The Old Vicarage Nursing & Residential Care Centre F51 F01 S34659 Old Vicarage V231982 230605 Stage 4.doc Version 1.30 Page 12 Residents shared their experience of living at The Old Vicarage. One resident said he had settled in, felt comfortable and could choose how he spent his day. ‘The place is quiet without everyone rushing around, I like that, I prefer to sit in the smoking area even though I don’t smoke. I have made friends with someone and we get on very well. We don’t like to sit in the other lounge there is gossip. I know the staff and they know me and when to help me, I only have to ask for help and they are there, they are great. I sit and talk with the staff. The owner is a great girl, if you want something doing you only have to ask’. The resident said that staff help him when he wanted, helped him to remain independent. Another resident said ‘staff are always there when I need help. I am very independent and they respect that, I only have to ask for help and I get it. I know the owner, he is a gentleman and will do anything for you. I please myself what I do and how I spend my day, I smoke so prefer to sit in the smoking area, I get bored sometimes but that’s my choice. I don’t like to socialise with the older ladies, who complain all the time when there is nothing to complain about, they just gossip. I go out independently three days a week into town it breaks my day up’. Another resident who recently moved into the home said her daughter had visited Oakmeadow on her behalf before she moved in. She was given the choice of a larger single bedroom to meet her health needs, as she required an oxygen concentrator. She said ‘I like the bedroom it is clean and bright and I would not change it, my family are now bringing some of my own furniture. I like to spend time in my bedroom and can have my meals here, for breakfast I had bacon and tomatoes and for lunch I have ordered fish and chips’. Another resident said ‘for breakfast I had cornflakes with milk, then sausage, egg and tomatoes, I choose this everyday’. Meals were served in the dining room and a choice was offered. The choice was seen as fish in batter, fish fingers, fish cakes and ocean pie with chips and peas. The evening meal was a buffet and hot snacks chosen by residents. Staff were available to assist those residents that required help. The Old Vicarage Nursing & Residential Care Centre F51 F01 S34659 Old Vicarage V231982 230605 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. Complaints are taken seriously and acted upon. Training for staff on the prevention of abuse of older people has enhanced the protection of residents. EVIDENCE: The complaints procedure is displayed in the entrance of the home. Some residents said they knew who to complain to. One resident said ‘the old ladies complain all the time, I don’t know what they complain for, there is nothing to complain about’. The home has an incidents and complaints book and no complaints were recorded. Two care staff interviewed, confirmed they had received adult abuse training and shared their knowledge. Further training dates had been arranged. The Old Vicarage Nursing & Residential Care Centre F51 F01 S34659 Old Vicarage V231982 230605 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22 and 26. Residents live in a safe and well-maintained home, which is clean and hygienic. There is a commitment to improving the standard of accommodation for the benefit of residents. EVIDENCE: All communal areas and some bedrooms were seen. The interior and exterior of the building was well maintained. The conservatory area of the building has been redecorated in a pastel yellow colour. Some bedrooms have been repainted in a neutral colour. The manager had purchased an electric profiling bed and air replacing mattresses for residents. The home was free from odours. Staff in the laundry were aware of the Control of Substances Hazardous to Health guidance on the use of cleaning products. The Old Vicarage Nursing & Residential Care Centre F51 F01 S34659 Old Vicarage V231982 230605 Stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28,29 and 30. The Old Vicarage provides sufficient staff to meet residents’ needs. Their recruitment policies were complete, ensuring residents are protected. Investment in training has been provided to maintain a skilled workforce. EVIDENCE: Information from the staff rota, showed that sufficient Registered Nurses and care assistants were employed to meet the residents` needs. The home employs its own bank of staff to cover gaps on the duty rota. Additional professional support is available to residents from PCT and local authority staff with referrals made when necessary. The records of two recently employed care staff were looked at. All had the relevant POVA and Criminal Records Bureau (CRB) checks in place. Staff did not commence employment until the CRB check had been issued to them. Recruitment records for two staff were completed in full. Staff had received training on basic food hygiene, moving and handling and health and safety. Two care staff clarified they were progressing through their NVQ level 2 and had completed additional units on equality and diversity from ‘Skills for Care’. One staff member identified she had a learning difficulty and said that the registered provider had purchased additional learning materials to assist her through her NVQ 2. She said ‘Mrs Hull- Buttler and Joanne the manager paid for support materials to be sent to my home, these included talking books and videos and they have really helped me’. The Old Vicarage Nursing & Residential Care Centre F51 F01 S34659 Old Vicarage V231982 230605 Stage 4.doc Version 1.30 Page 16 A recently employed care assistant was interviewed and had a copy of her induction programme, which she was still completing. This was based on the ‘Skills for Care’ standards for induction. She confirmed that she was being supervised by one of the trained nursing staff during her induction. Fire training was also included. She said that there was an expectation from the owner that she would do her NVQ and this was discussed at her interview. The Old Vicarage Nursing & Residential Care Centre F51 F01 S34659 Old Vicarage V231982 230605 Stage 4.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 The manager is competent and has made significant improvements. EVIDENCE: The Old Vicarage is managed by a Registered Nurse who has not yet completed the registration process for manager, with the Commission for Social Care Inspection. The manager has not yet completed the registered manager’s award. Staff said there had been positive changes in the home and they had been consulted about them. Staff also said that a change in the shift pattern fitted around family commitments, ‘I work shifts to suit me and the change in shifts allows you more time to spend with residents, when I go home I’m not exhausted like I used to be. Joanne has changed the routines, so residents have more choice, we now make decisions for some of the more frail residents, and an example is if they need bed rest to prevent pressure sores. There is no more of the getting so many up and putting so many to bed that the last manager had us doing, residents choose what time they get up and go to bed’. The Old Vicarage Nursing & Residential Care Centre F51 F01 S34659 Old Vicarage V231982 230605 Stage 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x 3 x x x 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 Standard No 16 17 18 Score 3 x 3 2 x x x x x x x The Old Vicarage Nursing & Residential Care Centre F51 F01 S34659 Old Vicarage V231982 230605 Stage 4.doc Version 1.30 Page 19 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 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. 1. Refer to Standard OP9 Good Practice Recommendations The auditing of medicines should be improved to ensure that erros are identified and approrpraite action taken, and records kept of the audit. The Old Vicarage Nursing & Residential Care Centre F51 F01 S34659 Old Vicarage V231982 230605 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection Unit D, off Rudheath Way Gadbrook Park Northwich Cheshire, CW9 7LT 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 Nursing & Residential Care Centre F51 F01 S34659 Old Vicarage V231982 230605 Stage 4.doc Version 1.30 Page 21 - 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. 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