Inspection on 25/10/05 for The Old Vicarage Nursing and Residential Care Centre

This inspection was carried out on 25th October 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 Nursing and... 18/04/07

The Old Vicarage Nursing and... 24/06/05

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 and Residential Care Centre The Old Vicarage Fir Tree Lane Burtonwood Warrington Cheshire WA5 4NN Lead Inspector Anthony Cliffe Announced Inspection 25th October 2005 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Old Vicarage Nursing and Residential Care Centre DS0000034659.V254212.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 Nursing and Residential Care Centre DS0000034659.V254212.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Old Vicarage Nursing and Residential Care Centre The Old Vicarage Fir Tree Lane Burtonwood Warrington Cheshire WA5 4NN 01925 229944 01925 229944 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) Cheshire Lifecare Ltd Mrs Gillian Grant Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places The Old Vicarage Nursing and Residential Care Centre DS0000034659.V254212.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 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 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 24th June 2005 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 and Residential Care Centre DS0000034659.V254212.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was undertaken by a regulatory inspector. The inspection took place over four hours and feedback was given to the manager at the end of the inspection. It included inspection of records, observation of staff practice and discussion with residents and visitors 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 Nursing and Residential Care Centre DS0000034659.V254212.R01.S.doc Version 5.0 Page 6 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 Nursing and Residential Care Centre DS0000034659.V254212.R01.S.doc Version 5.0 Page 7 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 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 medical history, mental health and current medication. The pre-admission form includes a skin integrity assessment and identified that one resident needed an air mattress to meet his needs. The registered provider purchased this. The Old Vicarage Nursing and Residential Care Centre DS0000034659.V254212.R01.S.doc Version 5.0 Page 8 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 Residents’ plans ensure that health and social care needs are identified and met. The procedures for managing medication have improved to ensure residents receive their prescribed medication. Residents are treated with dignity and respect. EVIDENCE: The care plans of two 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 indicated that the health needs of residents were met. Both residents were identified at risk of falling and had a moving and handling assessments completed, together with a falls risk assessment. Both residents’ care plans identified secondary mental health needs, which were acknowledged within their care plans. The care plans reflected the information obtained prior to and on moving into the home. The home had obtained an air-replacing mattress for one resident who was identified as being at risk of developing pressure ulcers. The resident had pressure ulcers to both heels on moving into the home. Care plans recorded that advice and treatment from the tissue viability nurse had been obtained. The Old Vicarage Nursing and Residential Care Centre DS0000034659.V254212.R01.S.doc Version 5.0 Page 9 The care plans was supported by a wound treatment plan, which recorded improvements to the pressure ulcers. Both residents were diabetic and staff was monitoring this. One resident had been diagnosed with an infection and there was a short-term care plan in place for the treatment of this. Records recorded visits from the general practitioner to review the health of residents and from the chiropodist for treatment as the residents had diabetes. Medication administration and recording has improved, with the introduction of 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 and the audit had picked up these errors with action taken to address them. The audit system was completed at the end of each month and used a document devised by the manager to record the audit findings. The outcome of one audit was that the registered provider for not completing medication administration records had given a qualified nurse a written warning. Residents spoken with said they were satisfied with the care they receive. A resident said ‘ I had to come into a home after my daughter could no longer care for me. The ladies look after me very well, I am well cared for they do a good job. The ladies look after my health, I do not grumble. I eat the meals but not everything as I don’t like everything but I am well fed, not a fussy eater’. Another resident said ‘I have settled in, the staff are very kind and have really made an effort to welcome me. They are loving, I have seen them with other people and they give me a hug. They explain what they are going to do and ask me if its alright if they help me. They knock before entering and call me by my name. The owners came to see me the first day I moved in and made a big fuss of me. That was very important. I see them regularly. Staff come and see me regularly to make sure I’m all right. I prefer to stay in my room, as I’m not mobile. My bedroom has nice views. The cook visits me everyday and she asks me what I want to eat. She said if I don’t want something I could have what I like or a snack if I’m not hungry. Since moving here I have really settled its my home from home I don’t have a bad word to say’. A visitor said that staff were ‘very attentive and lovely, they are very genuine caring people. When mum calls for help they are here very quickly. I chose this home because when I walked in it was a warm and friendly atmosphere. I was welcomed and given lots of information. They provided an air mattress when other homes said they couldn’t. A resident had moved to a larger first floor bedroom at his request. He said ‘ there is no comparison with my other bedroom. There is plenty of room in this bedroom. I am a collector by routine and there is plenty of room for my furniture. I have recently been on holiday to Southport. I do this most years and care is arranged’. The Old Vicarage Nursing and Residential Care Centre DS0000034659.V254212.R01.S.doc Version 5.0 Page 10 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): These standards were not inspected. EVIDENCE: The Old Vicarage Nursing and Residential Care Centre DS0000034659.V254212.R01.S.doc Version 5.0 Page 11 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): These standards were not inspected. EVIDENCE: The Old Vicarage Nursing and Residential Care Centre DS0000034659.V254212.R01.S.doc Version 5.0 Page 12 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 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. Some bedrooms and corridors have been repainted in a neutral colour. The continued programme of redecoration keeps the interior of the building looking fresh and bright. The home was free from odours. The Old Vicarage Nursing and Residential Care Centre DS0000034659.V254212.R01.S.doc Version 5.0 Page 13 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): These standards were not inspected. EVIDENCE: The Old Vicarage Nursing and Residential Care Centre DS0000034659.V254212.R01.S.doc Version 5.0 Page 14 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, 33, 35 and 38. There is leadership guidance and direction in the home to ensure residents receive consistent quality care. EVIDENCE: A registered nurse who has not yet completed the registration process for manager with the Commission for Social Care Inspection manages the Old Vicarage. The manager has not yet completed the registered manager’s award. The registered provider was very complimentary about the manager and said ‘ I have been able to pull back. I don’t feel I have to worry now with Joanne in place. I don’t worry as much and have every confidence in her ability. I can leave things in her hands she is a very capable manager’. The Old Vicarage Nursing and Residential Care Centre DS0000034659.V254212.R01.S.doc Version 5.0 Page 15 The manager and registered provider undertake quality assurance. The manager completes a monthly audit on clinical information, care plans, residents’ accounts, pressure ulcers and treatment, accidents to residents and staff, kitchen, laundry, hygiene of the home and residents’ bedrooms. These are completed using a pro forma document. Regulation 26 visits by the registered provider cross reference to the audits by the manager. Staff have responsibilities for health and safety with a staff member checking the water temperatures of water outlets used by residents and recording the results weekly. The manager had introduced a written audit of medicines. The registered provider completes a satisfaction survey annually. Visitors’ questionnaires were introduced as recommended and completed in May 2005. A visitor commented on a questionnaire that ‘ I do find the staff and management very approachable and easy to talk to and find that everyone is caring’. The manager has also used the NHS clinical benchmarking tool ‘The Essence of Care’ to provide quality standards in the home. She has taken the performance indicators from this for privacy and dignity. From the performance indicators she has produced a draft set of quality standards for care staff, which can be used as an audit tool. The home does not deal with any residents’ finances except for personal spending money. Two residents are subject to the court of protection and have finances managed by their family and another resident is subject to power of attorney. Otherwise residents control their own money or have relatives who assist them. Residents have personal money in safe keeping. Receipts are given to relatives for money paid in. Residents’ money is kept in separate envelopes; all transactions are recorded and double signed; receipts for all expenditure made on behalf of residents are filed. The manager as part of her monthly audit checks these. The manager provided details of the testing and servicing of all plant and equipment. The records maintained within the home relating to the health & safety of residents was examined. These included; Fire Log Book, Accident Book, Risk Assessments, Portable Electrical Appliance Tests, HACCP Records Maintenance Records for Hoists and Records of Discharged Hot Water. Fire drills and fire training have been held in May and August 2005. A weekly fire alarm test is recorded and monthly emergency lighting test. The Old Vicarage Nursing and Residential Care Centre DS0000034659.V254212.R01.S.doc Version 5.0 Page 16 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 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 3 x x x x x x 3 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 The Old Vicarage Nursing and Residential Care Centre DS0000034659.V254212.R01.S.doc Version 5.0 Page 17 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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 Nursing and Residential Care Centre DS0000034659.V254212.R01.S.doc Version 5.0 Page 18 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich 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. 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