Inspection on 20/08/07 for The Old Vicarage Nursing Home

This inspection was carried out on 20th August 2007.

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 Home 26/07/06

The Old Vicarage Nursing Home 10/01/06

The Old Vicarage Nursing Home 21/08/05

The Old Vicarage Nursing Home 12/01/05

The Old Vicarage Nursing Home 08/07/04

The Old Vicarage Nursing Home 16/03/04

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 Home, 160 High Street Chasetown Nr Walsall WS7 8XG Lead Inspector Mr Peter Dawson Unannounced Inspection 20th August 2007 08:45 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 Home, DS0000022358.V346360.R01.S.doc Version 5.2 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 Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Vicarage Nursing Home, Address 160 High Street Chasetown Nr Walsall WS7 8XG 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) 01543 685588 01543 683306 Morecare Limited Care Home 27 Category(ies) of Dementia - over 65 years of age (27) registration, with number of places The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. DE Dementia over the age of 60 years for 27 persons Date of last inspection 26th July 2006 Brief Description of the Service: The Old Vicarage Care home provides specialist nursing care for those service users suffering from the effects of dementia over the age of 60 years (27). Accommodation is on 2 floors with shaft lift access. There is a large lounge area with recessed areas and separate dining area. Four bedrooms are for shared use. There are no en-suite facilities but good access to toilet and bathroom areas. The building is well maintained internally and externally. The home is located on a main road in Chasetown with easy access for visitors, not far from a few shops. The main town is only two miles away. There is a medium sized garden with a sun patio and seating area. This is accessed via a ramp and suitable for wheelchairs. There are sufficient car parking facilities. This nursing home is in the same ownership as the adjoining nursing home on the same site, but are run independently of each other. The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was carried out on one day by one inspector from 8.45 am – 4.45 pm. The home was inspected against the National Minimum Standards for Homes Older People. Methods used for the inspection included tracking of individual care plans, reading of documents and records, speaking with residents, staff and visitors and general observations and discussions with the Manager. There was an inspection of the whole of the communal areas and a sample of bedrooms were seen also. An Annual Quality Assurance Assessment (AQAA) was completed by the Manager prior to the inspection and provides a basis for some information in this report. There were 27 people in residence at the time of this inspection – there were no vacancies. Five residents were spoken with and able to express a view about their experience of the home. All spoke positively about staff, their attitudes and care. Comments included “staff are really good, they look after me” and “nothing is too much trouble for the carers, they work hard and look after us all”. Three people visiting relatives were spoken to. Similarly they spoke highly of staff care, said that they were involved and kept informed about any changes in the health and welfare of their relatives. One said “I trust the staff here totally, they will do anything for the residents”. Negative comments were clearly, and in some instances, forcibly expressed by two residents and three visitors concerning the poor standards of food provision in the home. These are documented in this report and it is vital that these complaints are addressed, they affect the quality of life of residents and detract from the other good and improved standards in most other areas of care in this home. The current weekly fees for residents are in the range £304 - £500 What the service does well: A smaller nursing home catering mainly for the dementia care needs of 27 people. Visitors are received warmly and there were friendly, relaxed exchanges between staff and the visitors who know each other well. The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 6 Good, positive and sensitive interactions and engagement were evident between residents and staff. All residents able to express a view spoke highly of staff care and commitment to them. A well maintained environment with ongoing maintenance, repair and replacements. The Manager has been in post over 12 months, recently approved by CSCI as the Registered Manager. She has worked hard to improve many aspects of care in the home. These are outlined in this report. Staff spoken with showed warmth and understanding about the needs of residents and clearly committed to further improvements in standards. There is a positive approach to health care issues. Health care needs are clearly defined in care plans and actions taken to ensure health needs are met. There are regular reviews of health and medication with the GP. Clinical practice is good. What has improved since the last inspection? There have been many improvements. All the previous requirements have been wholly or partly addressed - Plans in place to complete those not wholly addressed. A Registered Manager has recently been approved by the Commission for Social Care Inspection. A more flexible and open approach to resident need is evident. Residents are given greater choice in the daily living situation including basis choices such as rising, retiring and bathtimes. Staff are listening to residents and keen to meet their individual needs. Care planning information has been improved, containing more comprehensive information about care needs based upon assessment and review. Activities in the home have been improved. A member of staff now takes a lead on activities and has attended a basic training course on the subject. An activities diary has been established recording the daily activities provided for individual residents. Shortfalls in dementia care training have been addressed, training provided for most staff and planned for the remaining staff. Training in safeguarding has been arranged and further courses in process to ensure all are trained. A staff training matrix has been established easily identifying areas of training need. Professional training for nurses on many aspects of clinical practice has been provided over the past year. Five staff have completed NVQ training and The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 7 courses made available for those not already involved in NVQ training. The objectives of the increase in training of staff is, of course to improve practice and standards. A quality assurance system has commenced with feedback from relatives and residents. Other means of soliciting feedback from users of the service and other stakeholders are being considered. Ongoing redecoration of bedrooms as they become vacant continues. There have been replacement specialist beds and purchase of wedged bed-guard protectors to increase protection of residents needing bed-guards for their safety. All the chairs in the large lounge area have been replaced, improving comfort and presentation for all residents. New procedures and documentation have been introduced to improve staff recruitment and selection. What they could do better: Food provision is poor and there are many complaints from residents and relatives about this. A review of total food provision must be carried out and changes made to improve this important area for residents which affects quality of life. Improvements must include the presentation of the dining area. Staff training is still required in areas of Fire Safety, food Hygiene, Safeguarding and Dementia care – several courses are arranged for some aspects of this training over the next few months. Recruitment procedures could be further improved ensuring required documentation is provided for new staff. POVA or CRB checks must always be obtained prior to employment to ensure safety of residents. Curtains are needed to complete the changes made in the lounge area. This need has been identified over a long period of time. The time off-rota for the Manager has been reduced from 2 days to 1. Additional supernumerary time for the Manager would assist the changes that are being made in the home. Medication Administration Records (MAR sheets) must always be signed when medication is given. PRN (as required) medication should have written protocols and recorded when given, why and what the outcomes are. The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 8 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 summary of this inspection report can be made available in other formats on request. The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 9 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 Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate The statement of purpose requires updating. All are assessed by the home prior to admission, have Care Management Assessments and invited to visit prior to admission. Written confirmation of capacity to meet needs should be put into place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some changes have been made to the Statement of Purpose since the last inspection. Further changes are necessary and discussed with the Manager who will ensure all items listed in Schedule 1 of the Regulations are included. All residents have contracts provided by the local authority or the home for self-funding residents. From a sample of records of recently admitted residents it was seen that all have pre-admission assessments carried out by the home in their current The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 11 setting prior to admission. Care Management Assessments (Single Assessments) were provided also for those seen. It is recommended that the home send written confirmation to new residents prior to admission, confirming that following assessment their needs can be met by the home. In the 2 records seen and discussions with the residents there had been no pre-admission visit by the person due to being in hospital but their relatives had visited and carried out negotiations for them and they were more than happy with this. The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good A new care planning system has improved the content and detail of plans. A change to further improve the system is in progress. Health care needs are well documented and fully met. Records, observations and discussions with the GP confirmed this. The medication system is safe, although some aspects of recording could be further improved. Residents are treated with respect, privacy and dignity assured. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the last inspection improvements in the care planning system were needed the one is use was dated and inadequate to cover comprehensive care needs. The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 13 A new format is now being used – the one in use in the sister home next to the Old Vicarage. This is an improvement on the previous system and all information transferred across to the new format – a significant task for 27 residents. However whilst the care planning information has greatly improved this is a temporary measure only – both homes are commissioning a new format which is more suitable and comprehensive for use. The care plans of 4 people were sampled including 2 recently admitted residents. Health care needs were clearly defined with plans that were actioned. The social and daily living needs of people were in place and there has been an improvement in provision of social histories, although these are still brief and need to be extended providing greater information about past and present needs and choices. Some gaps were noted in incomplete records of bowel movements and a missing moving & handling assessment due to member of staff being off sick. These will be addressed by the manager. Health care records showed clear diagnoses and treatment regimes. All had nutritional, waterlow and continence assessments. Wound care needs were defined and treatment regimes established with advice sought from the Clinical Nurse Specialist for tissue viability for the 2 people with pressure ulcers acquired in hospital. Where needed food/fluid balance charts and record of regular re-positioning of residents in bed were in place. There was evidence of early referral to GP and involvement of other health care professionals including Parkinson’s Specialist nurse. CPN’s, Consultant Psychiatrist etc. A pro-active approach was evident – the home had initiated referral concerning person with Parkinsonism, there had been review or medication etc and tremors been reduced with changed medication. All residents are weighed monthly and where there are concerns about weight loss – weekly. There is adequate pressure relieving equipment available and in use for those considered at risk. A visiting GP who visits the home weekly and provides a good service to the home was spoken with in some detail. He said there was good dialogue and co-operation with staff who take time to consider health care issues and have a good knowledge of needs. Treatment regimes are discussed and actioned, he confirmed that clinical practice was good. He said that regular 6 monthly health reviews of his patients were carried out by him with staff and also reviews of medication. There was an observed relaxed and positive dialogue between staff and the visiting GP who made very positive comments about the home and staff. The majority of residents have dementia, although some do not and have mental health needs – 2 have a bi-polar disorder and 1 mental health needs with regular depot injection. The home does not have registration to admit people with mental health needs (MD) and should consider a variation to registration for that purpose. This is an additional category of registration which the home does not presently have. The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 14 The medication system was inspected and recently changed from the Nomad to Blister pack system which has only been in operation for few weeks. Staff felt the system offered greater security in the administration of medicines. MAR (Medication Administration Records) showed some gaps in signatures following medication being given. All staff must ensure that medication is signed for at the point of administration. Some PRN (as required) medication was prescribed, other than analgesics, including Diazepam which had been given as required but not recorded to give the dose, reasons and outcomes. There were no written protocols. There is no self-medication in the home at this time. The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor Provision of activities have improved as previously required. Family contacts are promoted some accessing the community with their relatives. There was evidence of extended choice for residents and chosen lifestyles. The exception being in relation to food. Food provision is poor. Improvements must be made - the home must listen to residents and relatives and review food provision to improve the dining facilities, the planning, preparation and delivery of food to meet required standards. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were some concerns outlined in the last report about the lack of occupation and stimulus for residents – a requirement was made to consult residents and provide a range and programme of activities to meet residents needs. The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 16 This has been addressed and progress made. A member of staff now takes a lead on activities, has completed a training course relating to activity provision and established a daily diary of activities/events in the home recording the daily activities engaged in and by whom. Social histories were not present at the time of the last inspection but some progress has been made to include this as part of the care planning information as a basis for identifying interests and previous experiences which can be built upon. These were recorded in the improved care plans. This is particularly important for this group of people several having advanced dementia care needs. This progress is to be further built upon by incorporating a more detailed social history as part of the new care planning format proposed to be introduced. Entertainment is not regularly provided in the home and staff are organising fund-raising events to extend this. There was evidence of the home extending the choices of people in the daily living situation in areas of rising, retiring and bathtimes. Some residents confirmed this in conversation. One did say that she was going to bed earlier previously but her needs have changed and now wishes to go later – the problem was that if she wanted to prepare for bed at 10pm this was a busy time for night staff and she had to wait sometimes. The Manager will further discuss this with the resident and review the evening arrangements. Some residents were seen accessing their bedrooms throughout the day. One resident said her chosen lifestyle was to rise later for breakfast, spend the morning in the lounge, have lunch and then return to her bedroom where she spent the rest of the day as she wished, having tea delivered to her room and later being assisted to bed. This was an example of chosen lifestyles being accommodated. The home promotes contacts with family and friends. Several people have daily visits, some taken out by relatives. Three have husband/partner visiting daily, spending time privately in their bedrooms and assisting with feeding at lunchtime etc – an example of a shared care concept. Food provision in this home is poor. Concerns were identified in the last inspection report about this. A 2 weekly menu was in place a 4 weekly menu was suggested. This was provided and the autumn/winter menu remains without change. There is no choice of dish for the main mid-day meal. Also the tea menu of soup and assorted sandwiches daily provided very limited choice and it was suggested that more variety could be provided at teatime. The report also stated that the tables in the dining room were bare and uninviting. At the time of this inspection the 4 weekly menu was still operative from the winter. There were no choices of main dish. Residents spoken to said that liver, sausage and faggots were regularly provided and they did not like them. The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 17 They said that there was no alternative, two said that if they did not like the lunch of the day they would simply have potatoes and vegetables. Three residents said that the food was poor, one when asked said it was “crap” and then proceeded to give details of the reasons for that statement. Three visitors spoken with who were very regular visitors, said that food provision was poor and “inadequate” one said that he had made a complaint about the poor food provision and there had been little improvement. The complaints centred around repetitive single-choice meals, “poorly cooked” not always sufficiently hot. Breakfasts consist of cereal/porridge and toast and marmalade/jam – seen on the day of the inspection. Occasionally cooked breakfasts are provided (from adjoining home) but residents said that the bacon was over-cooked, brittle and could not be digested and quoted a recent occasion when 5 hash-browns were provided for 27 people. One person said that when meals were cooked on the premises food provision was better but “about 18 months ago”, the food has been prepared at the sister home next door and there had been a deterioration in the quality and presentation of the food. In a quality audit by the home written feedback was seen to include dissatisfaction with the food provided. The home has a well-equipped kitchen quite suitable to prepare food on the premises. A kitchen assistant works in the kitchen area daily from 7.30 – 2pm who appears mainly to prepare vegetables used in the main kitchen next door and prepare sandwiches for tea. The dining room was stark as stated previously. Large old, marked wooden, uncovered tables with no linen, crockery or placemats presented a picture of dated institutional eating rather than a domestic inviting dining experience to be enjoyed by residents in accordance with current thinking and standards. The mid-day meal was seen arriving and being served. Twenty two residents were seated in the dining room for 12.15 - the agreed time for delivery of the meal from the adjoining home. The meal arrived 20 minutes later, many residents being unable to remember why they were sitting at the table. The meal consisted of mashed potato, mashed carrots and beans with corned beef slices (cold –certainly at the point of eating). There was no alternative choice. A salad accompanied the meal small in quantity and more suited to a meal for 6 people. A pudding was provided with custard. The meal looked basic and uninviting. The above fails to meet Standard 15 – which states “service users receive a wholesome, appealing balanced diet in pleasing surroundings at times convenient to them. This was discussed with the provider following the inspection who said he was unaware of complaints about food. The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 18 A requirement is made to review the food provision in the home. Residents should have an input into menu planning. Alternative dishes must be provided at all mealtimes. Consideration should be given to cooking food on the premises to improve some of the issues raised in complaints. The dining tables are totally unsuitable for their purpose and should be replaced to comply with Standard 23(2)(a) of the Care Home Regulations. The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The complaints procedure is in place and available to all providing protection for residents. There has been training in the protection of vulnerable adults (Safeguarding) and arrangements in hand to complete this for all staff. A copy of the interagency Safeguarding (Adult Protection) procedures will be obtained by the manager. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a satisfactory complaint procedure in place a copy posted in the home for residents and visitors. There have been no complaints to the home or the Commission since the last inspection. A complaints book records past complaints made and the Manager conscious of the need to act swiftly and positively when complaints are made. The Manager intends to provide a comments box for residents and visitors providing the opportunity for them to make suggestions or complaints about the service, anonymously if they wish. A requirement of the last report to provide training for staff in the protection of vulnerable adults has been addressed. An internal policy/procedure is now in The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 20 place. The home do not have a copy of the Staffordshire Inter-agency Safeguarding Policy and was advised of the route to obtain a copy. Most staff have received training in abuse awareness since the last inspection, some distance learning options have been used, further training is needed to ensure all staff are trained. Staff spoken to had a knowledge of the various forms of abuse and the actions to be taken in the event of any concerns. They also have been informed and given details of the Whistle-blowing procedures and their use. The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. The building is generally well-maintained and improvements have been made. Dining room tables are unsuitable and should be replaced. There are adequate communal bathing and toilet areas. Bedrooms suit the needs of residents and are well personalised. The standards of hygiene throughout are good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the last inspection it was recommended that shabby, worn or damaged furniture should be replaced. This has been done in some bedroom areas and most significantly in the lounge area. All chairs in the lounge area have been replaced with good, suitable, comfortable seating, improving the appearance of the large recessed lounge area. The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 22 It was noted that there are no curtains in the rear lounge area and these should be provided to improve presentation by day and privacy and security for residents and staff at night time. Apparently several quotations have been sought over a long period of time but never fitted. A sample of bedrooms were seen on both floors and all were bright, well furnished and personalised to reflect individuality. There has been some redecoration of bedrooms and some new specialist beds purchased. There are 2 bathrooms and a shower room providing choice for residents. The shower room has been completely refurbished, tiled and new shower seat provided. Some bathroom/toilet areas have been refitted with quality vinyl flooring, improving appearance and infection control. There are no en-suite facilities, many rooms have commodes and 10 new ones on order to replace those worn. There are 4 shared bedrooms, all were seen and provided good space, were well furnished and personalised and had privacy curtains fitted. Discussion revealed that people had made conscious decisions to share – 2 residents choose to go to bed at the same time, others have expressed the wish to have company and to share. One resident is presently being nursed on the floor on mattresses in her bedroom due to risk of providing bedguards and also falls from the bed. This has been referred for multi-disciplinary assessment and review – options being presently considered. Several mattresses are in place to avoid movement onto the carpeted area. Carpet burns have been a previous concern. It was noted in this room that a low-level electric point near to the mattress was readily accessible by the resident. This should be covered to ensure safety. Furniture, fittings and equipment in the environment as a whole, were generally good – the exception being the dining area – referred to in Standard 15 – the tables are large, dated, bare and quite unsuitable for purpose. They should be replaced to vastly improve the presentation and facilities. The laundry and sluicing areas were inspected and provided adequate safeguards against infection. All areas of the home seen were clean with high standards of hygiene. There is a secure patio area to the rear of the property with good seating and allows residents to wander safely as they wish. The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. Staffing levels remain satisfactory. The many shortfalls in areas of training have been addressed and are ongoing. Training in both statutory and professional training have been considerable in the past year improving the competencies and skills of all staff. Recruitment procedures have been improved, although there are still identified shortfalls. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a requirement of the last report to provide training for staff appropriate to the work they perform. This included a lack of dementia care training. This has now been provided for most staff on a distance learning basis over a period of about 6 months. This provides more detailed training over a longer period than day courses some staff still to complete this. This is very important given that the homes registration is for people with dementia care needs. Other aspects of training have provided in areas of Safeguarding for all staff. There is now a staff training matrix identifying training undertaken and training needs. Some further statutory training is required for Moving & Handling – arranged for 23-24th August. Fire Training – arranged for 25 – 27th September The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 24 and also Food Hygiene training for some staff. Progress has certainly been made in areas of staff training and continues. Professional training for nursing staff provided in the past year include: Management of Parkinsons disease. Continence care. Medication management (Rosemount). Wound care (Convatec). Nutritional assessment and care. Management of use of bedrails (Health Trust). Staffing levels remain the same for the 3 shifts which is 5:4:3 and includes one nurse throughout the 24 hour period. There are currently 27 people in residence (no vacancies) – staff rota’s were seen and from observations and discussions appeared adequate to meet the needs of the current resident group. The home is fully staffed at this time with 2 recent appointments. There is only minimal use of agency staff. It was identified at the last inspection that recruitment procedures should be strengthened. New procedures are now in place. A new database has been established and new application form and interview format put into place. A sample of staff files were seen. It was evident in one instance that a member of staff had been employed prior to POVA or CRB clearance. Checks must always be carried out prior to employment to ensure protection of residents. It was also found that some documents required for staff as listed in Schedule 2 of the Regulations were not in place – these included copies of birth certificates, passport and evidence of qualifications. The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The Registered Manager has shown positive leadership in managing the necessary changes and improvements to the home over the past year. A more resident centred approach improves choices and quality of life for residents. Record keeping, policies and procedures have improved and in the best interests of residents. The health, safety and welfare of residents are the objectives of a committed staff group who are well supported and managed. This judgement has been made using available evidence including a visit to this service. The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 26 EVIDENCE: At the time of the last inspection 12 months ago the Acting Manager had been in post for 3 months and requirement made to make an application to CSCI for a Registered Manager. This has been done and in the week prior to this inspection the Acting Manager approved by the Commission as the Registered Manager. The Manager is a registered nurse and has the required experience to run the home. She is presently involved in training for the RMA (Registered Managers Award) with a completion date in approximately 9 months. The Manager has made considerable progress in many areas over the past year. Shortfalls were identified in areas of care planning, choice for residents, considerable training needs and the need to established a Quality Assurance system to review the care and service provided. These tasks have all been addressed either in total or in part and progress made in many other areas of the service identified throughout this report. The Manager is allowed one day per week for management duties, working as the nurse on duty for the remainder of the week. This is surprising in the light of the progress made in many areas of practice and care over the past year as outlined in this report and the plans to sustain and further improve the standards in the home. Additional supernumerary hours are indicated to maintain the impetus of necessary change and progress. A visiting relative and the GP commented particularly on the progress and positive changes made in the home by the Manager. There was a very relaxed and open atmosphere in the home during this inspection. Several staff on duty showed very positive commitment to resident care in discussions and all were keen to improve quality of life for residents. Staff made a valuable contribution to the inspection process. All residents and visitors spoken with said that the care provided was good, staff were caring, sensitive and supportive. The only negative comments were about the poor food provision and these were expressed quite forcibly. This is an area of dissatisfaction which must be seriously addressed by the home. A Quality Assurance system has commenced with surveys completed by relatives and some residents. The Manager is keen to use these as a means of service improvement. There are plans to introduce resident and relatives meetings providing a forum for feedback and review. The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 27 There has been an improvement in record keeping over the past year including more detailed care plans, recording of daily activities, staff recruitment and selection, social histories and details of preferred lifestyles and choice. The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 28 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 2 3 3 2 3 N/A 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 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 3 2 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X X 3 3 2 The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 29 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. 1 Standard OP9 Regulation 13(2) Requirement MAR sheets must be signed at the point medication is given. PRN medication must have protocols recording dose, reason given and outcomes recorded Urgently review food provision to ensure suitable, wholesome & nutritious food which is varied and properly prepared and available at times required by service users. Tables in dining area do not meet the needs of service users and should be replaced. Provide curtains in lounge area to improve presentation, privacy and security. POVA/CRB checks must be obtained prior to employment of staff. Copies of documents listed in Schedule 2 must also be provided for new staff. Further staff training is required for Moving & Handling, Fire Safety, Food Hygiene and Safeguarding. Timescale for action 31/08/07 2 OP15 16(2)(i) 30/09/07 3 4 5 OP19 OP19 OP29 23(2)(a) 16(2)(c ) 19(1) & Schedule 2 19(1)(c ) 31/10/07 30/09/07 31/08/07 6 OP30 31/10/07 The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 30 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 OP31 Good Practice Recommendations Consider additional supernumerary time for the Manager to allow time for the effective and efficient running of the home. The Old Vicarage Nursing Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Local Office 1st Floor, Ladywood House 45-56 Stephenson Street BIRMINGHAM B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Home, DS0000022358.V346360.R01.S.doc Version 5.2 Page 32 - 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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