Inspection on 21/08/05 for The Old Vicarage Nursing Home

This inspection was carried out on 21st August 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Old Vicarage Nursing Home 20/08/07

The Old Vicarage Nursing Home 26/07/06

The Old Vicarage Nursing Home 10/01/06

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 Keith Jones Unannounced 21 August 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 Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Old Vicarage Nursing Home Address 160 High Street Chasetown Nr Walsall WS7 8XG 01543 685588 01543 683306 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) Morecare Ltd Mrs Deborah Withington CRH 27 Category(ies) of DE(E) - 27 registration, with number of places The Old Vicarage Nursing Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: DE Dementia over the age of 60 years for 27 persons Date of last inspection 12 January 2005 Brief Description of the Service: With its Victorian façade, thoroughly renovated and entirely private, 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).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. The Old Vicarage Nursing Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was conducted with the duty registered nurse and the care manager at a later stage. The last inspection report was discussed, and it was noted that recommendations made have yet to be addressed. The tour of the home was carried out in a relaxed, courteous and professional manner, everyone concerned cooperated with the inspection process. All the service users approached were generally complimentary of the care, service and attention they received. There were 27 residents on the day of inspection, categorised as needing nursing care. Four residents were case tracked offering an insight and appraisal of the standards of care. The Inspector noted the freedom that residents enjoyed and the involvement that the manager and her staff encouraged. Everyone appeared comfortable and at ease with their surroundings A sample review of the administration records helped to formulate the audit of care practice and policy. A feedback session was offered at the end of the inspection with open discussion involving the care manager. What the service does well: What has improved since the last inspection? The attention to the direct provision of care by a focused team has contributed significantly to improving overall standards throughout the Home The Old Vicarage Nursing Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 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 Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 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 Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 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) 1,2,3,4 and 5 The Registered nurse and care manager confirmed that the Statement of Purpose is the foundation on which the philosophy and practice of care is based. Admission policies ensure a positive approach to informing residents and families of services available, and a determination of the suitability of applicants. Residents were generally supportive of their placement and the environment, confirming that staff took every effort to meet their needs. EVIDENCE: The Statement of Purpose was recognised as a reflection of the organisational and professional philosophy to meet resident’s needs and enhance their quality of life. The Old Vicarage Nursing Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 Page 9 Examination of care records evidenced that an opportunity to determine an element of choice was offered, through the pre-admission procedure. The admission process is carried through by the care manager, and/or a senior member of staff. Several admission records were examined and mainly offered a clear picture of the resident’s physical, psychological and social needs. One record was however poorly compiled, relying on a multi agency assessment and care plan provided by the Social services department. Contracts were approved, usually through Social Services at the review period. At the time of inspection there were several residents on bed rest requiring, and identified as needing high dependency care. The Old Vicarage Nursing Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 Page 10 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) 7,8,9,10 and 11 Overall the care assessment and planning system is an organised, yet homely process offering meaningful and valid documentation of care administered. A broad vision of needs is addressed through the care planning process, attempting to meet personal and health needs. The provision of a secure and safe medicines administration is managed efficiently by registered nurses. Staff were seen to demonstrate a personal empathy with residents through a respectful, yet friendly discourse. The Old Vicarage Nursing Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 Page 11 EVIDENCE: Four service users were case tracked, with a full examination of care records, health records including general practitioners visits, risk assessments, dependency charts, records of reviews and action plans. The pre-admission assessment represented the foundation for a well-considered and detailed care planning process. A profile of the service user’s social, physical and psychological status offered an individual plan of care, based upon a multiple point activity of daily living, to be implemented and reviewed monthly. Each service user has a key worker who is responsible for maintaining an indepth awareness of those service users. The Home operates a Standex system of care records, which was well presented and maintained. However there was a case where a resident was being barrier nursed for a clostridium difficile, which had been cleared in July, but had not been communicated effectively, whereby a senior nurse was not aware of the clearance, and was assuming barrier care. Nevertheless the care plans for barrier nursing were seen to have been well organised, with the involvement of relevant other professional direction. Evidence of health care professional visits showed an attentive awareness to service user’s needs Daily reports were acknowledged as a valuable process that have been standardised for all service users. There was evidence of consultations from medical specialists and other professional support services. There was evidence that administration of drugs procedures were seen to be up to date and accurate. There were no residents self-medicating at the time of inspection. The clinical room is very small and the owner has agreed to move this to an unused room at the rear of the building, although not actioned as yet. Records identified that any homely remedies had been identified. Examination of the accident records showed various inconsistencies in the completion of the record which rendered the record open to dispute. It was also noted that there were poor descriptions of injuries and in one instance of a head injury no referral to medical intervention was made. The spiritual orientation of each service user is recognised within care records. The policy of handling death and care of the dying was to offer a sensitive and supportive assurance that all care will be given. The prevailing personable atmosphere in the home is extended to encompass the needs of relatives and friends during a difficult time. The Old Vicarage Nursing Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 Page 12 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 Routine is seen as flexible to acknowledge individuality, yet maintain a focal point for service users to latch on to without dictating events. An open visiting policy is a popular and well-used option, several visitors were spoken to during the morning tour of the home. Service users are encouraged to exercise choice and control over their life as far as is possible, and encouraged to bring into the home personal possessions. Service users were offered a varied and nutritious choice of meals from a rotating menu. The organisation, preparation and delivery of meals are through arrangement with the main kitchen at the neighbouring care home. Special diets were accommodated with the kitchen assistant making every effort to engage with service users to discuss personal preferences. EVIDENCE: The daily routine was discussed with staff and several residents and was seen to be flexible to acknowledge individuality, yet present a focal point for residents to offer the security of consistency. Through case tracking, resident’s life-styles and interests were recognised, discussed with their relatives prior to admission, and documented as far as possible to enhance a position of supported independence. Those who wish to bring in personal possessions are encouraged to do so. The Old Vicarage Nursing Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 Page 13 Residents spoken to were generally complementary with the relaxed environment and the standards of care. During the inspection several residents and staff were seen to be engaged in social activities. . Staff were observed to hold a friendly and sympathetic interaction with service users in lounge areas, and at lunchtime in helping those who required assistance. Service users were offered a varied and nutritious choice of meals from a 2week rotating menu. It was pleasing to discuss with the catering assistant the degree of involvement she had in the daily nutritional affairs of the residents, including accommodation of special diets and regimes. Staff were seen to offer discreet assistance to those who required it. The choice of dining room, lounge or bedroom was at the discretion of service users. The kitchen reception area was inspected with the catering assistant and found to present a well equipped and organised area. All fridges and freezers were seen to be used in the appropriate manner, well maintained, and checked daily by the kitchen staff. A cleaning schedule was in place and found to be accurate, up to date and comprehensive. COSHH signs and notices were in evidence with cleaning chemicals secure, appropriate and under control. The Old Vicarage Nursing Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 Page 14 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) 16,17 and 18 Residents and families have a clear avenue of expressing their concerns and/or complaints. Staff are aware of their right to express their grievances and are aware of Whistle –blowing procedures. The policies and procedures protect the individual with a heightened awareness of the issues surrounding abuse. Staff training clarified the responsibilities of all staff in their daily contact with service users, especially their privileged position in protecting service users from abuse, of all natures. EVIDENCE: The Home had a meaningful complaints policy, clearly identifying the CSCI as a resource to approach with a complaint or grievance. Several formal complaints had been received via the Commission since the last inspection; of which some of the issues, mainly environmental and organisational, were upheld. A complaints book is maintained which shows a responsible approach in handling complaints appropriately. Advocacy service is available to those who require it as indicated in the Statement of Purpose, although no one is formally represented at this time. Service users’ legal rights are protected by the systems in place, including a contract, the continual assessment of care planning and policies in place i.e. the complaints procedure. The care staff and provider had showed satisfactory evidence of a protocol and The Old Vicarage Nursing Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 Page 15 response to anyone reporting any form of abuse, to ensure effective handling of such an incident. The accident reporting procedures, as previously mentioned, need to be tightened up, to ensure robustness of accountability. Steps have been taken to secure booklets from the General Social Care Council’s Code of Conduct for all staff to help reinforce the induction and training programmes. The Old Vicarage Nursing Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 Page 16 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) 19,20,21,22,23,24,25 and 26 The location of The Old Vicarage is conveniently placed for a care home. The external state of repair and maintenance is generally good, and the interior state of repair is at a satisfactory standard. There are some bedrooms that lack the necessary attention in décor and furnishings, with peeling wallpaper/plaster, poorly maintained furniture and beds, and lacking the homeliness or ambience of a personal domain. Nevertheless the majority of bedrooms inspected were of a good standard and presentation. Communal areas are furnished and decorated to a good standard to present a homely and comfortable environment. Some furniture is still in need of renewal. Decoration is of a good standard. Bathrooms and toilets are suitably equipped and adapted. The domestic services in the home were seen to be of a very high standard. The home presented a clean and pleasant, odour-free atmosphere, much to the credit of staff. The Old Vicarage Nursing Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 Page 17 EVIDENCE: The home is well appointed to meet the needs of mentally ill people. A traditional large town home setting provides a safe, comfortable, and homely environment. External access is satisfactory for visitors parking; pathways and fencing were safe and recently attended to. There is a small garden facility for service users to take advantage of. Internal access was facilitated with ample fittings of hand and grab rails in adequate, well-lit corridors. Wheelchair access was satisfactory throughout all areas of the home. Bedrooms were generally well maintained, but some remedial work to bedrooms and service areas identified in a complaint investigation have not as yet been dealt with, and will be a requirement for action. There is a need to ensure that each bedroom has a lockable facility available. The care manager was asked to make ready a programme for maintenance and refurbishment for the next twelve months as a means of identifying and planning improvements. Institutional notices were evident in resident’s bedrooms. Most bedrooms however have been well maintained with evidence of attention to meet service user’s personal preferences. It is the policy that on bedrooms becoming vacant, that each room is reappraised for redecoration. It was noted that there were several physically ill residents in bed on the first floor. The facilities and arrangements were seen to be satisfactory. Communal areas were pleasantly furnished with facilities to accommodate social or reflective needs, in a homely setting. Some of the furniture still needs renewal. Toilets are accessible to all, and within close proximity to all communal areas, the standard and presentation of all the toilets and bathrooms were of a high quality, clean, and odour-free. There are a number of toilet roll holders either empty or difficult for residents to use. There was evidence of the storage of items on toilet cistern lids which counters good cross infection practice. Policies for handling soiled and infected linen were satisfactory. One Parker bath was damaged and leaking. Water temperature was deemed to be safe, but a lotion thermometer in each bathroom is recommended. The domestic services in the home were seen to be of a very high standard. There was no evidence of unpleasant smells or unsightly debris anywhere throughout the inspection. The nurse-call alarm system was satisfactorily tested. The heating The Old Vicarage Nursing Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 Page 18 arrangements throughout the home are by central heating with guarded radiator or low surface temperature convection. The home is well appointed to meet the needs of mentally ill people. A traditional large town home setting provides a safe, comfortable, and homely environment. External access is satisfactory for visitors parking; pathways and fencing were safe and recently attended to. There is a small garden facility for service users to take advantage of. Internal access was facilitated with ample fittings of hand and grab rails in adequate, well-lit corridors. Wheelchair access was satisfactory throughout all areas of the home. Bedrooms were generally well maintained, but some remedial work to bedrooms and service areas identified in a complaint investigation have not as yet been dealt with, and will be a requirement for action. There is a need to ensure that each bedroom has a lockable facility available. The care manager was asked to make ready a programme for maintenance and refurbishment for the next twelve months as a means of identifying and planning improvements. Institutional notices were evident in resident’s bedrooms. Most bedrooms however have been well maintained with evidence of attention to meet service user’s personal preferences. It is the policy that on bedrooms becoming vacant, that each room is reappraised for redecoration. It was noted that there were several physically ill residents in bed on the first floor. The facilities and arrangements were seen to be satisfactory. Communal areas were pleasantly furnished with facilities to accommodate social or reflective needs, in a homely setting. Some of the furniture still needs renewal. Toilets are accessible to all, and within close proximity to all communal areas, the standard and presentation of all the toilets and bathrooms were of a high quality, clean, and odour-free. There are a number of toilet roll holders either empty or difficult for residents to use. There was evidence of the storage of items on toilet cistern lids which counters good cross infection practice. Policies for handling soiled and infected linen were satisfactory. One Parker bath was damaged and leaking. Water temperature was deemed to be safe, but a lotion thermometer in each bathroom is recommended. The domestic services in the home were seen to be of a very high standard. There was no evidence of unpleasant smells or unsightly debris anywhere throughout the inspection. The nurse-call alarm system was satisfactorily tested. The heating arrangements throughout the home are by central heating with guarded radiator or low surface temperature convection. The Old Vicarage Nursing Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 Page 19 The laundry area was clean and very well organised. The room is left unlocked when not in use and represents a significant risk area. The quality of the bed linen and counterpanes was seen to be generally poor. Evidence of torn bedding newly placed on beds confirmed that there is a poor supply and replacement policy. A significant number of sheets were slightly discoloured and looked very thin. Those residents with poor family support were given cutup towels for face cloths, laundered on a communal basis. The Home must make suitable provision for individual items for personal use. Procedures were in place for coping with soiled/infected linen with the provision of alginate bags to minimise handling and cross-infection. It was advised to make those bags more readily accessible for general use. COSHH signs were evident, for dealing with chemical cleaners, which were seen to be used appropriately throughout the home. However there were no specific instructions clearly visible for handling toxic de-stainer in use. Some electrical items did not display the appropriate PAT identification stickers. The Old Vicarage Nursing Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 Page 20 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 overall staffing coverage manages to maintain the expected levels each shift that was inspected. However there is an over-reliance upon existing staff working significantly over their contracted hours. Two members of staff who discussed hours worked in excess of 50 hours. There is also a heavy involvement in using agency staff to maintain the rotas The procedures for recruiting and appointing staff were seen to be inconsistent with various stages of the process not completed. Staff training was discussed and was found to need a review of the arrangements in regular training and supervision. EVIDENCE: Two staff files were inspected with one member of staff interviewed and a discussion of the overall staffing position with the care manager. Two weeks off duties were examined and found to maintain the agreed levels of staffin 0700 – 1400 - one qualified nurse and 4 care staff 1400 – 2100 - one qualified nurse and 3 care staff 2100 – 0700 - one qualified nurse and 2 care staff Staffing levels are based on the dependency levels of service users in the Home and these are reviewed on a regular basis. However the rotas showed The Old Vicarage Nursing Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 Page 21 that staff were working in excess of contracted hours. Staff spoken to confirmed their willingness to work long hours, sometimes without a day off to ensure coverage. The senior carer who worked frequently over 60 hours a week (has worked up to 95 hours/week on a regular basis) emphasised that it was of her volition, and not pressure from the manager. However steps should be taken to ensure that all staff have at least one day a week off, and recognised periods of rest during long shifts. There was also an over reliance on agency staff to maintain coverage due to difficulties in recruiting both registered nurses and carers. Staff sickness levels were considered high at the time of inspection. There is no recognised deputy care manager although coverage has been arranged for the care manager’s maternity leave from Morecare. The discussions with staff were positive and enlightening, with a clear determination that they belong to a committed team and have in the past generated a voluntary effort to help in the improvement of the resident’s stay. One carer informed the inspector she had been part of a team that generated a supply of bed counterpanes/throw-overs that residents still enjoy. Domestic, laundry and kitchen staffing levels were adequate; staff spoken to were seen to be confident, experienced and competent in their duties. The senior nurse informed the inspector that there are a full time administrator and a part time gardener/ maintenance man. The care manager confirmed that there are 2 care staff with NVQ level II or above, none in training at present, but 4 staff starting this year. This equates to a maximum commitment of 40 assuming that all will complete training. It is recognised that the Home will need to review it commitment to this required training resource. The care manager hopes to commence level IV on return from maternity leave. Several staff files were examined which showed an inconsistency of application of procedure in appointing staff. Some records showed no references taken, one with no application information. To comply with the Equal Opportunities Act employers are required to make a record of interviews and the conditions/agreements come about at that interview. This should be followed up with a letter of appointment to confirm those conditions and clarify any domestic arrangements for starting employment. CRB and POVA checks were seen to be up to date. Discussions with care staff and the care manager indicated that there are deficiencies in the staff training programme, i.e. one carer had had no fire drills for two years. The staff training files were not available for inspection but it was agreed to review the process of training with the care manager. The Old Vicarage Nursing Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 Page 22 Staff have received a continual attention to work supervision ‘on the job’, but there was no evidence to demonstrate that formal supervision is carried out every two months, as is required. The Old Vicarage Nursing Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 Page 23 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) 31,32,33,34,35,36,37 and 38 The care manager has a commitment to her residents and staff, which was demonstrated at this unannounced inspection. The management style is highly personable, with direct hands-on leadership. The general atmosphere is conducive for the care of the mentally ill in an inclusive environment, involving residents and family. Staff supervision has been essentially unrecorded, clinical and practical rather than the formalised regular supervision that is expected. Care records were of a satisfactory standard offering an informative and meaningful record and plan of care. Random sample policies and procedures were inspected and found to be suitable. The Old Vicarage Nursing Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 Page 24 EVIDENCE: The registered care manager Mrs Claire Witherington is a first level Registered Mental Nurse and has been working in EMI nursing homes for several years. She has been in charge of this home for over a year, and demonstrated her willingness to lead, and be part of the team in maintaining a direct influence over day-to-day matters. The evidence showed that Mrs Withergton was over committed in wanting to perform at all levels, and to be dealing with all issues. There is no recognised deputy care manager to support Claire during these recent difficult times with recruitment and sickness problems. Morecare have made arrangements for an RGN to stand in during maternity leave that starts this October. Mrs Witherington is expected to undertake a management qualification relevant to her role in line with the above standard in the near future. The inspector found that staff and residents were interacting well in an informal and relaxed atmosphere. The lounge area was animated, and encouraged responses from some residents with unresponsive histories. Staff were seen to encourage inclusion and activities in a friendly and constructive manner. Evidence was secured to confirm a quality monitoring system has been introduced, based upon audit of care standards, care plans and feed back from service users and relatives. The care manager stressed that standards are discussed at staff meetings, daily reports, direct observation and involvement and one to one staff meetings. The process of quality assurance would be complimented with a more structured approach to maintenance and risk assessment evaluation, placing the Home on a more preventative, rather than reactive status. Recent review of the environment identified the need for a structured approach. The care manager agreed to address the development issues of risk assessment, maintenance and renewal for discussion at the next inspection. As previously mentioned there is a willingness to create a training environment. A prepared programme is to be re-established and will represent a focal point for further examination as to its progress. Similarly a staff supervision policy and procedure is in place in the home, and will be reasserted to form an established routine alongside a cascading training programmes. The Old Vicarage Nursing Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 Page 25 All members of staff receive practical induction training in relation to moving and handling, food hygiene and an appreciation of infection control. Staff are to receive fire safety training every 6 months including night staff, although the records did not show evidence to that effect. These issues and routines ensured the health, safety and welfare of service users and staff The Old Vicarage Nursing Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 Page 26 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 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 2 2 2 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 x x 2 2 2 The Old Vicarage Nursing Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 Page 27 Yes 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. 2. OP29 Standard Regulation 12 (1)(2)(3)( 4)(5) 19 Sch 2 (5) 23(2)(c ) 16 38.4 Requirement You must ensure all previous outstanding requirements are fully met. You must demonstrate robust recruitment, application and interview procedures within the home That remedial work is carried out to bathrooms and bedrooms Lockable facilities are to be organised for each individual’s room. That staff work hours commensurate to Health and Safety recommended standards, to comply with employment legislation and to ensure the safety of service users. That there is a review of the fire procedures, including training throughout the home. That accident forms offer a full report and record of the event That NVQ targets are met Timescale for action Immediate Immediate 3. 4. 5. OP21 OP35 OP27.3 Immediate 01/04/06 Immediate 6. 7. 8. OP19 OP38.4 OP28.1 23(4)(iii) Schedule 3.3 (j) 18 (1) (c) (i) Immediate Immediate 01/04/06 The Old Vicarage Nursing Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Refer to Standard OP38.2 OP33.2 OP19.2 OP31 OP25.8 OP36 OP10.3 OP26.5 OP21 OP38 OP24.1 OP38.4 OP24.1 OP9 Good Practice Recommendations The practice of storing items on toilet pedestal lids cease forthwith, and ensure toilet roll holders are maintained. The management provide the CSCI a refurbishment/development plan for the Old Vicarage site for period 2006/07. Consideration be given to implementing a planned maintenance and risk assessment programme. That the care manager allocates more of her hours to the management process, and seeks to delegate responsibilities. Bathrooms to have hot water thermometers. Supervision of carers is to be formally documented six times a year. That the practice of providing communal face cloths for service users to cease. That COSHHE signs and information be displayed in all areas involving the use of hazardous chemicals, i.e. destainers. That remedial work is carried out to the damaged Parker bath That service (laundry) and store rooms be secure when not in use. That the practice of displaying Home instructions in service users bedrooms be more discrete. That PAT testing of service user’s personal electrical equipment be seen to be maintained. That a review of bed linen supplies take into account accelerated wear and tear. Consideration should be given to moving the clinical room to the larger store room down the corridor. The Old Vicarage Nursing Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 Page 29 Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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 Home E51-E09 S22358 The Old Vicarage V245539 210805 Stage 4.doc Version 1.40 Page 30 - 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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