Inspection on 09/07/08 for The Old Vicarage Residential Home

This inspection was carried out on 9th July 2008.

CSCI found this care home to be providing an Adequate service.

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 Residential Home 01/03/10

The Old Vicarage Residential Home 07/09/09

The Old Vicarage Residential Home 18/05/07

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

CARE HOMES FOR OLDER PEOPLE The Old Vicarage Residential Home 2 Tibberton Road Malvern Worcestershire WR14 3AN Lead Inspector Wendy Barrett Key Unannounced Inspection 9th July 2008 09:30 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 Residential Home DS0000068376.V368276.R02.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 Residential Home DS0000068376.V368276.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Vicarage Residential Home Address 2 Tibberton Road Malvern Worcestershire WR14 3AN 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) 01684 569523 01684 569523 SJS Care Ltd Mrs Annette Hoskins Care Home 17 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (2), Old age, of places not falling within any other category (17), Physical disability over 65 years of age (17) The Old Vicarage Residential Home DS0000068376.V368276.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home may also accommodate a maximum of 9 people over 65 years of age with dementia illnesses. 18th May 2007 Date of last inspection Brief Description of the Service: The Old Vicarage is situated a short distance from Malvern town and all the town’s amenities. The Provider owner, S.J.S. Care Ltd., was registered with the Commission in November 2006. Dr. R.C. Sumanasuriya has been nominated as the ‘responsible individual’ who supervises the management of the care home on behalf of the Provider company. The home is a Victorian house on three levels that has been adapted to provide care for older people. There are thirteen single bedrooms, seven of which have en-suite facilities, and two shared bedrooms. In addition there is a communal lounge and a communal dining room. A stair lift is fitted to the main staircase to facilitate movement between the ground and first floor. A small number of steps do have to be negotiated, as the stair lift does not reach the first three or four steps from the ground floor. Grab rails are, however, provided. The house is surrounded by a well-established, accessible garden. The home is registered to accommodate 17 residents who have care needs arising from the ageing process or who are over 65 years of age and have care needs arising from physical disability. The service can accommodate up to nine residents over 65 years of age who have care needs arising from dementia and two residents over 65 years of age who have care needs arising from mental health problems. On 5th April 2007 the fees ranged from £350 to £440 per week. There are additional charges made for hairdressing, chiropody, optician, continence wear (cost shared), newspapers, activities and transport. The Old Vicarage Residential Home DS0000068376.V368276.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was undertaken with reference to a variety of information sources. Mrs. Hoskins completed an annual quality assurance assessment report (AQAA) at our request. This provided details of the home’s own view of the service-what aspects are good, what things have been improved in the past year, and what plans have been made to address things that need to be better. A sample of survey forms was sent out to the home so that comments from residents, relatives, staff and visiting professionals could be obtained. Unfortunately, although Mrs. Hoskins posted completed surveys back to us they were not received. In view of this, survey forms were distributed to some staff during the inspection visit, and reference was made to resident and relatives responses to the home’s consultation exercise that was conducted in May 2008. Only 2 staff survey forms had been returned at the time of writing this report. We considered information held in our service records regarding any complaints or other contacts about or from the service since the last key inspection. An unannounced inspection visit took place on 9th July between 9:30am and 5pm. What the service does well: An experienced and qualified care manager manages the service. Residents benefit from the manager’s willingness to continue updating her knowledge and skill and using this to improve the quality of the service. There are well-organised records of the way each resident’s care is planned and provided. They clearly show how the potential risks to residents are regularly monitored to keep them as safe as possible. People who use the service are happy with the way they spend their days. They also appreciate the way staff protect their privacy and dignity. Relatives feel the residents are offered good leisure activities. The Old Vicarage Residential Home DS0000068376.V368276.R02.S.doc Version 5.2 Page 6 Staff receive regular, relevant training so they know how to work effectively with the residents. The staff are also supported in obtaining an appropriate national vocational qualification (NVQ). What has improved since the last inspection? What they could do better: The staff should make more use of the written care plans so they keep up to date with residents’ changing needs and work consistently with each individual. Medication should be managed more carefully so that instructions are clear enough to reduce the risk of errors as far as possible. Mrs. Hoskins’ proposals to revise menus should be given priority because there are indicators that the catering service should be improved. This work should include consultation with the residents, and reference to specialist guidance on managing a catering service for older people. The accommodation would benefit from redecoration and refurbishment. There should be more attention to strengthening the relationships between staff and management because some don’t feel as well supported as others. The Old Vicarage Residential Home DS0000068376.V368276.R02.S.doc Version 5.2 Page 7 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 Residential Home DS0000068376.V368276.R02.S.doc Version 5.2 Page 8 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 Residential Home DS0000068376.V368276.R02.S.doc Version 5.2 Page 9 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): 1,2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service, and their representatives, have accurate written information of the type of service being offered at the home. New residents are only accepted once the Care Manager has obtained enough details about the individual’s care needs and expectations to assess if the home will be suitable. EVIDENCE: Information literature that describes the service at The Old Vicarage had been updated since the last inspection. A Statement of Purpose is displayed in the main entrance to the home and all rooms have a copy of a Service User Guide. Temporary admission agreement seen-signed by Mrs. N. and son 30/04/08. Terms of Residence-not yet completed but seen ready in care file –still on temp. basis. Mrs. Hoskins has strengthened the way referrals for admission are assessed. This means that potential residents are more likely to have a comfortable The Old Vicarage Residential Home DS0000068376.V368276.R02.S.doc Version 5.2 Page 10 introduction to the Old Vicarage. Those people who have needs and expectations that can’t be met at the home can be advised that the placement may not be suitable. A married couple were met at the home. They had been admitted quite recently and both were happy with the way staff received them into their care. The daughter of a resident described how her mother had been able to visit the home and look around before her admission. Written records of this initial assessment work refer to areas of risk for the individual e.g. whether they are likely to fall, have fragile skin. Information from other professionals e.g. social workers, is obtained to contribute to the overall picture. The records seen at the home included the necessary information to tell staff how to work safely with a new resident, and to approach their work in a way that suits the individual e.g. preferred getting up and going to bed times. When residents are admitted they receive a copy of a statement of Terms and Conditions so they know exactly what service they can expect. The first agreement is a temporary one because all new residents have a trial period before having to decide if they want to stay at the home on a longer-term basis. The Old Vicarage Residential Home DS0000068376.V368276.R02.S.doc Version 5.2 Page 11 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): 7,8,9 and 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who use the service are happy with the care they receive. They feel the staff treat them well. Health care professionals are consulted appropriately so they can support staff in keeping residents’ safe. The care planning and related records have been strengthened by Mrs. Hoskins but some staff are not yet making use of them to keep themselves up to date about each resident’s situation. The way that medication is managed needs to be more carefully monitored to be sure risks to residents are reduced as far as possible. EVIDENCE: People who use the service are generally happy with the care they receive. Comments arising from the home’s consultation exercise confirmed this –‘very content in the home’, ‘overall a very high standard of care’, ‘feels safe…staff seem attentive to the residents’. A relative was met during the inspection visit. She described how her mother was sleeping on a pressure-relieving mattress because she had sore feet. The district nurse was visiting regularly. The staff were ‘very helpful’. The relative was clearly being kept informed about her mother’s care. The Old Vicarage Residential Home DS0000068376.V368276.R02.S.doc Version 5.2 Page 12 All residents met during the inspection, and a visiting relative, confirmed their confidence in the staff. Mrs. Hoskins had responded to a comment arising from the home’s recent consultation exercise. Staff had been reminded that they should avoid addressing residents in a manner that some may find patronising. The residents’ given names should always be used. This is good to hear because it shows that Mrs. Hoskins is committed to upholding residents’ dignity and respect. Mrs. Hoskins has introduced new ways of recording the way the care is planned and provided for each resident. A sample of these records i.e. risk assessments and care plans, contained up to date information because they had been very recently reviewed by the staff. There were records of visits from district nurses and G.P’s. Residents’ weights were being monitored and there were examples of contact with opticians. The records were well arranged so that staff should be able to find the information they need in their everyday care of each resident. However, two out of three staff said they didn’t look at the written records very often. The third staff member did use them regularly. She was involved in reviewing the records. One of the other staff did recall a recent review meeting with the resident and a specialist nurse where the resident’s sight loss was discussed. Most staff received training in handling medication in November 2007. Boots pharmacy audited the home’s medication arrangements in February 2008. There were 13 recommendations made and a follow -up audit was due to be undertaken in July. One of two staff survey forms included the comment that home needs to make sure ‘we don’t run out of medication’ and information passed on about changes to medication regimes. A sample of medication records was checked. These were being properly maintained in many ways but there were examples of inconsistencies in staff practices e.g. one hand written entry was signed by two staff to confirm both had checked its accuracy. Another handwritten entry had not been double signed. A pre-printed administration instruction had been altered. The instruction should have been re-written and the original instruction crossed out because alterations can be difficult to read accurately. There was an example of a resident who was prescribed diazepam medication ‘when required’. The records, and information from staff, indicated a lack of clarity about the way the medication was supposed to be used. There was also a period of a few days when the medication was out of stock so the resident couldn’t receive any. It is essential that medication, particularly tranquillising medication, is very carefully managed to avoid inappropriate use. The staff were recording instructions about changing doses of warfarin medication in a separate record rather than with the medication administration record. This separation of related records could increase the risk of staff making a mistake when administering medication because the up to date information is not readily to hand. Some residents appeared rather sleepy during the morning period. Sometimes this can indicate that medication regimes may need review. Mrs. Hoskins The Old Vicarage Residential Home DS0000068376.V368276.R02.S.doc Version 5.2 Page 13 confirmed that local G.P’s were very supportive and regularly reviewed the medication prescribed for each resident. There has been reference to unsatisfactory medication procedures in an anonymous complaint received by the Commission since the last inspection. The Commission’s pharmacy inspector will be asked to undertake an inspection at The Old Vicarage. This will provide a more in depth specialist assessment. The Old Vicarage Residential Home DS0000068376.V368276.R02.S.doc Version 5.2 Page 14 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): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service feel that they are able to spend their days as they wish. They enjoy a variety of social occasions and their relatives are welcomed at these events. There has been some work done to improve the quality of the menus, but the overall catering service would benefit from additional attention to the particular dietary needs and preferences of older people. EVIDENCE: The written care records include information about each resident’s preferred lifestyle although staff differed in their accounts of the degree of flexibility residents enjoy e.g. the opportunities for residents to get up at a time of their choosing. One staff member felt that all residents, bar one, were up and dressed for breakfast at 8am. Another staff member described how some residents remained in bed a little later and could have breakfast taken to their bedroom. Perhaps this discrepancy re-enforces the need for staff to read the written care plans as a way of getting to know each resident as an individual. Mrs. Hoskins intends to get more details about residents’ social histories whenever possible. She recognises how important this is in helping staff recognise the individuality of each resident. The Old Vicarage Residential Home DS0000068376.V368276.R02.S.doc Version 5.2 Page 15 All staff would like to have more time to spend on social care although feedback suggests that people who use the service enjoy their days –‘we are pleased with the daily activities’, ‘I enjoy being a part of (resident’s) life when I attend functions. I think these are really good and enjoyable’. A resident was going out dancing the day of the inspection visit. This was a regular activity, which he much enjoyed. He had a large bedroom full of personal items –including two finches he had received as a birthday present. Another resident is able to entertain two friends at the home every Friday. There are regular resident meetings and plans to introduce a newsletter. Relatives feel welcomed into the home –‘all the staff are very pleasant and helpful to me when I visit’. Mrs. Hoskins intends to revise the menus at the home so that residents’ suggestions can be reflected. The new menus will also take better account of nutritional needs. Nutritional assessment tools form part of the care planning work and weights are regularly monitored. Supper menus had already been made more substantial. The Residents had recently enjoyed the inclusion of fresh salmon and smoked haddock on the menu. Lunch on the day of the inspection provided a choice of bacon, omelettes, tomatoes and potato croquettes or soup and bread and butter. This was a packet soup –the cook said she only makes home made soup about once a month. Packet soup seems rather insubstantial for a main meal of the day. Residents have cake with a cup of tea mid afternoon and were having pate and toast or sandwiches for supper. Breakfast had been brought forward from 9am to 8am because residents felt there was too little time between breakfast and lunch at midday. Although this change may have been introduced at their request it is important that personal choices about times of rising are accommodated. It seems unlikely that all residents would want to start their day at 8am. Staff gave differing accounts of breakfast routines so it is unclear how much flexibility there is. It may have been more appropriate to make lunch a little later-midday seems rather early and ‘institutional’. Cold drinks are offered between meals during hot weather. It would be a good idea to consider making cold drinks available at all times as a means of encouraging residents to maintain good hydration. The cook didn’t feel she was given much information about individual residents’ dietary preferences although she was aware of current special dietary needs and could recall a respite client who only wanted to eat chicken and jacket potato. According to the results of the home’s consultation exercise in May 2008 most residents are satisfied with the meals, and all or most of them indicate that they can spend their days as they wish and staff respect their privacy and dignity. The Old Vicarage Residential Home DS0000068376.V368276.R02.S.doc Version 5.2 Page 16 The Old Vicarage Residential Home DS0000068376.V368276.R02.S.doc Version 5.2 Page 17 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): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service feel safe with the staff, and they are confident their problems will be listened to and taken seriously. The staff know how to recognise and report any possible abusive practices. Some of them need to develop more confidence in the managers so they can work together more effectively in protecting the residents. EVIDENCE: All 7 residents who completed survey forms in May 2008 were confident that their complaints would be listened to, taken seriously, and acted upon. Relatives also refer to residents feeling safe at the home. The home’s complaints policy and procedure has been revised recently. Each resident has a copy of it in his or her Service User Guide. Staff have access to the policy at the home. There haven’t been any complaints made to the home since the last inspection. The Commission has received two anonymous complaints alleging a deterioration in everyday care practices. We asked the Provider to investigate the issues raised and we received a prompt and detailed response. This was considered satisfactory. An allegation that residents were being forced to take medication was referred to a multi agency safeguarding group for investigation. There was no evidence to substantiate the allegation. There have been changes in management personnel at The Old Vicarage, and sometimes this type of situation does result in a little disquiet as everyone gets used to the inevitable differences in management styles. This is why it is so The Old Vicarage Residential Home DS0000068376.V368276.R02.S.doc Version 5.2 Page 18 important for new managers to ‘get staff on board’ and to create a trusting and open relationship. Some staff feel that they have a supportive and open relationship with their new managers -‘manager very supportive, yes-seen the owners 6 or 7 times’. Others seem less satisfied-‘ things a bit ‘up and down’ at the moment-jobs not always getting done’. The training records listed 9 staff who received training on adult protection in December 2007. Two other staff had completed it in 2005 and only 3 staff had yet to undertake this type of training. The home has relevant policies and procedures to advise staff about protecting residents. There was an example seen in the records of a relative being consulted before bed rails were put in place. This is the correct procedure because bed rails are a restraint and should not be used without consultation and risk assessment(district nurses are also consulted as part of this process). A staff member confirmed that she had to wait until the home had completed criminal records bureau checks before she was allowed to start work. This is the correct approach to keep residents safe from unsuitable individuals The Old Vicarage Residential Home DS0000068376.V368276.R02.S.doc Version 5.2 Page 19 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): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a well maintained home and they are happy with their accommodation. There has been some improvement to the accommodation in the past year but the general décor and furnishings still need upgrading, as does the kitchen. Staff are trained to work in a way that will keep everything clean and hygienic and they are supplied with the equipment they need to do this. EVIDENCE: The accommodation isn’t ideal for people who have mobility difficulties because the stair lift can only be accessed via a short flight of internal steps. There have been aids and adaptations made to help residents get about, and there is a large toilet close to the communal rooms. The premises are subject to routine maintenance and servicing checks to be sure residents will be safe. A new conservatory has been built in the past The Old Vicarage Residential Home DS0000068376.V368276.R02.S.doc Version 5.2 Page 20 year. This has provided a very light and attractive communal area where residents can be ‘almost in the garden’. It also offers an alternative quiet room without a television. There are plans to undertake redecoration of the home during this year. Much of the home is in need of redecoration and upgrading. The current décor is very dated, dull and ‘tired’. Furnishings in some areas are a mix of unmatching items that have obviously been acquired over a period of time. A planned refurbishment of the kitchen had been delayed due to slow progress with the conservatory, but it is due to be done soon. A new oven had already been purchased, though, and the kitchen was clean and tidy at the time of this inspection. Ten out of 14 staff have received training in infection control. Most completed this very recently in December 2007 so their knowledge will be up to date. Staff who were met during the inspection said they had the equipment they needed to work hygienically, and disposable products, liquid soaps etc were seen around the home. There was no mal odour in the building. The Old Vicarage Residential Home DS0000068376.V368276.R02.S.doc Version 5.2 Page 21 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): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are enough staff to care for the residents needs and they have been receiving the training they need to work safely and professionally. New staff are carefully selected to be sure they will be safe to work with the residents. Some staff feel less well supported than others although there is a supervision and appraisal system in place and staff meetings are held. EVIDENCE: Mrs. Hoskins and three care assistants were on duty when the inspection took place. A cook and cleaner were also at work. This was a satisfactory level and was representative of the usual staffing arrangements. Residents and relatives have confidence in the staff and get on well with them –‘the staff are very attentive and extremely helpful’, ‘staff are excellent’, ‘all staff are helpful’. A matrix confirmed a regular programme of training opportunities during the last year to meet health and safety requirements e.g. manual handling, fire safety, first aid. There are proposals to use more in-house training because external trainers are expensive and cannot always provide training when required. This proposal may be acceptable but it is important to ensure a satisfactory standard of instruction. The Old Vicarage Residential Home DS0000068376.V368276.R02.S.doc Version 5.2 Page 22 A staff member was being supported to work towards a National Vocational Qualification at level 4. Several other staff were being supported to achieve level 2 and level 3 awards. A sample of two staff files provided evidence of good recruitment procedures that included the required checks of the applicant’s suitability to work with vulnerable adults i.e. criminal records bureau checks. A staff member described her experience of recruitment and this accurately reflected the process found in the written documentation. Mrs. Hoskins has introduced a new induction programme. This is in line with national specifications. A completed example was seen and a staff member described how she was introduced into her job gradually i.e. 2 to 3 weeks shadowing more experienced staff. The staff differed in their views of how supported they felt. One staff member hadn’t been offered any one to one supervision meetings with the manager. She didn’t feel well supported. One staff had attended a recent staff meeting although another said there hadn’t been one for some time. Two staff felt well supported by their manager and were able to go to her with any problems. A record of an appraisal meeting held in February 2008 was seen in a staff file so there is obviously a programme of supervision and appraisal in place. The Old Vicarage Residential Home DS0000068376.V368276.R02.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Care Manager is experienced and competent. She understands how to fulfil her responsibilities. There are satisfactory systems in place to monitor the quality of the service in the best interests of the residents. EVIDENCE: Mrs. Hoskins was approved for registration with the Commission as the care manager at the Old Vicarage in November 2007. She has 14 years relevant experience and holds the Registered Manager’s Award, which is the recognised qualification for her position. She also holds a National Vocational Qualification in care at level 4 and is a qualified NVQ assessor. She was keeping her knowledge up to date e.g. she had attended a training day on the Mental Capacity Act and was hoping to embark on a degree course for Health and Social Care. The Old Vicarage Residential Home DS0000068376.V368276.R02.S.doc Version 5.2 Page 24 Mrs. Hoskins completed an annual quality assurance assessment at the request of the Commission. The details were rather brief in parts. In future, it would be useful to refer to the guidance contained in the document available on the CSCI website-Key Lines of Regulatory Assessment (KLORA). This would provide pointers for entering relevant information in the AQAA report and for designing development plans for the service. There had been a consultation exercise in May 2008 as part of the home’s quality assurance work. The results of resident and relative surveys were available. The record showed how the home had responded to ideas or concerns raised e.g. staff instructed not to us ‘pet names’ when addressing residents and always to offer refreshments to visitors. Mrs. Hoskins had also introduced a very thorough process of auditing accidents at the home. Representatives of the Provider company were visiting the home, monitoring the service and making reports of their visits, as required. Although one staff member hadn’t seen them, another staff member was aware of several visits they had made. Quite a few residents have amounts of money in safekeeping at the home. A sample was checked and was found to be managed appropriately i.e. records maintained of transactions and receipts kept. Mrs. Hoskins is the only staff member who handles this aspect of the service. Perhaps the records and cash balances could be audited during Provider visits, or a second staff member could be asked to do this. This would support Mrs. Hoskins in the event of any complaint regarding the safekeeping arrangements. It would also be sensible to try and encourage residents’ families to provide support with personal monies and to reduce the involvement of staff at the home. Mrs. Hoskins agreed that although valuables were rarely taken into safekeeping they should also be recorded, with signatures obtained to confirm any movements. The AQAA report confirmed regular maintenance checks of the accommodation to keep residents safe e.g. checks of fire safety equipment, water quality, heating etc. The training programme for the past year showed good attention to health and safety training for staff. Policies and procedures are in place to guide staff how to work in a way that complies with health and safety regulations. The Old Vicarage Residential Home DS0000068376.V368276.R02.S.doc Version 5.2 Page 25 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 3 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 2 x x 3 The Old Vicarage Residential Home DS0000068376.V368276.R02.S.doc Version 5.2 Page 26 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. 1. 2. 3. 4. 5. Refer to Standard OP7 OP9 OP15 OP19 OP32 Good Practice Recommendations Staff should be encouraged to make more use of written care plans as part of their everyday work with residents. The way that medication is managed should be reviewed to be sure it is as safe as possible. The catering service needs to be reviewed so that it better reflects the special needs and preferences of the resident group. The plans for redecorating and refurbishing the accommodation should be given priority so residents enjoy a more pleasant environment. The system for supporting and supervising individual staff and the staff team should be strengthened because some staff are less positive about their work environment than others. The Old Vicarage Residential Home DS0000068376.V368276.R02.S.doc Version 5.2 Page 27 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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. 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