Inspection on 12/08/08 for The Old Vicarage (Staverton)

This inspection was carried out on 12th August 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 (Staverton) 15/08/06

The Old Vicarage (Staverton) 26/01/06

The Old Vicarage (Staverton) 09/09/05

The Old Vicarage (Staverton) 10/02/05

The Old Vicarage (Staverton) 27/10/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Old Vicarage (The) The Old Vicarage Staverton Trowbridge Wiltshire BA14 6NX Lead Inspector Alison Duffy Key Unannounced Inspection 12th August 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000057134.V368227.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. DS0000057134.V368227.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Vicarage (The) Address The Old Vicarage Staverton Trowbridge Wiltshire BA14 6NX 01225 782019 01225 784060 info@equality-care.co.uk 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) Equality Care Ltd Mrs Gretta Jane Mackenzie Care Home 21 Category(ies) of Dementia - over 65 years of age (7), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (7), Old age, not falling within any other category (21) DS0000057134.V368227.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users who may be accommodated in the home at any one time is 21 No more than 7 service users aged 65 years and over with a mental disorder or dementia, excluding learning disability, may be accommodated at any one time 15th August 2006 Date of last inspection Brief Description of the Service: The Old Vicarage is a privately owned residential care home, which can accommodate twenty one older people. Five people may also have a mental disorder that excludes learning disability or dementia. The home is registered to Equality Care Ltd and the registered manager is Mrs Gretta MacKenzie. The home is situated in the village of Staverton. This provides limited amenities, yet the County town of Trowbridge, is approximately two miles away. The home provides all single accommodation. All but three of the bedrooms are provided with en-suite facilities. Bedrooms are located on the ground and first floor. There are three stair lifts to access the various levels of the building. Communal areas consist of a lounge, conservatory and separate dining room. Staffing levels are maintained at three or four care staff on duty throughout the waking day. At night there are two waking night staff and a member of staff provides sleeping in provision. DS0000057134.V368227.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 key inspection took place on the 12th August between the hours of 9.00am and 6.30pm. There were two inspectors. Mrs Gretta MacKenzie was available throughout the inspection and received feedback at the end of the day. We met with people who use the service in their own rooms and within communal areas. We met with the staff members on duty. We looked at the management of peoples’ personal monies. We observed the serving of lunch. We looked at care-planning information, training records, staffing rosters and recruitment documentation. As part of the inspection process, we sent surveys to the home for people to complete, if they wanted to. We also sent surveys, to be distributed by the home to peoples’ relatives, their GPs and other health care professionals. The feedback received, is reported upon within this report. We sent Mrs MacKenzie an Annual Quality Assurance Assessment (AQAA) to complete. This was completed in full and returned on time. Information from the AQAA is detailed within this report. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people using the service. What the service does well: People are happy with the service they receive and can use their room as they wish. People are able to bring in their personal possessions on their admission, to enable a homely environment. People are clear about the ways in which they can raise any concerns. Staff are aware of their responsibilities of reporting any allegation or suspicion of abuse. Training is given priority and ranges of subjects, other than those, which are mandatory, have been arranged. DS0000057134.V368227.R02.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: People are assessed before being admitted to the home yet each assessment should clearly reflect the person’s needs. The subject of resuscitation must be removed from all documentation. Any person wishing to pursue specific instructions related to resuscitation must discuss their views with their GP, not with the staff at the home. People have access to social activity provision yet a review of the productivity of the activities, should take place. The activity should be conducive to people’s needs and address matters such as sensory impairment. Care plans must be in place for the use of medicines prescribed ‘as required’ so that the prescriber’s instructions can be followed safely. Any changes to the expected pattern of use must be reported to the prescriber. Staff must ensure that they sign the administration record when applying topical creams. The abbreviation, ‘O’ for other, within the medication administration record must be clearly explained. Staff should ensure that they see people take the medication administered to them. The environment would benefit from some refurbishment. This includes in particular, redecorating communal areas, the upstairs landing and stairwells. The conservatory is in need of some attention to make it more pleasant for people. Some radiators need to be guarded. The hot water from two hand washbasins needs to be reduced in temperature. All hot water outlets need to be regularly monitored to ensure safe temperatures. Individual risk assessments need to be developed. Practices such as free access to the laundry and staff carrying trays of hot food, should be reviewed as part of the risk assessment process. Staffing levels should be reviewed to ensure people’s individual needs are met. DS0000057134.V368227.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. DS0000057134.V368227.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 DS0000057134.V368227.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): 3. Standard 6 is not applicable to this service. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are assessed before receiving a service yet greater clarity within assessment documentation would ensure people’s needs are met. EVIDENCE: The AQAA states ‘new residents are admitted only after a full assessment has been carried out by people trained to do so. Assessments from outside professionals including CPN’s, Social Services and GP’s involved are used to ensure that all the necessary details are included in the care plan to be implemented.’ People told us that they received sufficient information about the home before deciding upon moving in. One person said ‘my family looked at lots of homes but decided this was the best. People were very welcoming and everywhere seemed very homely.’ DS0000057134.V368227.R02.S.doc Version 5.2 Page 10 Within a survey, one person told us ‘I have always been happy to recommend this care home.’ They said they were happy with the information they had been given, before deciding to make The Old Vicarage their home. A relative also confirmed that the information they received was satisfactory. We looked at the assessment documentation of the two most recent people to the service. We saw that there was some conflicting information. For example, it was identified that one person was ‘self-managing.’ However, the person told us they needed help in certain areas. Information within daily records confirmed the assistance the person received. Another assessment stated ‘needs support to choose clothes.’ It later stated the person was independent. We advised, within one assessment that further information was needed. The assessment stated ‘has lost a lot of weight.’ There was no evidence, as to the reasons for this and how to minimise further weight loss. Aspects such as using an inhaler for asthma was identified yet not detailed within the person’s care plan. We saw that one person, within their assessment was able to take responsibility for their own medication. There was no further evidence of this within the care plan. Mrs MacKenzie told us that after the person was admitted, it was decided that self-medicating would not be a safe option. Documentation should demonstrate this. As good practise, assessments detailed people’s social interests and aspects of their life history. One assessment stated ‘I am happy with my own company.’ However, within a key worker review, it was stated ‘would like to see XX become more interactive with resident’s activities.’ We said that staff should promote people’s preferred wishes and be cautious in exercising their own opinions. Within two assessments we saw that there was a declaration regarding resuscitation. Within the front sheet of some care plans, ‘do not resuscitate’ was identified. We said that this must be removed from all documentation and not be included within the assessment format. If a person has a particular view about resuscitation, they must discuss this directly with their GP. The service must not be involved in any such decision. The Old Vicarage does not provide intermediate care, so standard 6 is not applicable to this service. DS0000057134.V368227.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. Care plans do not fully reflect people’s needs. People have good access to health care provision. Some aspects of medication administration need to be addressed to ensure people’s safety. People’s privacy and dignity is not always upheld. EVIDENCE: People told us they were happy with the care provided. One person said ‘you can’t complain about what they do for you. They are all very good.’ Another person said ‘they are all very helpful, you only need to ring your bell and they come to you quickly.’ We looked at a sample of care plans. We saw that basic information was identified, which did not necessarily reflect peoples’ needs. Some of the information required greater detail. For example, one plan identified a skin condition. The plan stated ‘staff to ensure that they report and record any concerns.’ There was no information about the management of the skin condition or what staff needed to look for, when they monitored the condition. DS0000057134.V368227.R02.S.doc Version 5.2 Page 12 We saw that some aspects within care plans were not followed in practice. For example, one plan identified the need for the person to elevate their legs. We saw that the person did not have a footstool. Another plan stated ‘staff to monitor whilst walking and report any concerns.’ We saw the person walk independently without any support or staff observation. The care plans addressed aspects such as mobility, washing and dressing, skin care and personal grooming. Each aspect was given a risk level, yet the nature of the risk or any preventive measures, were not clear. We saw that one person was at risk of urinary tract infections. Another person was at risk of constipation. There were no control measures identified to minimise these risks. One person had lost weight. The plan highlighted the need for monitoring yet there was no evidence of this. We saw that one plan identified that the person could get low in mood due to their personal circumstances. It was not clear, how staff should support the person during these times. There were some aspects within care plans, which were difficult to apply in practice. One plan stated ‘when tired, can stumble, staff to monitor and assist when tired.’ Another plan stated ‘staff to check discreetly she has washed her bottom.’ We said this also compromised the person’s privacy and dignity. The terminology used, relating to encouraging another person to wash, also compromised their dignity. We saw that daily routines were identified within each person’s care plan. These were generally the same for each person and were centred around mealtimes and serving hot drinks. We advised individual choices and people’s personal interests, be added to this documentation. Within one plan, it was stated ‘to have a bath twice a week. Staff to inform XX of the day to have a bath.’ There was no evidence that the person was able to choose when they wanted a bath. One person told us ‘sometimes I have a bath and sometimes a shower. They treat me nicely.’ Mrs MacKenzie told us that good support is received from the local surgery. People said that they could see their GP, as required. We saw that one person needed a continence assessment. There was no evidence of foot care within some care plans. We saw that greater focus was required in relation to tissue viability. One assessment identified a high risk of developing a pressure sore. The plan stated ‘staff to report immediately any concerns.’ There was no information as to how the risk of developing a pressure sore was minimised. Another plan identified ‘improve level of skin integrity’ yet there was no information, as to how this was to be achieved. One recently employed member of staff told us that they had not completed their medication training. They said ‘a more senior member of staff ‘pots up’ the tablets and then I deliver them to each recipient.’ We asked if they felt competent in giving the tablets to the right person. They replied ‘I am getting DS0000057134.V368227.R02.S.doc Version 5.2 Page 13 to know who has what.’ We advised that only staff who have received training in medication administration, handle medication. At lunchtime, we saw Mrs McKenzie place medication in a pot and give it to a member of staff. The staff member delivered it to the person. They did not wait to make sure the tablet had been taken. We advised that only one person should administer medication and sign the medication administration record. We saw that the member of staff explained the reason of the medication, to people whilst in communal areas. We said that this practice did not respect people’s privacy or dignity. At the last inspection we made a requirement to ensure that staff countersign any hand written medication instructions. We saw that this requirement had been met. As good practice, medication with a short shelf life had been dated when opened. Staff had signed the medication administration record although there were entries denoting ‘other,’ which were not explained. We saw that some medication was prescribed, ‘as required.’ We said that details of what triggers an administration must be identified within the person’s care plan. We saw that one person was prescribed two different types of pain relief. The reasons for these and when they should be administered must be stated within the care plan. Staff must also ensure that they sign to denote when topical creams have been administered. DS0000057134.V368227.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 adequate. This judgement has been made using available evidence including a visit to this service. While some activity provision is in place, greater variety, which is conducive to people’s needs, would be beneficial. People are encouraged to maintain important relationships. People enjoy the food provided yet a review of mealtimes may ensure further satisfaction. EVIDENCE: Within surveys, there were two comments about the need to improve activity provision for people. As a means to improve the service, one relative said ‘by improving the programme of activities to stimulate the brain. Taking them on short trips, also using the garden more in the summer time.’ They continued to say ‘an exercise programme could only be positive.’ A health care professional told us ‘improve the activities for residents.’ Within their survey, one person said that there were ‘sometimes’ activities arranged by the home that they could take part in. On the notice board in the hallway, we saw an activity programme. This showed activities such as pet therapy, newspapers, clay modelling, creative writing, puzzles, knitting and music club. Massage and aromatherapy were also DS0000057134.V368227.R02.S.doc Version 5.2 Page 15 stated. A member of staff told us the activity co-ordinator comes in three times a week to arrange arts, crafts and bingo. She said that most people enjoy the bingo sessions. We saw a bingo session taking place. This was not conducive to some people’s needs. For example, one person was sat away from the group and could not hear the numbers being called. Staff did not enable the person to fully participate. The television was also on, which gave background noise and impacted on people’s ability to hear. We did not see any other social activity provision during the day. One person told us that they had not been invited to take part in any activities so far. They said they enjoyed watching television in their room and liked to sit in their armchair looking out of the window. Another person told us ‘I like to read a book or paper. I haven’t been to any entertainment yet.’ One person told us that a trip to Longleat had been arranged for August. Staff told us that sometimes they support people into town to have a coffee and do some shopping, but this is dependant on staffing levels. We said that consideration should be given to developing the activity programme in terms of variety and meeting people’s individual needs. Within the AQAA we saw that the manager recognised this as an area of development. As a means to improve the service, the AQAA stated ‘new ideas. Involve the residents and relatives in co-ordinating activities. Plan activities.’ Following the inspection, Ms Wilcox, Operations Manager, said ‘we have a broad and stimulating range of activities held in group and individual sessions. As well as having an activities coordinator staff are expected to be involved in daily activities.’ People told us that they could have visitors at any time. They could entertain in their own room or in the communal areas. One person told us that they got up early on Sunday, so they would be ready for their family, to take them to church. Another person told us they regularly go out with their family. People told us they were happy with the meals. Specific comments included ‘the food is aright and it is hot’, ‘food is quite good. They tell us the day before what meals we will be having and we can pick what we want.’ Also, ‘on the whole the food is very good. We always have a choice’ and ‘sometimes the soup is not very hot, but I think it is homemade’. Within a survey, one person told us they usually liked the meals. They said ‘no problem with the amount offered at all.’ We were told that there are three cooks working at the home. One cook told us that there is a four-week rotating menu. The main meal of the day is at lunchtime, when there is always homemade soup, a choice of main meal and a desert. We saw that people were eating their main meal at 1.20pm. We said that people should be consulted, as to whether they would like their meal earlier than this. The cook told us that homemade cake is always available. There was some fresh fruit in DS0000057134.V368227.R02.S.doc Version 5.2 Page 16 the kitchen. We suggested that a fruit bowl in the lounge would make the fruit more accessible to people. DS0000057134.V368227.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 are aware of how to make a complaint. Adult protection systems are in place to safeguard people from abuse yet gaining a copy of the local safeguarding policy would ensure any incident is efficiently reported. EVIDENCE: People told us they were aware of how to make a complaint. One person said ‘I would see the manager’. Another person told us ‘the manager will come up at least once a week and is always wandering around. She is very approachable and if I have any worries, she will always act on them straight away’. Within a survey, one person told us they knew how to make a complaint. They said ‘I do not often need to complain.’ They said they knew who to speak to if they were not happy. They told us ‘quite often the role is reversed!’ We looked at the complaints record. Documentation identified any complaints together with any actions taken, timescales and the outcomes of investigations. We saw in one instance, that the action to be taken was recorded in a manner, which could have been misinterpreted. We said staff should give consideration to the terminology they use. The home has a policy on protecting vulnerable people. We advised that a copy of the local safeguarding policy covering Wiltshire and Swindon should be available. Two staff told us that they had attended a course on ‘abuse in the DS0000057134.V368227.R02.S.doc Version 5.2 Page 18 care home.’ They said they were aware of how to report an allegation or suspicion of abuse. Another member of staff was new to their position. They had not attended a course on safeguarding people yet knew what action to take, if abuse was suspected. Within documentation, we saw that staff had received training and updates in relation to safeguarding issues. Mrs MacKenzie told us that she had delivered some training on the Mental Capacity Act, at the last staff meeting. This included the impact of the Act on people living at the home. DS0000057134.V368227.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. Some redecoration would enhance the environment for people. People are at risk of harm from some hot water outlets and unprotected radiators. EVIDENCE: Peoples’ bedrooms are located on the ground and first floor. The main staircase and three stair-lifts, enable access to the different levels of the home. All but three of the bedrooms have en-suite facilities. People told us that they could personalise their room, as they wished. People had their call bells within easy reach. Communal areas consist of a lounge, conservatory and a separate dining room. We saw that some areas of the home would benefit from redecoration. Wallpaper was coming away from the wall in the dining room. Some wallpaper was stained and showing its age. The carpet within the corridor and the stairs would benefit from replacement. The lounge and conservatory did not appear DS0000057134.V368227.R02.S.doc Version 5.2 Page 20 inviting. Small tables were worn and needed re-staining. The curtains were in need of a clean. The windowsills were dusty and a toilet roll was prominent on one sill. Mrs MacKenzie told us that chairs in the lounge, conservatory and dining room had recently been purchased. She agreed however, that some refurbishment would enhance the environment for people. Mrs Mackenzie said she had already discussed this, with the directors of the home. Following the inspection, Ms Wilcox told us that it had been identified that the lounge and dining areas were in need of redecoration. She said a residents meeting had been held and people had chosen the colours of the paintwork and curtains etc. Within a survey, one person told us that the home is always fresh and clean. During the morning of the inspection, one toilet was very dirty with faeces around the seat and the toilet bowl. During the afternoon, we saw that the toilet had been cleaned. A sensor controlled the lighting in this toilet. One person told us that the sensor was unsatisfactory. The hot water tap was incomplete. Mrs MacKenzie told us she would investigate these aspects. Within another toilet, the water from the hot water outlet reached 50°C. We said the temperature needed to be reduced without delay. The door contained frosted glass yet there was no curtain to ensure people’s privacy. The toilets contained pump action soap dispensers with hand towels. We advised paper towels be used to minimise the risk of infection. A risk assessment identified that hot surfaces were protected. We saw that this was not the case, as some radiators were uncovered. The laundry was ordered yet the room was unlocked. We advised the room be fitted with a keypad to ensure authorised access. DS0000057134.V368227.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 adequate. This judgement has been made using available evidence including a visit to this service. It is the opinion of some people that staffing levels are insufficient to meet people’s needs. People are protected by a robust recruitment procedure. Staff training is given priority with a range of subjects, available to staff. EVIDENCE: We saw that staffing levels are maintained at three staff on duty throughout the waking day. Mrs MacKenzie told us that she supports the staff team, as required, while she is on duty. In her absence, an additional member of staff is deployed. Domestic and catering staff complete the staff team. At night there are two waking staff and a member of staff provides sleeping in provision. Within surveys, there were some negative comments about staffing levels. A relative told us, as a means to improve the service, ‘more staff needed to stimulate their needs, as many sit all day in the lounge without moving.’ A health care professional said ‘I think that staff try very hard with the resources that they have available to them. However, I think that these resources are often limited and staffing numbers appear to be low at times.’ A member of staff said ‘we have been very short staffed at times with no one to cover so the staff working that shift, have to do 1 or 2 other members of staff work load.’ DS0000057134.V368227.R02.S.doc Version 5.2 Page 22 Within a survey, one person said that staff listen and act on what they say. They said that staff were available when needed although at times, ‘a shortage of staff may present difficulties.’ Within discussion, a member of staff told us ‘staffing levels can be up and down, with a fair amount of staff sickness’. They said however, that staffing levels were fine at present. At the last inspection, we made a requirement that the registered individuals must undertake a review of the numbers of care staff providing direct care to people. Mrs MacKenzie told us that the home had struggled with staff shortages. She said that additional staff have been recruited and once in post, the staffing situation should improve. Ancillary staff were also being recruited to prepare tea, so that care staff have greater time to spend with people. As we have received various comments about staffing levels, further consideration must be given to this area. People were complimentary about staff. Specific comments included ‘I am quite comfortable and they treat me nice,’ ‘they are all very good,’ ‘they help me with what I need’ and ‘they can’t do enough for you.’ One person said ‘they will bring my mail up for me, but sometimes it builds up.’ A relative told us ‘they are friendly and make them feel secure.’ At the last inspection, we made a requirement that the registered individuals must ensure that appropriate recruitment practices were followed in respect to all members of staff employed. We saw that this requirement had been met. Staff told us that they were properly recruited. They said the appropriate checks and references had been sought before they started work. We looked at the recruitment documentation of the three most recently employed members of staff. The files contained the required information. There was a photograph, an application form and two written references. We suggested that the health declaration form should be attached to the application form. Within one application we saw that a health care condition was stipulated. We advised that this should be further investigated, to ensure the safety of the person and others. As good practice, we said that greater detail should be documented to evidence the person’s interview. Each staff member had been checked against the Protection of Vulnerable Adults register before commencing employment. This ensured they were suitable to work with vulnerable people. Staff have access to a range of training opportunities. Following their induction, all staff are expected to complete a range of mandatory training. This includes fire safety, manual handling, health and safety, food hygiene and first aid. Following this, additional training relating to older age is completed. Training records demonstrated that training in Parkinson’s disease, adult protection, nutrition, infection control, depression, dementia care and palliative care had been undertaken. Some staff had attended a workshop, which was organised by the Safeguarding Adults Unit. Within a survey, a district nurse DS0000057134.V368227.R02.S.doc Version 5.2 Page 23 told us she would be happy to facilitate some staff training. Staff have the opportunity to achieve a National Vocational Qualification (NVQ). Mrs MacKenzie told us that there is a training co-ordinator who makes sure staff attend the necessary courses and refresher updates, when required. She said that refresher training in fire safety is given at each three monthly staff meeting. Other refresher training may also be given during this meeting. A member of staff told us ‘they are really good with their training here. I am currently attending training in MRSA’. Within a survey, a staff member told us, they have the right support, experience and knowledge to meet peoples’ needs. They said, in relation to what the home does well ‘offer training, the care provided is very good when the more experienced staff are working. However, due to short staffing levels, the new employees taken on are inexperienced and mainly young and lack experience and knowledge. Even with training given they seem to cut corners and other staff members carry them. When reported to manager these matters seem to get over looked in case these employees leave, leaving us with even less staff.’ DS0000057134.V368227.R02.S.doc Version 5.2 Page 24 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 adequate. This judgement has been made using available evidence including a visit to this service. The manager has the skills and experience to fulfil her role. People are encouraged to give their views yet a formal auditing system would further develop service provision. Attention to some aspects of practice and the environment is needed to ensure peoples’ health and safety, are maintained. EVIDENCE: Within the AQAA, it was stated ‘open and supportive management within the home. Small family business – supportive to all – very personal – not institutionalised.’ Mrs MacKenzie was registered with us, as the registered manager in April 2008. Mrs MacKenzie told us that she had previously worked at the home. She therefore knew people well and had experience of the home’s systems. Mrs DS0000057134.V368227.R02.S.doc Version 5.2 Page 25 McKenzie told us she has an open management approach and works closely with staff. She also works, as part of the working roster, when needed. The staff we spoke to were complimentary about Mrs MacKenzie. They said she was approachable and they felt confident to tell her, if they were not happy about anything. Staff told us they received regular supervision. Two people told us that Mrs MacKenzie would visit them in their rooms, to make sure they were satisfied with their care. One person said ‘the manager comes in to see me and I would tell her if I was worried about anything.’ The home has a quality assurance system in place. We saw that different aspects of the service are focused upon within surveys, on a monthly basis. Recently, worship, dealing with complaints, financial affairs and the laundry had been considered. While the surveys were on file, they had not been clearly evaluated. There was no development plan showing planned action, in response to the feedback received. There was no evidence that the home had been regularly audited. We advised that an audit should compliment the surveys. The outcome of both systems should then be coordinated and evaluated with a clear action plan, readily displayed. A number of people have placed small amounts of their personal monies, for the home to hold safely. We looked at the systems for managing this. The cash amounts we checked, corresponded with the balance sheets. All staff are up to date with their manual handling, first aid and food hygiene training. All have regular fire safety training. The fire log book showed that regular checks to the fire protection systems were regularly undertaken. Regular fire drills were completed. A fire risk assessment had been completed in relation to each person’s bedroom. We saw that a record of accidents had been maintained. We advised the format be that of a formalised book, which meets the requirements of data protection. A number of environmental risk assessments were in place. We advised that assessments, more specific to people’s needs should be developed. A risk assessment addressing hot surfaces stated ‘radiators are thermostatically controlled and hot surfaces are protected.’ We saw that some radiators in communal areas were unguarded, so the assessment was not accurate. The risk assessment in place, with regard to the first floor windows was in need of updating. We advised that current guidance on window restrictors should be sought, to ensure people’s safety. As stated earlier within this report, the laundry room needs to be assessed, as to whether it should have restricted access. At lunchtime, we saw a member of staff carry a tray of dishes, containing hot soup, from the kitchen to the dining room. This involved negotiating a number of small steps. We advised the safety of this practice, be investigated. DS0000057134.V368227.R02.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 DS0000057134.V368227.R02.S.doc Version 5.2 Page 27 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 OP7 Regulation 12(1)(a) Requirement The registered person must ensure that individual wishes in relation to resuscitation are discussed only with the person’s GP. All such information within documentation must be removed. The registered person must ensure that care plans fully reflect people’s individual care needs and how they are to be met. The registered person must ensure that control measures are in place to minimise the risk of people developing a pressure sore. The registered manager must ensure that staff sign the medication administration record when applying topical creams. Any symbol they use on the medication administration record must be clearly explained. The registered person must ensure that care plans are in place for the use of medicines prescribed ‘as required’ so that the prescriber’s instructions can DS0000057134.V368227.R02.S.doc Timescale for action 12/08/08 2 OP7 15 31/10/08 3 OP8 12(1)(a) 30/09/08 4 OP9 13(2) 12/08/08 5 OP9 13(2) 30/09/08 Version 5.2 Page 28 6 OP19 13(4)(a) (c) 13(4)(a) (c) 7 OP19 8 OP27 18(1)(a) 9 OP38 13(4)(c) be followed safely. Any changes to the expected pattern of use must be reported to the prescriber. The registered person must ensure that the risks from radiators are minimised through the installation of covers. The registered person must ensure that the hot water, which is accessible to people, is of a safe temperature and regularly monitored. The registered person must ensure that the numbers of care staff providing direct care to people are sufficient to meet people’s needs. The registered person should ensure that factors such as carrying hot food and free access to the laundry are addressed within the risk assessment process. Risk assessments in relation to people’s individual needs must also be developed. 31/10/08 12/08/08 30/09/08 30/09/08 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 Refer to Standard OP3 OP10 OP12 OP14 Good Practice Recommendations The registered person should ensure assessments are sufficiently detailed to ensure people’s individual needs are clearly identified. The registered person should ensure that people’s privacy and dignity are enhanced through addressing the identified practices with staff. The registered person should ensure a review of social activity provision is undertaken so that variety is enabled and activities meet people’s individual needs. The registered person should ensure that ways in which DS0000057134.V368227.R02.S.doc Version 5.2 Page 29 5 6 7 8 9 OP15 OP18 OP19 OP19 OP33 people can exercise their choice, in terms of having a bath are promoted. The registered person should ensure that people are consulted, as to their preference of the time of their lunchtime meal. The registered person should ensure a copy of the Safeguarding Vulnerable Adults protocol is available within the home. The registered person should ensure that the decoration of the home is updated. The registered person should ensure that the light in the upstairs toilet is conducive to people’s needs. The registered person should ensure that regular audits form part of the home’s quality assurance system. DS0000057134.V368227.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 DS0000057134.V368227.R02.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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