CARE HOMES FOR OLDER PEOPLE
Old Vicarage (The) The Old Vicarage Staverton Trowbridge Wiltshire, BA14 6NX Lead Inspector
Thomas Webber Unannounced 9 September 2005
th 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. Old Vicargae (The) D51_D01_S57134_OldVicarage_V240750_090907_Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Old Vicarage (The) Address The Old Vicarage Staverton Trowbridge Wiltshire BA14 6NX 01225 782019 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) Equality Care Ltd Care Home 21 Category(ies) of MD(E) Mental Disorder - over 65 (5) registration, with number OP Old Age (21) of places Old Vicargae (The) D51_D01_S57134_OldVicarage_V240750_090907_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The maximum number of service users who may be accommodated in the home at any one time is 21. 2. No more than 5 service users aged 65 years and over with a mental disorder may be accommodated at any one time Date of last inspection 10th February 2005 Brief Description of the Service: The Old Vicarage is a privately owned residential care home offering accommodation and personal care to a total of 21 residents over the age of 65 who require care primarily through old age, although the home is registered to accommodate 5 residents with a mental disorder that excludes learning disability or dementia. The home is situated in the village of Staverton which provides limited amenities. However, its location is only approximately two miles from the County town of Trowbridge. The home has a number of car parking spaces available to the front of the property. The home is registered to Equality Care Ltd and the registered manager’s post is currently vacant, although Mrs Wilcox is the acting manager. The home provides all single accommodation for residents’ use and all but three of the bedrooms are provided with en-suite facilities. Residents’ bedrooms are located on the ground and first floor levels with residents having free access to all the communal areas and to their bedrooms. Three chair lifts have been installed to enable residents to access the first floor of the building. The home provides suitable communal space together with adequate bath, shower and toilet facilities.
Old Vicargae (The) D51_D01_S57134_OldVicarage_V240750_090907_Stage4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, undertaken during the course of one day from 09:20 to 14:10. The main purpose of this inspection was to obtain the views of the residents regarding the care and services provided by the home. These were ascertained in conjunction with a tour of the premises and the views of eighteen of the nineteen residents, in situ, were sought on an individual and group basis. In addition to a number of the core standards being assessed, records in relation to residents’ contracts, assessments, care plans and medication were checked as well as complaints, menus, staff supervision and staff levels. What the service does well:
The home provides an accessible, safe and suitably maintained environment to meet the individual and collective needs of the residents. Residents are provided with their individual bedrooms and they have personalised them to their individual wishes. Residents have access to safe, comfortable and suitably furnished and decorated communal facilities together with sufficient toilet shower and bathroom facilities. Residents have appropriate equipment to maximise their independence. The home is maintained to a good standard being clean, tidy and comfortable and provides suitable laundry facilities to meet the needs of the home. Residents spoke positively about the standard and cleanliness of their accommodation. Residents also commented favourably about the laundry arrangements in place, stating that their clothing is returned in good condition. The home continues to provide sufficient numbers of staff on duty at all times to meet the needs of the residents. Residents spoken to commented very positively about the care provided, stating that the staff are very kind, helpful, and they couldn’t be any better. Residents stated that they are treated well by the staff. Staff were observed to undertake their duties in a warm, caring and attentive manner. Residents are supported and protected by the home’s recruitment practices. Detailed assessments are undertaken by the home in respect to prospective residents, prior to admission, to ensure that the home can meet their needs. Opportunities are available for prospective residents and their families to make pre-visits to the home to assess the quality of facilities and suitability of the home. Residents are provided with a copy of either the home’s written contract or placing authority’s terms and conditions, depending on the funding
Old Vicargae (The) D51_D01_S57134_OldVicarage_V240750_090907_Stage4.doc Version 1.40 Page 6 arrangements. Care plans have been established for all residents, which clearly identify their individual needs and these are reviewed periodically. Residents’ health care needs are being suitably met which includes the administration of their medication. Resident’s privacy and dignity are respected at all times. Opportunities are available for residents to pursue their social, religious and recreational activities. Residents maintain contact with their families, friends and relatives in accordance with their preferences. Residents, within their capabilities, can exercise personal autonomy and choice. Residents receive a varied, appealing and balanced diet and meals are taken in a relaxed and congenial setting. Information is provided to residents on how to complain should they wish to and residents are confident that any complaints/concerns would be listened to, taken seriously and acted upon. The home records and responds promptly to all complaints and concerns however minor. Since the last inspection the home has received and dealt with ten complaints/concerns which have related to food, stimulation, facilities, level of noise, conduct of a resident, staff communication and the lack of action by staff. These complaints/concerns were fully investigated and resolved to the satisfaction of all parties. Appropriate procedures are in place to protect residents from abuse. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Old Vicargae (The) D51_D01_S57134_OldVicarage_V240750_090907_Stage4.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 Old Vicargae (The) D51_D01_S57134_OldVicarage_V240750_090907_Stage4.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) 2, 3, 5 and 6 Residents have been provided with a copy of either the home’s written contract or placing authority’s terms and conditions. Detailed assessments have been completed, prior to admission, to ensure that the home can meet their needs. Opportunities are available for prospective residents and their families to visit the home, prior to admission, to assess the quality of facilities and suitability of the home. EVIDENCE: Documentary evidence was available to confirm that two of the three residents most recently admitted to the home, had received a copy of the home’s written contract as they are privately funded. The third resident had received a copy of the placing authority’s terms and conditions as she is funded by social services. Written evidence was available to confirm that the home had completed a detailed assessment in relation to all three residents most recently admitted to the home as well as having obtained a copy of the community care assessment in relation to the resident funded by social services, prior to admission. As part of the home’s admission procedure, evidence was available to confirm that the
Old Vicargae (The) D51_D01_S57134_OldVicarage_V240750_090907_Stage4.doc Version 1.40 Page 9 home had written to the residents’ next of kin confirming that the home could meet the residents’ needs. As part of the home’s admission procedure, opportunities are available for prospective residents and their families to visit the home as many times as they wish, prior to admission. Residents and their relatives are given the opportunity to meet with staff, other residents, tour the premises and ask any questions relating to the running of the home. The manager reported that one of the residents and her family visited the home whilst only the families visited in relation to the other two residents. The home does not provide intermediate care therefore this Standard is not applicable. Old Vicargae (The) D51_D01_S57134_OldVicarage_V240750_090907_Stage4.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 and 10 Care plans have been established for all residents, which clearly identifies their individual needs. Residents’ health care needs are being suitably met including administration of their medication. Resident’s privacy and dignity are respected at all times. EVIDENCE: Care plans have been established for all residents and those checked were good in content, informative and well written. Manual handling, waterlow, nutritional and risk assessments have also been established for each resident as well as a dependency profile. Evidence was available to confirm that residents’ care plans are internally reviewed by the home, which involves the resident and key worker. This process occurs on a monthly basis or where changes occur. The other assessment documents are also reviewed internally either on a monthly or three monthly basis depending on the document. Residents’ placements are formally reviewed initially after four to six weeks, then six monthly and thereafter yearly. Evidence was again available to confirm that this process involves all interested parties. Residents admitted to the home are registered with one of five different surgeries. The majority of doctors’ appointments are held within the home. District nurse appointments are also held within the home All examinations
Old Vicargae (The) D51_D01_S57134_OldVicarage_V240750_090907_Stage4.doc Version 1.40 Page 11 and any treatment are undertaken in the privacy of the resident’s bedroom with the resident having the option of there being a member of staff present or not. District nurse records are now maintained within the home. Appropriate aids are provided for those residents with incontinent and/or problems. Residents can and do access other health care services such as dental, opticians and chiropody as and when required. On the day of inspection, none of the residents were self-medicating apart from some creams and eye drops. However, residents who are deemed capable following a risk assessment and who wish to, could maintain control over their medication. The manager has agreed to ensure that this area of care is included as part of prospective residents’ pre-assessment undertaken by the home. Staff only administer medication to residents once they have been deemed competent by management following internal training. A number of staff have also attended external training in respect to medication. Examination of residents’ drug sheets showed that, in the main, they are being appropriately signed for when medication is administered and the home uses the Lloyds monitored dosage system for this purpose. A suitable recording system has also been established for the receipt and disposal of unwanted medication. The visiting pharmacist checked the home’s receipt, recording, storage, administration and disposal of medicines in July 2005 and no major issues were raised. Residents are provided with their own single bedroom where they can conduct all their personal affairs in complete privacy. All residents have the option of having a telephone installed in their bedroom, which is linked to the home’s main telephone system. Residents are charged a fee for this facility and any calls made by them are subsidised by the home. Alternatively, residents have the option of using the home’s handset or the office telephone. Residents’ mail is given directly to them unopened, unless prior agreement has been reached between residents and their next of kin. Old Vicargae (The) D51_D01_S57134_OldVicarage_V240750_090907_Stage4.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 Opportunities are available for residents to pursue their social, religious and recreational activities. Residents maintain contact with their families, friends and relatives in accordance with their preferences. Residents, within their capabilities, can exercise personal autonomy and choice. Residents receive a varied, appealing and balanced diet and meals are taken in a relaxed and congenial setting. EVIDENCE: From observations and discussions with residents, it is apparent that they can choose where and how to spend their time, including rising and going to bed. Residents have the opportunity to pursue their own individual interests as well as being able to participate in the various organised activities arranged by the home should they wish to. The manager reported that a survey has been recently undertaken in consultation with the residents and in the light of this the range of activities has been reviewed to take into account the residents’ wishes and preferences. In addition, a hairdresser visits weekly and the Church of England vicar provides communion at the home on a monthly basis. Other clergy can visit at other times. The home supports and encourages residents to maintain contact with their families, friends and representatives and has an open policy with regard to visiting times. Residents can choose whom and where to see any visitors,
Old Vicargae (The) D51_D01_S57134_OldVicarage_V240750_090907_Stage4.doc Version 1.40 Page 13 either in the privacy and comfort of their own bedrooms or in the communal rooms available. These arrangements are referred to in the home’s service users’ guide. Observations and discussions with some residents confirmed that they can exercise personal autonomy and choice within their capabilities. Residents can and have brought items of furniture and personal possessions to make their bedrooms more homely, they can choose what time to get up and go to bed, where to spend their time, where to eat, and what activities to participate in. They can handle their own financial affairs in the privacy of their own bedrooms, if they are capable. A new satisfactory and varied four weekly menu is in operation, which has been introduced in consultation with the residents. The menu now provides choices at breakfast, lunch and suppertime. Mealtimes are flexible and breakfast can be taken up to 11 a.m and special arrangements can also be made for residents to have either early or late meals at lunch and suppertime. Residents’ dislikes are sought and recorded on admission. Drinks and snacks are also available at other set times of the day. Residents can choose where to eat their meals although they are encouraged to use the dining room for their main meal as part of socialisation. The vast majority of residents spoken to commented very favourably about the quality and quantity of food provided stating that they receive plenty and the food is well presented. The main meal was observed to be eaten in a relaxed and congenial setting with staff on hand to assist where needed. Old Vicargae (The) D51_D01_S57134_OldVicarage_V240750_090907_Stage4.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 and 18 Information is provided to residents on how to complain should they wish to and residents are confident that any complaints/concerns would be listened to, taken seriously and acted upon. Appropriate procedures are in place to protect residents from abuse. EVIDENCE: A satisfactory complaints procedure has been established by the home and residents have been provided with a copy of this procedure. The home records and responds promptly to all complaints and concerns however minor. Since the last inspection the home has received and dealt with ten complaints/concerns which have related to food, stimulation, facilities, level of noise, conduct of a resident, staff communication and the lack of action by staff. Of the ten complaints/concerns investigated four were upheld, two were partly upheld and four were not upheld. Since the last inspection, the home has introduced a new format for the recording and monitoring of all complaints/concerns received, in line with its sister home. The home has appropriate procedures for responding to suspicion or evidence of abuse and has obtained a copy of the Department of Health Guidance “No Secrets”. In addition, a number of copies of the shortened version of the Swindon and Wiltshire Vulnerable Adults procedures, which is in line with the Department of Health’s guidance document, have been obtained. Copies of the shortened version of this document have been distributed to all staff. Old Vicargae (The) D51_D01_S57134_OldVicarage_V240750_090907_Stage4.doc Version 1.40 Page 15 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, 24 and 26 The home is accessible, safe and suitably maintained to meet the individual and collective needs of the residents. Residents are provided with individual bedrooms which they have personalised to their individual wishes. Residents have access to safe, comfortable and suitably furnished and decorated communal facilities together with sufficient toilet shower and bathroom facilities. Residents have appropriate equipment to maximise their independence. The home is maintained to a good standard being clean, tidy and comfortable and provides suitable laundry facilities. EVIDENCE: The home is well maintained throughout and there is an ongoing maintenance programme to enhance the residents’ living environment and to comply with the various requirements of the national minimum standards. The premises provide sufficient heating, lighting and ventilation and the standard of furnishings, fittings and decoration are suitably maintained. The grounds are spacious, safe and well maintained with an attractive garden, which is accessible and used by the residents, weather permitting.
Old Vicargae (The) D51_D01_S57134_OldVicarage_V240750_090907_Stage4.doc Version 1.40 Page 16 The home provides sufficient communal rooms, which are comfortable, suitably furnished and decorated and includes a lounge that leads from a conservatory together with a separate, large dining room. The grounds are spacious, safe, well maintained with an attractive garden, which is accessible and used by the residents, weather permitting. The home provides sufficient bathrooms, shower and toilet facilities, which meet the needs of the residents. There are three assisted bathrooms, one wheel in shower room and five separate toilets available, which are suitably located on both the ground and first floor levels. Since the last inspection, new flooring has been laid to one of the bathrooms. These facilities do not include those toilets located within the bathrooms and the en-suite facilities located within residents’ bedrooms. Residents have free access to the communal areas and to their bedrooms. Three chair lifts have been installed to enable residents to access the first floor of the building. In addition items such as grab and hand rails, assisted baths and zimmer frames are provided, where appropriate, to meet the needs of specific individuals and groups of residents. A call bell system is installed in each room, which can be used by residents to call for staff assistance. Residents’ bedrooms vary in size but are suitably furnished and equipped to ensure comfort and privacy. Residents can and have brought items of furniture and personal possessions to make their bedrooms more homely and they have personalised them to their individual wishes. Locks have been fitted to residents’ bedroom doors. Planned admissions can choose the colour of decoration to their bedrooms as well as those residents who have been at the home for a long time, particularly where the bedroom needs redecorating. Residents spoke positively about the standard and cleanliness of their accommodation. The home continues to be maintained to a good standard being clean, tidy and free from offensive odours. The laundry room is located on the ground floor and provides suitable facilities to meet the needs of the home. Residents’ clothing is labelled to ensure that their garments are appropriately returned. A part time laundry person is employed to undertake this task with the support from the care and waking night staff. Residents spoken to commented favourably about the laundry arrangements in place, stating that their clothing is returned in good condition. Old Vicargae (The) D51_D01_S57134_OldVicarage_V240750_090907_Stage4.doc Version 1.40 Page 17 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 and 29 The home continues to provide sufficient numbers of staff on duty at all times to meet the needs of the residents. Residents are supported and protected by the home’s recruitment practices. EVIDENCE: The deployment of staff continues to provide four members of care staff on duty in the mornings with three on in the afternoons and evenings. There are two members of waking night staff on duty each night with one member of care staff sleeping in. The above staffing levels exclude those hours worked by the manager and the number of ancillary staff employed. The manager reported that there have been a number of changes to the staff team since the last inspection but this has not been to the detriment of the residents. The structure within the home is in the process of being increased to provide another deputy manager due to the opening of a dementia unit in the near future. Residents spoken to commented very positively about the care provided, stating that the staff are very kind, helpful, and they couldn’t be any better. Residents stated that they are treated well by the staff. Staff were observed to undertake their duties in a warm, caring and attentive manner. A sample of files for two newly appointed staff were checked and showed that appropriate recruitment practices are being followed for the protection of the residents. Old Vicargae (The) D51_D01_S57134_OldVicarage_V240750_090907_Stage4.doc Version 1.40 Page 18 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) 36 Staff are being appropriately supervised. EVIDENCE: Documentary evidence was available to confirm that staff are being supervised on a regular basis and a new monitoring form has been established for this purpose. Old Vicargae (The) D51_D01_S57134_OldVicarage_V240750_090907_Stage4.doc Version 1.40 Page 19 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 x 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x 3 x x Old Vicargae (The) D51_D01_S57134_OldVicarage_V240750_090907_Stage4.doc Version 1.40 Page 20 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. 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. Refer to Standard Good Practice Recommendations Old Vicargae (The) D51_D01_S57134_OldVicarage_V240750_090907_Stage4.doc Version 1.40 Page 21 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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