Inspection on 09/03/06 for The Rectory

This inspection was carried out on 9th March 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Rectory 27/08/09

The Rectory 07/09/07

The Rectory 14/11/06

The Rectory 07/10/05

The Rectory 21/02/05

The Rectory 26/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Rectory SRC Residential Care Home 2 Trinity Road Taunton Somerset TA1 3JH Lead Inspector Sally Murphy Unannounced Inspection 9th March 2006 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 Rectory SRC Residential Care Home DS0000003302.V286110.R01.S.doc Version 5.1 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 Rectory SRC Residential Care Home DS0000003302.V286110.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Rectory SRC Residential Care Home Address 2 Trinity Road Taunton Somerset TA1 3JH 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) 01823 324145 Maners Care Limited Mr Matthew James Parrish Care Home 23 Category(ies) of Dementia - over 65 years of age (0) registration, with number of places The Rectory SRC Residential Care Home DS0000003302.V286110.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Two named service users in category MD to be accommodated in the Home, as agreed with the Responsible Individual Bedroom 9 must only be used to accommodate fully mobile service users. Admissions must be accompanied by an appropriate risk assessment. The Registered Manager must obtain the NVQ4 qualification in Care and Management by 31st December 2006 7th October 2005 Date of last inspection Brief Description of the Service: The Rectory is a two storey detached property on the outskirts of Taunton town centre. Service user accommodation is provided over two floors. All service user’s rooms are single occupancy. A passenger lift, assisted bathroom and call system are provided. There is a garden at the rear of the property that is accessible to service users. The home is registered with the Commission for Social Care Inspection, to provide personal care for up to twenty-three people who have a dementia. The Registered Manager is Mr Matthew Parrish and the Registered Provider is Maners Care Ltd. The Rectory has been approved by Somerset Social Services as a special rate care (SRC) home providing enhanced care for people suffering from dementia. The Rectory SRC Residential Care Home DS0000003302.V286110.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out as part of the planned annual programme of inspection. The inspection was unannounced and carried out by Sally Murphy and John Hurley, Regulation Inspectors over one day. The previous inspection was unannounced and took place on 7th October 2005. On the day of the inspection there were twenty-one service users residing at the home. During the course of the inspection the Registered Manager, General Manager, Proprietor, service users, relatives and staff members were spoken with. Care practice was also observed, records examined and a tour of the premises was made. What the service does well: What has improved since the last inspection? Since the last inspection, three senior staff have taken responsibility for the management of medication, and all senior staff have completed a distance learning course on the safe handling of medications. Brian Coomber has taken over the role of Assistant Manager. The Inspectors were advised that since the last inspection, the staff handbook has also been updated. The Rectory SRC Residential Care Home DS0000003302.V286110.R01.S.doc Version 5.1 Page 6 There is an on-going program of re-decoration and refurbishment throughout the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Rectory SRC Residential Care Home DS0000003302.V286110.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection The Rectory SRC Residential Care Home DS0000003302.V286110.R01.S.doc Version 5.1 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 the following standard(s): 1, 2, 3, 4 & 5. (Standard 6 does not apply). The home ensures that prospective service users are provided with appropriate information regarding the home. Service users and their families are invited to visit the home and assess the services provided. An assessment of need is completed prior to any service user being admitted to ensure that the home will be able to fully meet their needs. EVIDENCE: The home has a Statement of Purpose and Service User Guide that provide details of the services and facilities provided at The Rectory. These documents have been updated since the last inspection. The Registered Manager ensures that an assessment of need is completed prior to any service user moving into the home. The Rectory SRC Residential Care Home DS0000003302.V286110.R01.S.doc Version 5.1 Page 9 The care plan for one service user indicated that they did not have dementia care needs and included details of a mental health diagnosis that was outside the conditions of registration for the home. This was discussed during the inspection. The Registered Manager has agreed to seek further information regarding the needs of this service user. The Registered Manager must comply with the conditions of registration. The Registered Manager must ensure that staff have the knowledge and skills to meet the needs of any service user admitted to the home. Where it is proposed that a service user be admitted whose primary needs are not that of dementia care, an application to vary the conditions of registration must be made to CSCI, prior to the service user being admitted to the home. The Registered Person must develop a statement of terms and conditions, and ensure that this is made available to service users and their relatives on entry into the home. Prospective service users and their families are invited to visit the home. Respite care is provided. Placements are made via Somerset Social Services who have block purchased all of the beds at this home. The Rectory SRC Residential Care Home DS0000003302.V286110.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9 & 10. The home has developed an appropriate plan to meet service users’ needs. Care plans were comprehensive and are regularly reviewed. The home works closely with the Link Nurse from Somerset Partnership. Medications are appropriately maintained. Service users are treated with dignity and respect. EVIDENCE: Care plans are maintained for each service user. These include details of individuals’ needs, daily routines and preferences. Care plans were thorough and included detailed directions to staff of the level and type of assistance to be provided to each person. A moving and handling assessment had been completed for each service user. Care plans had been regularly reviewed and updated as required. Pressure area and falls risk assessments had been completed. Pressurerelieving equipment is provided as required. A behavioural chart had been completed for one person. The Link Nurse visits the home each week, and is available to offer further advice as required. The Rectory SRC Residential Care Home DS0000003302.V286110.R01.S.doc Version 5.1 Page 11 Since the last inspection, three senior staff have taken responsibility for the management of medications. Staff have received medications training from the supplying pharmacy. All senior staff have completed a distance learning course on the safe handling of medications. All medications are stored securely. Medication records include a photograph of the service user. Those medications requiring refrigeration are stored securely, and the temperature monitored each day. Opening and discard dates had been recorded for creams. Variable doses had been recorded. Controlled Drugs records and Medication Administration Records had been appropriately maintained. Staff were observed knocking on doors before entering. Service users are able to meet privately with visitors in their bedroom or one of the lounges. Interaction between staff and service users was friendly and respectful. The Rectory SRC Residential Care Home DS0000003302.V286110.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 14, & 15. The home has taken appropriate action to meet service users’ social needs. Service users are encouraged to exercise choice over their lives. Meals are of a good standard and offer a well-balanced diet. EVIDENCE: Daily routines are flexible to meet the needs of service users. Service users are able to participate in a range of activities, including: flexercise, cold bake, walks, singing, shopping, picture making, bingo, manicures and listening to music. The weekly program of activities is displayed in the dining room. Service users spoken with were satisfied with the activities provided, and advised that staff had asked them to suggest places to visit during the summer months. Activities records are maintained and audited on a monthly basis, to ensure that all service users are provided with regular opportunities to participate. Visitors are welcomed at the home. Meals are provided by an external catering company. A choice of meals is provided each day. Those service users requiring support during meal times were assisted in a dignified manner. The menu has been recently updated. The Rectory SRC Residential Care Home DS0000003302.V286110.R01.S.doc Version 5.1 Page 13 Staff are aware of service users dietary needs and preferences. Service users stated that they enjoyed the meals provided. The Rectory SRC Residential Care Home DS0000003302.V286110.R01.S.doc Version 5.1 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 the following standard(s): 16 & 18. The home has appropriate policies relating to complaints and the protection of vulnerable adults. EVIDENCE: The home has a complaints procedure, that includes details of external agencies that service users and their families may contact, including CSCI. There have been no complaints received by the home or CSCI since the last inspection. The home has appropriate policies relating to the Protection of Vulnerable Adults. The Rectory SRC Residential Care Home DS0000003302.V286110.R01.S.doc Version 5.1 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 the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26. The home has been decorated and furnished to a high standard. There are sufficient communal areas and bathroom facilities to meet service users needs. Service users rooms are personalised to reflect their individual tastes. There is an on-going program of re-decoration throughout the home. The home must take further action to ensure that the issues identified within three service users bedrooms are addressed. The home follows good practice with regard to infection control. The home is maintained to a high standard of cleanliness. EVIDENCE: Service user accommodation is provided over two floors. There is a passenger lift, assisted bathroom and call system available to service users. Communal areas comprise of a lounge, observation lounge and dining room. There is a secure garden at the rear of the property that is accessible to service users. The Rectory SRC Residential Care Home DS0000003302.V286110.R01.S.doc Version 5.1 Page 16 Service users are able to bring personal possessions with them into the home. Service user rooms seen had been personalised with pictures, furniture and photographs. Waterproof flooring has been provided in some service user rooms to meet individuals’ needs. Pressure mats used during the night in some service user rooms, to alert staff that a service user might require assistance. The commode seen within one service users’ room requires replacement. The bedroom curtains in a further service users room did not close. The Registered Manager must ensure that appropriate action is taken to promote the dignity of this service user. Denture cleaning tablets were found within the en suite bathroom of one service user room, and may pose a risk if ingested by the service user. The Registered Manager must ensure that a risk assessment is completed in relation to the risk of service users swallowing the latex gloves that were available within one service users room. During the inspection, it was observed that the lounge door was held open on a magnetic closure that is not linked to the fire system. The home must ensure that the lounge door is kept closed or an appropriate closure device fitted. The laundry is locked when not in use. The home follows appropriate infection control procedures. The home was found to have a high standard of cleanliness. The Rectory SRC Residential Care Home DS0000003302.V286110.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Staff are provided with appropriate training to undertake their role. There are sufficient staff on duty to meet service users’ needs. Staff are provided with regular supervision. The home has failed to operate a robust recruitment procedure. EVIDENCE: Duty rotas are maintained. There are generally four staff on duty throughout the day, and two waking staff at night. Additional domestic and catering staff are also employed. The Registered Manager works approximately three shifts each week as a member of the care team, and feels that this is an important aspect of his role. Since the last inspection, Brian Coomber has taken on the role of Assistant Manager. The Registered Manager and Assistant Manager provide on call cover during alternate weeks. The home ensures that staff are provided with opportunities to receive further training. A comprehensive training matrix is maintained. All staff receive regular updates in mandatory training. At present there are seven staff studying for the NVQ level 2 qualification and one person for the level 3 qualification. The Registered Manager will shortly begin studying for the NVQ level 4 qualification in Management and Care. The Rectory SRC Residential Care Home DS0000003302.V286110.R01.S.doc Version 5.1 Page 18 Newly appointed staff receive Induction training. Staff receive regular supervision, and appraisals are completed on an annual basis. Staff stated that they enjoyed working at the home, and received appropriate support. Recruitment records were examined for four staff that have been recently employed by the home. Application forms for two staff members did not contain a full employment history, and references had not been obtained from the most recent employer. The home had been following previous outdated guidance and had failed to obtain a POVA First check or enhanced CRB disclosure for staff commencing employment at the home. Where a conviction is recorded on a CRB disclosure, or issues of concern are raised within references, a risk assessment must be completed to determine whether they are suitable for the role. Areas of concern must be monitored during supervision records and appropriate records maintained. Recruitment practice was discussed fully with the Registered Manager and Provider at the end of the inspection. The Rectory SRC Residential Care Home DS0000003302.V286110.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37 & 38. The Registered Manager provides effective leadership to the staff team. There are appropriate systems in place to obtain the views of service users. Records relating to service users are stored securely. Health and safety records have been appropriately maintained. EVIDENCE: The Registered Manager is Matthew Parrish. He has considerable experience of providing care to older people and plans to study for the NVQ level 4 qualification in Management and Care. There was a relaxed atmosphere within the home. Staff spoke highly of the Registered Manager, and stated that he was approachable. The home holds The Rectory SRC Residential Care Home DS0000003302.V286110.R01.S.doc Version 5.1 Page 20 monthly meetings with service users, in additional to seeking feedback from service users and relatives on an informal basis. The home will keep money for service users who wish them to. Records are maintained of all transactions involving service users finances, and are supported by staff signatures and receipts. Records relating to service users are stored securely. The home displays appropriate Employers Liability Insurance. Fire safety equipment has been serviced and tested as required. Staff have been provided with regular fire safety training. Equipment servicing records have been appropriately maintained. The fire risk assessment had been reviewed on 01/02/06. Staff confirmed that they are provided with health and safety training, on commencing employment at the home. The home operates a comprehensive system of quality audits to ensure that service users are provided with a safe and comfortable environment. Hazardous substances are stored securely and are not accessible to service users. Accidents are recorded and reported as required. The Rectory SRC Residential Care Home DS0000003302.V286110.R01.S.doc Version 5.1 Page 21 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 1 3 2 3 x 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 Standard No Score 16 3 17 X 18 3 2 3 3 3 3 2 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 The Rectory SRC Residential Care Home DS0000003302.V286110.R01.S.doc Version 5.1 Page 22 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 OP2 Regulation 5 (1b) Requirement The Registered Person must develop a statement of terms and conditions, and ensure that this is made available to service users and their relatives on entry into the home. The Registered Manager must comply with the conditions of registration. The Registered Manager must ensure that staff have the knowledge and skills to meet the needs of any service user admitted to the home. Where it is proposed that a service user be admitted whose primary needs are not that of dementia care, an application to vary the conditions of registration must be made to CSCI, prior to the service user being admitted to the home. 3. OP19 13(4) Denture cleaning tablets were found within the en suite bathroom of one service user room, and may pose a risk if DS0000003302.V286110.R01.S.doc Timescale for action 01/05/06 2. OP4 12 (1) 07/04/06 07/04/06 The Rectory SRC Residential Care Home Version 5.1 Page 23 ingested by the service user. The Registered Manager must complete a risk assessment should this practice continue. The Registered Manager must ensure that a risk assessment is completed in relation to the risk of service users swallowing the latex gloves that are available within service users rooms and bathrooms. 4. OP19 13(4) The home must ensure that the lounge door is kept closed or an appropriate closure device fitted. The commode seen within one service users room requires replacement. The bedroom curtains in a further service users room did not close. The Registered Manager must ensure that appropriate action is taken to promote the dignity of this service user. 6. OP29 19 (1b) & Schedule 2 14/04/06 The Registered Manager must ensure that a full employment history is obtained, and any gaps explored during the interview. References must be obtained from the most recent employer. A POVA First check must be obtained prior to a member of staff commencing employment at the home. An enhanced CRB disclosure must be obtained for each staff member. Where a conviction is recorded on a CRB disclosure, or issues of concern are raised within references, a risk assessment The Rectory SRC Residential Care Home DS0000003302.V286110.R01.S.doc Version 5.1 Page 24 07/04/06 5. OP24 12 (4a) 28/04/06 must be completed to determine whether they are suitable for the role. Areas of concern must be monitored during supervision and appropriate records maintained. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Rectory SRC Residential Care Home DS0000003302.V286110.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Rectory SRC Residential Care Home DS0000003302.V286110.R01.S.doc Version 5.1 Page 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!