Inspection on 25/05/06 for The Vale

This inspection was carried out on 25th May 2006.

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

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

Other inspections for this house

The Vale 09/09/08

The Vale 06/07/07

The Vale 30/10/06

The Vale 27/09/05

The Vale 14/01/05

The Vale 26/08/04

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

CARE HOMES FOR OLDER PEOPLE The Vale 191 Willington Street Maidstone Kent ME15 8ED Lead Inspector Eamonn Kelly Key Unannounced Inspection 25th May 2006 09:45 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 Vale DS0000061139.V294404.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Vale DS0000061139.V294404.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Vale Address 191 Willington Street Maidstone Kent ME15 8ED 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) 01622 762332 Charing Vale Ltd Vacant Care Home 28 Category(ies) of Dementia - over 65 years of age (28) registration, with number of places The Vale DS0000061139.V294404.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th September 2005 Brief Description of the Service: The Vale Residential Home is registered to accommodate up to 28 older people with dementia. The home is one of some 18 residential homes operated by Charing Healthcare Ltd. Service users at the home have significant levels of dementia, sensory impairments and/or physical disabilities associated with advancing years. Twenty-four hour care is provided. Three care assistants are on duty at night. Four care assistants (including a senior carer) are on duty at all times during the day. The home is currently without a registered manager. Charing Healthcares’ area manager, Mrs Louise Yates, visits the home regularly as part of its general management and quality monitoring on behalf of the owner. Resident’s bedrooms are on 3 floors. The 2nd floor is accessible by stairs and a passenger lift. The 3rd floor is accessible only by further stairs and 2 stair lifts. There are 3 bedrooms on this floor. The garden is suitable for use by frail older people and has a concrete ramp to assist access by wheelchair users. There are 17 single and 5 shared bedrooms. Five bedrooms have en-suite facilities (one of which does not have a WC). The current scale of charges are £480-£550 per week. Additional charges are contained in the Service User’s Guide and personal contract provided to each service user. The Vale DS0000061139.V294404.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced visit between 09.45am-4.00pm consisted of meeting with most service users, members of staff on duty and visitors. Ten service users completed a CSCI written survey. The responses indicated that they were generally satisfied with the care and support they received at the home. The report outlines areas of concern by service users that were outlined in the survey. The previous CSCI report requested that a number of issues needed to be addressed. The purpose of this report is to indicate if reasonable progress had been achieved in addressing these issues. Over the past 6 months, the manager has reviewed the home’s provision of services. A number of the improvements requested have been carried out and further are soon to be implemented. The report concentrates on the care and support in place for service users. Meetings with members of staff, service users and visitors served to give a broad understanding of how service user’s current and changing needs are addressed. The improvements carried out and the expected outcome of imminent improvements outlined by the manager and district manager are likely to enable the claims made in the home’s Service User’s Guide to be fully met in practice. What the service does well: The training programme now in place for all members of staff gives them the opportunity to develop their knowledge and skills to work effectively with service users who have a wide range of support needs. This training comprises the provision of 14 new places to achieve an NVQ Level 2 award, 2 new places to achieve NVQ Levels 3 & 4 award and one for a Level 4 in Management award. The provision of mandatory training (annual updates in moving and handling, fire safety, first aid, food hygiene) for all staff is continuing. All members of staff receive training in recognising the effects of dementia and how to support service users. They also receive training in meeting the needs of service users who have physical and mental health support needs and sensory impairments. The number of staff on duty at night has been increased from 2 to 3. This gives service users the benefit of having appropriate care and attention at night within premises that are dispersed over a wide area and 3 floors. The Vale DS0000061139.V294404.R01.S.doc Version 5.2 Page 6 A recently appointed activities organiser has improved the programme of activities and contributed to the lifestyles of service users. The emphasis on reviewing service user’s changing support needs and meeting these needs is of benefit to service users and their relatives. All members of staff now have the benefit of 1:1 time with their supervisor to discuss their progress and agree on any training or other support needs they have to enable them to address the complex requirements of service users. The commitment to quality assurance measures as described by the manager and district manager is likely to have direct benefits for service users, members of staff and relatives/visitors. What has improved since the last inspection? A revised Service User Guide is being prepared. This will be fully in line with the order recommended in Care Home Regulations and is likely to provide even better information to prospective service users, their supporters and care commissioners. The care plan records for each service user have been updated. In the examples seen, support needs have been identified and the way each need is being met has been identified and recorded. In particular, risks to service users have been highlighted and all staff are aware of specific risks relating to service users. The serious defects in medication storage and administration have been addressed and a new training procedure has been implemented. Improvements to the premises have taken place. A full schedule of repairs and larger scale refurbishments is now underway. The manager is meeting recruitment targets set by the organisation. This includes a commitment to have sufficient numbers of trained staff on duty at all times to meet the complex support needs of service users. All members of staff now have 1:1 contact with their supervisors. This is helpful in reviewing areas of practice and any need for staff development. The unstable management situation may undermine this progress. The home is reviewing its success in providing food and fluids to service users to better enable them to combat skin deterioration and recover more quickly from infection. The provision of a greater level of choice of food and meals is under active review as is the provision of a more congenial setting for taking meals. The Vale DS0000061139.V294404.R01.S.doc Version 5.2 Page 7 The lifestyles of service users have been improved through the efforts of staff and a recently appointed activities organiser. To complement this advance, more commitment initially in terms of hours provided is under active consideration according to the manager. 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 Vale DS0000061139.V294404.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Vale DS0000061139.V294404.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 Quality on this outcome area is good. This judgement was made using available evidence including a visit to this service. Residents and representatives have access to written information needed in making a decision if the home can meet their needs. Residents have their support needs assessed before admission so that they may be confident that their support needs would be met. EVIDENCE: Prospective service users receive a full assessment by the manager prior to admission. Particular care is taken in fully assessing prospective service users so that they (and their families) are assured that their support needs would be comprehensively met. Pre-admission information is more fully recorded now than previously. The Vale DS0000061139.V294404.R01.S.doc Version 5.2 Page 10 The pre-admission written information provided to prospective service users and their families was being updated to enable clear information to be given at this stage. The feedback from service users and visitors indicated that they were generally satisfied with the support available and provided and that their original expectations had been met. The home accepts service users for periods of respite care. Increased attention is now given to fully assessing their support needs prior to admission and producing and maintaining care plan records similar to those for permanent service users. The Vale DS0000061139.V294404.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality on this outcome area is good. This judgement was made using available evidence including a visit to the service Service users receive reasonable care and support. The increasing frailty of some service users and how their changing needs are addressed are contained in care plan records that are being improved. The safety of service users is now better promoted by better medication administration. Service users are receiving increasingly better support for in meeting challenges due to sensory impairments. EVIDENCE: Care plan records have recently been improved. This is to ensure that each service user’s health and personal/social support needs have been addressed and are being met at all times with records explaining all aspects of this at any given time. The new records have not yet been extended to service users. The home is making a good effort to implement it fully. The test is to enable members of staff to have a full picture at any time of service user’s health and The Vale DS0000061139.V294404.R01.S.doc Version 5.2 Page 12 wellbeing, how general and critical support needs are being addressed and the outcomes of these efforts. Considerable work has been done in assessing aspects of risk associated with the care of each service user. Examples were contained in the new care plan records. Members of staff and the manager had a good knowledge of each service user’s support needs and of specific risks including those associated with falls. All but 3 of the home’s service users were met on this occasion. District nurses visit a number of service users twice a week to attend to pressure sores and problems with skin deterioration. The cook was aware of the connections between intake of fluids and food and recovery from and prevention of infections. On one occasion, a member of staff spent considerable time assisting a service user to eat lunch. On two other occasions, service users having their meal in their bedroom were not receiving such assistance. On first sight, this seemed to present a problem but there were reasons presented in both cases for the situations seen. A quarter of service users took their meals in their bedroom. In keeping with the home’s claims in it’s service user guide, the manager is seeking to ensure that most service users are assisted to dress and have meals in the dining room and receive appropriate staff assistance. There is also additional thought being put into improving the ambiance of the dining room (ie. provision of linen tablecloths and serviettes and menu cards) at mealtimes. Menu cards for each day would show the choices available that day which on the visit day were limited. Members of staff have an effective means of advising staff on new shifts (changeover) of service user’s health and potential problems that might occur during the new shift. Members of staff demonstrated how they support service users who have sensory impairments. There was some evidence that more support is needed in helping people maintain their hearing aids and that staff are working towards improving practice in this area (with some input from the activities organiser). The medication administration system has been improved following recommendations made by a CSCI pharmacy inspector in 2005. Part of an administration round was observed and that part of the procedure was effective. Where service users keep their own medication, risk assessments are carried out from time to time and the results are noted in care plan records. Service users met stated that they were satisfied with the support they received. This view was confirmed by visitors and through the surveys completed by service users (with assistance in some cases from relatives or The Vale DS0000061139.V294404.R01.S.doc Version 5.2 Page 13 members of staff). The impression gained during the visit to the home was that service users are treated with courtesy and respect. With the wide variation in the levels of service users’ physical infirmity, mental health support needs and sensory impairments together with the dispersed nature of the premises and access difficulties, four care assistants worked hard to cope effectively in meeting resident’s support needs. This opinion is supported by feedback from service users and their representatives in the CSCI survey. Service users are cared for until at the home unless they require, in the opinion of a GP, the manager or care manager, care that can only be provided at a hospital or care home with nursing. The Vale DS0000061139.V294404.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality on this outcome area is good. This judgement was made using available evidence including a visit to the service Service users maintain good contact with friends and relatives. They exercise control over their own lives insofar as their health allows and they receive support in maintaining good lifestyles. The home is making a good effort to enable service users to have good lifestyles and to help them cope with the effects of dementia, the onset of dementia, decline in physical and mental health, and significant sensory impairments. EVIDENCE: The manager and members of staff demonstrated a good knowledge of service user’s general expectations and preferences. This knowledge included an appreciation of expectations stemming from service user’s previous lifestyles and occupations. This knowledge enabled staff to provide a degree of customised daily life support to each service user (examples of which were discussed during the inspection visit). The Vale DS0000061139.V294404.R01.S.doc Version 5.2 Page 15 A quarter of service users stayed mostly in their bedrooms. The manager and activities organiser are addressing how best to assist service users have their meals in the dining room and to get dressed for such “outings” and be helped from their bedrooms. Service users on the 2nd floor are isolated to a considerable extent and the manager and activities organiser are reviewing this situation. About eight service users attended an activities session. Some had significant levels of sensory impairment and they were helped to communicate by written information exchange. Members of staff and the activities organiser are concentrating more on how best to support people with the extensive range of physical and mental health difficulties suffered by service users. A record book is maintained that details the activities service users are encouraged to take an active part in. The activities organiser explained how she was making measurable progress in improving service user’s lives. Since March 2006 when the activities organiser took up her appointment, there have been significant advances in assisting service users develop their enjoyment of daily life. The availability of 20 hours a week is a good start. The extreme pressures on staff in such a dispersed premises in meeting the assessed and changing needs of service users are alleviated only partially by such therapeutic support. There were examples seen where more support is needed by service users and their needs are recognised by the manager and members of staff. There was a good store of books, newspapers and magazines available. Visitors said they are made welcome at all reasonable times. Discussion took place on the effectiveness of fluid and food provision to service users. The manager is seeking to improve all aspects of food provision both in its quality and presentation. Over the longer term, the cook agreed that this aspect of service provision would be monitored closely to assess the effectiveness of more recent improvements. The CSCI provided the home with further advice (good practice guidance on food for older people in care homes) by letter. The Vale DS0000061139.V294404.R01.S.doc Version 5.2 Page 16 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. Quality on this outcome area is good. This judgement was made using available evidence including a visit to the service Residents and representatives were confident that their views are listened to and acted upon. This serves to protect service users from forms of abuse. EVIDENCE: Visitors and service users said that the manager and members of staff listen to concerns and complaints and take these seriously. Service users spoke openly about how they had no hesitation in making their views known. A copy of the local authority adult protection policy was available at the home. Members of staff were aware through experience and training of the risks to vulnerable people from various forms of abuse. The home has a complaints policy that is provided to all service users and known to members of staff. The manager was aware of current POVA (protection of vulnerable adults) arrangements and, according to her, all members of staff are aware of the potential consequences if abuse of service users took place. No complaints or allegations have been received since the last inspection. The Vale DS0000061139.V294404.R01.S.doc Version 5.2 Page 17 The Vale DS0000061139.V294404.R01.S.doc Version 5.2 Page 18 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, 23, 26. Quality on this outcome area is adequate. This judgement was made using available evidence including a visit to this service. The premises are safe and comfortable and are suitable for the provision of support for older people. The safety and comfort of service users is being improved by imminent major redecoration and refurbishment. EVIDENCE: The premises comprise bedrooms on the ground, first and second floors. The first floor is reachable by stairs and a passenger lift. Access to the third floor is more difficult as there is no passenger lift and service users use 2 stair lifts. Five bedrooms have en-suite facilities. There are 17 single and 5 shared bedrooms. One shared bedroom has an “en-suite” facility that does not comprise a WC. The Vale DS0000061139.V294404.R01.S.doc Version 5.2 Page 19 Shared bedrooms are currently under refurbishment to improve their decoration and to install sufficient facilities for the promotion of privacy for their occupants. These improvements include full-length screens around beds and washbasins, separate vanity units for each service user and a lockable facility for each service user. The manager is reviewing the practice of employing a commode to each bedroom (with 2 in shared bedrooms) as better toileting regimes with suitable staff training are likely to be more effective. The maintenance schedule also includes the provision of a suitable lock on all bedroom doors that service users have the choice of using at any time. The in-house maintenance person has successfully attended to a variety of routine and more major maintenance tasks. This included the repainting and refurbishment of some 5 bedrooms in the past 6 months. External contractors have been employed to fully refurbish the premises. This includes the fitting of double glazed windows, internal repainting and replacement of many soiled carpets. The manager and area manager explained how this work is being carried out imminently. There are car-parking facilities at the side of the premises. The garden is suitable for use by frail older people. The gardener also maintains the gardens of other homes owned by the company. Water temperatures are taken regularly and recorded to guard against accidental burns (temperature controllers are fitted). Disposable towels and soap dispersers are used. The district nurse team supplies additional equipment (for example, seat cushions, special mattresses) agreed as necessary for the ongoing care of service users. There was some untidiness and potential hazard to frail people with storage of equipment and materials in communal areas. The manager has made arrangements for storage facilities and cleanliness to be improved. All residents’ rooms and communal areas seen were reasonably fresh and there were no persistent odours generally evident. The Vale DS0000061139.V294404.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 Quality on this outcome area is adequate. This judgement was using available evidence including a visit to this service. The home provides good support for staff in enabling them to obtain suitable training for the care of service users. EVIDENCE: During the inspection visit, the manager was on duty in addition to 4 care assistants (including a senior care assistant), cook and maintenance person. A domestic worker or kitchen assistant was not on duty. Three members of staff are on duty at night. The manager is continuing to make improvements in the level of staffing at the home. Four care assistants (with the lack of a domestic worker and kitchen assistant) worked hard to cope effectively with support needs of service users (a quarter of whom were in their bedrooms at the time of the visit and who received their meals there). Two staff files checked indicated that application forms are completed by all new staff, two written references are taken up, CRB (criminal record bureau) checks are taken up and an induction procedure is followed. A telephone reference is now additionally taken up for prospective new members of staff. The Vale DS0000061139.V294404.R01.S.doc Version 5.2 Page 21 Examples of supervision records were seen. These indicated that the manager discussed aspects of good and poor practice with staff regularly. The procedure also led to agreement on the types of support and training needed by staff. Fourteen places on NVQ Level 2 in Care have been agreed with a training organisation. Members of staff are taking up these places. A trainer and assessor from the training provider will visit home. A senior member of staff is starting NVQ Level 3 in Care. Another senior member of staff is due to undertake NVQ Level 4 in Care. The manager has NVQ Level 4 in Care. Each member of staff receives training in safe movement and handling, first aid and fire safety. Both cooks have current certificates in food hygiene. Each member of staff administering medication receives training that includes competency assessment. A certificated course in underway for all care staff to enable them to learn more about how to work well with people with dementia or the onset of dementia. This is to complement the 3 days training each member of care staff has already received. The Vale DS0000061139.V294404.R01.S.doc Version 5.2 Page 22 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, 33, 35, 38. Quality on this outcome area is adequate. This judgement was made using available evidence including a visit to the service Service users have the benefit of living in a home where a number of improvements to the service have been made or are imminent to increase their comfort and safety. The management of the home is not stable as there has been a failure to register a manager for some considerable time. This instability has a negative effect on the well being of service users and effectiveness of staff (for example, access by staff to 1:1 support by the manager may be curtailed). EVIDENCE: The Vale DS0000061139.V294404.R01.S.doc Version 5.2 Page 23 The manager has achieved the NVQ Level 4 in Care and is completing the RMA (registered manager’s award). Over the previous 18 months, there had been statements to the Commission that improvements requested had either been implemented or under active consideration. These statements proved ineffective due largely to a period of unstable management. The manager and area manager on this occasion have made definite improvements that contribute to service user’s comfort and safety and imminent improvements are acknowledged. The manager left since the inspection visit and no application for registration was made. There is a good skill mix of staff at the home: this comprises the area manager, home manager, senior care assistants, care assistants, cooks, activities organiser, domestic workers, night time carers, maintenance person and gardener (who also attends other homes in the company). The manager is assessing how best to achieve the optimum skill mix at all times. During the visit, a kitchen assistant or domestic worker was not on duty. Care assistants were filling the gap. The number of staff on duty at night has been increased from 2 to 3. During the visit, there was a relaxed and good atmosphere at the home. Ten service users at the home made their views known to the Commission via completed survey forms (“Have Your Say About..”). Together with views expressed by visitors met during the inspection, the outcome of the survey was that service users and relatives were generally satisfied with the standard of service provided. However, they also provided specific information about some care issues as follows: • • • • • “I know staff are very busy but on most occasions are around when I need them”. Is the home fresh and clean? “There has been an improvement over the last few months”. Do staff listen and act on what you say? “Not always. Sometimes Mrs ! has to ask often”. “Sometimes I get worried when one of the male residents comes into my room uninvited, sometimes when I am asleep. I do not think that I am in any danger but I wish that staff could prevent it”. There is high staff turnover that makes it difficult to know who is who. But the new manager is very good…”. In answer to the questions on medical support, activities provided, cleanliness of the home and availability of staff, six replies stated “usually” on the “always-usually-sometimes-never” options given. The Vale DS0000061139.V294404.R01.S.doc Version 5.2 Page 24 New care plan records incorporating better risk assessments have been introduced. Whilst currently being put into practice, the manager was confident that these would contribute to improved care and support for service users and better understanding of their increasing levels of frailty. Improvements carried out have contributed to the safety and welfare of service users. Members of staff undertake what is referred to as mandatory training and an extensive NVQ programme is underway. The advances on provision of suitable foods and fluid have had a benefit for service users. There has been improvement in the provision of mental and physical stimulation for service users and an emphasis on this is continuing through staff knowledge and skill and the efforts of the activities organiser. There was evidence that the manager is well supported by the company in a variety of ways including the periodic reports prepared under Regulation 26 reports (Care Home Regulations). In written information provided by the manager to the Commission prior to the visit, a declaration was made that all safety checks have been made and all necessary safety and maintenance certificates and checks are in place and upto-date. Service users or their families or advocates are expected to be responsible for service user’s financial and legal matters. The home would provide advice to a service user in obtaining independent advice if circumstances required this. The Vale DS0000061139.V294404.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x 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 Standard No Score 16 3 17 x 18 3 3 x x x 2 x x 3 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 1 x 2 x 3 x x 3 The Vale DS0000061139.V294404.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 OP31OP31 Regulation 8 & 10 Requirement A manager must be appointed to run the home and the manager must be registered with the Commission. “The registered provider shall appoint an individual to manage the care home..”. 2 OP27OP27 OP33OP33 18 01/11/06 The efforts of the previous manager to provide the necessary levels of staff and skill mix are acknowledged. The response from service users and their representatives indicate that improvement is needed in this area of service. This is due to the heavy dependency needs of service users and the dispersed nature of accommodation within the home. “The registered person shall, having regard to the size of the care home..ensure that at all times suitably qualified..persons are working at the home in such numbers..”. The schedule of repairs and maintenance is acknowledged. DS0000061139.V294404.R01.S.doc Timescale for action 01/10/06 3 The Vale OP23OP23 16 & 23 01/02/07 Page 27 Version 5.2 This should include the upkeep of individual bedrooms and particularly shared bedrooms for the promotion of privacy and safety for service users. “The registered person shall provide facilities and services..” 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 Vale DS0000061139.V294404.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Vale DS0000061139.V294404.R01.S.doc Version 5.2 Page 29 - 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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