CARE HOMES FOR OLDER PEOPLE
The Vale 191 Willington Street Maidstone Kent ME15 8ED Lead Inspector
Eamonn Kelly Key Unannounced Inspection 08:45 6th July 2007 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.V337576.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.V337576.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 sally@charinghealthcare.co.uk Charing Vale Ltd Sally Sharpe Care Home 28 Category(ies) of Dementia - over 65 years of age (28) registration, with number of places The Vale DS0000061139.V337576.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 30th October 2006 Brief Description of the Service: Residents have significant levels of dementia, sensory impairments and/or physical disabilities associated with advancing years. Their bedrooms (18 single and 5 shared) are on ground, first and second floors. The garden is suitable for use by frail older people and has a concrete ramp to assist access by wheelchair users. The current scale of charges is as follows • • Kent County Council: £402 per week. Other local authorities may pay different fees. Privately funded residents: £500-£550 per week. The Resident’s Guide contains information about services and facilities. Additional charges are made for hairdressing, chiropody, newspapers, private telephones and call costs, Freeview converters). The Vale DS0000061139.V337576.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place on 6th July 2007 from 8.45am-4.35pm. It consisted of meeting with residents, the manager and members of staff, the owning company’s service manager and visitors. Support practices were observed and discussed with members of staff. A variety of records was seen during the visit principally those that supported the care of residents. The manager submitted a completed AQAA (annual quality assurance assessment) to the commission. This was helpful in the preparation of this report. Time was spent observing the care being given to a small group of residents in the main lounge. The report contains information about progress made since the previous inspection. Requirements contained in the previous inspection report have been addressed. What the service does well: What has improved since the last inspection?
A new registered manager is in post and progress has been made in achieving a number of improvements. Mrs Sally Sharpe and members of staff have made good progress in improving the comfort and safety of residents. Care staff numbers have been increased by one in the earlier part of the day. Two new kitchen assistants, a laundry assistant and a weekend domestic assistant have eased some of the pressures on carers. An induction programme commensurate with Skills for Care recommended procedures has commenced. All new members of staff undertake this before unsupervised duties are undertaken. An activities co-ordinator attending each weekday afternoon assists in a broad range of support activities for residents. This includes some liaison with relatives and visitors. The Vale DS0000061139.V337576.R01.S.doc Version 5.2 Page 6 The Residents and Relatives Guide is becoming a more accurate guide to services and facilities actually provided. This will be further updated at 6monthly intervals to reflect services as accurately as possible. A programme for premises upkeep has taken place and some bedrooms have been redecorated. Further improvements are either underway or planned. This includes maintenance of bedrooms before new residents move in, replacement of some carpets, redecoration of some communal areas, bathroom refurbishment, and review of privacy conditions in some shared bedrooms. A new conservatory is now in use. Stair lifts have been fitted where steps might otherwise impede resident’s movement. Better staff training is either underway or planned with definite objectives in place. Medication procedures are grounded in appropriate training and procedure improvement. Progress is being made in helping as many members of staff as possible achieve NVQ training (mostly NVQ Level 2 in Care but also Level 3 in some instances). Most members of staff receive support on topics regarded as mandatory (eg. infection control, food hygiene, H&S, fire prevention, first aid, POVA, moving & handling and COSHH). Planning to enable all carers achieve the Certificate in Dementia Care is at an advanced stage. This is complementary to the introductory course on dementia care that most carers have attended. Better meals are provided to residents. This has been achieved with the assistance of the company’s catering manager. What they could do better:
The good progress in improving food and meal provision is likely be complemented by serving food from a heated trolley in the dining room. This would reduce the constant movement of staff in transporting individual plated meals from the kitchen to the dining room. Portions could be more accurately served and gravies added as necessary. It might also enable staff to have more time and opportunity to help with feeding. The privacy of residents in most shared bedrooms should be improved. Residents, staff and visitors would benefit by replacement of carpets in some bedrooms where odours persist despite constant attention and steam cleaning. Each member of staff should receive appropriate training. This proposed provision is well advanced and should be in place over the coming year for all carers and other staff. The personal file for each resident should be simplified so that it contains relevant information pertinent to the current support of the resident. Staffing levels in the afternoon and evening (1-7pm and 7-9pm) should be reviewed because of the current low numbers, the high dependency levels of
The Vale DS0000061139.V337576.R01.S.doc Version 5.2 Page 7 residents and the dispersed nature of the premises. Observation of how care is carried out in the late morning period when 5 carers are on duty suggested some challenge with maintaining the well being of residents at that time. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Vale DS0000061139.V337576.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.V337576.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5, 6. Quality on this outcome area is good. This judgement was made using available evidence including a visit to the service. Residents and their relatives receive written pre-admission information about services and facilities. They receive good support at the time when a decision about entering residential accommodation is being made. EVIDENCE: Written pre-admission information (Residents and Relatives Guide) is given to prospective residents and/or their main supporter. The current copy is reasonably accurate and will be updated to enable prospective residents to have accurate information in every respect. An information pack is displayed in the hall. When an admission is agreed, residents receive a copy of a personal contract. A new contract is provided when circumstances change significantly (eg. move
The Vale DS0000061139.V337576.R01.S.doc Version 5.2 Page 10 to a different bedroom, different payment situation). Representatives of both parties do not sign current contracts. The manager says all new contracts will be signed. The manager assesses prospective residents (generally with care manager and psycho-geriatrician assistance and reports) prior to admission. Mrs Sharpe gives prospective residents and their relatives every opportunity to visit, meet staff and other residents and ask questions to enable them to make a decision. The home provides longer-term support or periods of respite care for residents. The Vale DS0000061139.V337576.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. 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. The healthcare and personal needs of residents are being addressed. More accurate detailing in individual care plans of the care they need would contribute further to this support. EVIDENCE: Each resident’s personal file contains too much data which is no longer relevant to their current support needs. In the examples checked, care plan records were not sufficiently accurate in identifying their present needs, how these are being addressed and outcomes of support/reviews of care. The charts maintained are somewhat duplicated. In some cases, useful resident profiles are included in typed form. These are likely to be of benefit to staff in understanding the previous lives of residents to assist with current support interventions. The manager and service manager intend to address the need
The Vale DS0000061139.V337576.R01.S.doc Version 5.2 Page 12 for more accurate care plan records and for resident’s personal files to reflect their current support needs. With increased emphasis on reviewing resident’s support needs, residents and their supporters re encouraged to participate. District nurses visit a number of service users as often as necessary to attend to pressure sores and other health difficulties. Information received as part of this inspection from social services indicates that care managers have seen noticeable improvement in resident’s access to local health services and in the ways they are supported. Members of staff showed how they lift residents where necessary and how they weigh them (including how weights are recorded and compared). These skills are important because of the extreme fragility of some residents. Medication administration seen at breakfast and lunch times suggest that improvements made over the past 9 months are helping to ensure that administration, recording and storage facilities contribute to the safety of residents. In all instances during the inspection, residents were treated with respect and understanding. The Vale DS0000061139.V337576.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15. Quality on this outcome area is good. This judgement was made using available evidence including a visit to the service. Residents 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. EVIDENCE: During the morning, thirteen residents were in communal areas and the remainder (13) were in their bedrooms. The observation procedure during the inspection suggested that some residents are left unattended for considerable periods without sufficient engagement and staff interaction. This led to withdrawn states of being for those residents. The manager is aware of this position and is addressing it. Most residents are at an advanced age. Some 25 have impaired vision, virtually all need direct staff support with dressing, washing/bathing and toileting. Nineteen have a significant physical disability. Twenty-two have
The Vale DS0000061139.V337576.R01.S.doc Version 5.2 Page 14 diagnosed conditions of dementia. The three residents on the 2nd floor are somewhat isolated but all had lunch in the dining room. An activities organiser visits each afternoon during weekdays but was not present when the inspection visit was made. Increased activities organiser hours would benefit residents and staff. Visitors say they are satisfied with the care and attention given to their relative by staff. Written and verbal feedback is obtained from families and visitors. The manager is progressing a number of initiatives and intends to sustain these. A good supply of books (including large print), newspapers and magazines are available for reading and as objects for residents. The reminiscence room is of high quality and is valued by residents, visitors and staff. Choice of food available at breakfast, lunch and evening meal have improved and there is better presentation. This includes changes in the way food is served. Staffing levels drop to 4 carers from 1-7pm and to 3 from 7-9pm. As mentioned above, there are some difficulties in keeping residents suitably engaged in the morning when 5 carers are on duty. The manager understands that it is important to maintain such engagement during the day to enable residents to sleep properly at night. There may, according to the annual quality assurance assessment (AQAA), be additional activity organiser hours to help residents remain more mentally and physically active during the day and to be able to sleep better at night. The open door policy for families and friends is being maintained. Religious services at least once a month will continue. Progress is being made in sustaining the family support group and residents will generally be present at reviews. The Vale DS0000061139.V337576.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality on this outcome area is good. This judgement was made using available evidence including a visit to the service. Residents are protected from abusive practices. EVIDENCE: Residents and their relatives have a copy of a complaints procedure that enables them to make their views known. There have been no recent complaints but residents and visitors are encouraged to comment about services and facilities. Results of formalised feedback are included in quality monitoring results. Staff have a good understanding of their responsibilities under POVA (protection of vulnerable adults). They receive training that includes adult protection procedures to enable them to support residents in accordance with expected standards. Employment checks including CRBs are taken up. Family members are encouraged to join and contribute to the family support group and residents are generally present at review. There is good documentation of client’s monies. Resident’s families or an independent advocate look after resident’s financial matters. The Vale DS0000061139.V337576.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24, 26. Quality on this outcome area is good. This judgement was made using available evidence including a visit to the service. The premises are broadly suitable for the provision of support for older people. Residents on the 2nd floor are isolated to a significant extent. Some shared bedrooms do not provide sufficient privacy for residents. EVIDENCE: Resident’s bedrooms are on 3 floors. The 1st floor (but not the 2nd floor) is accessible by a passenger lift. There are 3 bedrooms on the 2nd floor and residents are somewhat isolated. Some ceilings in this area are heavily sloped and there is an unlocked disused toilet. The intention is to refurbish this area and install an en-suite to each bedroom. The Vale DS0000061139.V337576.R01.S.doc Version 5.2 Page 17 Overall, there are 18 single and 5 shared bedrooms. Five bedrooms have ensuites. One shared bedroom that is suitable for purpose has an “en-suite” without a WC. Information such as this should be included in the revised Residents and Relatives Guide. Two other shared bedrooms are largely unsuitable for the purpose of sharing as they do not provide sufficient privacy and dignity for residents. The garden is suitable for use by frail older people and has a concrete ramp to assist access by wheelchair users. Bedroom doors are not equipped with suitable door-locks. Prospective residents and their families expect suitable door-locks to be in place even though many people would prefer not to use the facility. This shortfall should be outlined in the guide to facilities. There are faint but persistent odours in places. The manager says that carpet replacement is now the only option to cope with this. Water temperatures are taken regularly and recorded to guard against accidental burns. Temperature controllers are fitted. The manager is endeavouring to make the premises suitable for the support of residents. Some bedrooms have been redecorated. A ground floor bathroom will be altered to a wet-room as an alternative bathing facility. The Vale DS0000061139.V337576.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30. Quality on this outcome area is adequate. This judgement was made using available evidence including a visit to the service. Residents are in the care of members of staff who are increasingly well trained and supported. The poor ratio of staff to residents in the afternoon/evening period where residents are so dependent and premises so dispersed leaves residents at risk of isolation and inadequate support. EVIDENCE: All new staff complete application forms, two written references are required, CRB (criminal record bureau) checks are taken up and an induction procedure is followed. Induction procedures have improved in line with Skills for Care standards. The manager discusses aspects of good and poor practice with staff regularly. The procedure also leads to agreement on the types of support and training they need. Better staff training is either underway or planned with definite objectives in place. Medication procedures are grounded in appropriate training and procedure improvement. All carers administering medicines receive such training. Progress is being made in helping as many members of staff as possible achieve NVQ training (mostly NVQ Level 2 in Care but also Level 3 in
The Vale DS0000061139.V337576.R01.S.doc Version 5.2 Page 19 some instances). Most members of staff receive support on topics regarded as mandatory (eg. infection control, food hygiene, H&S, fire prevention, first aid, POVA, moving & handling and COSHH). Updates of the Residents and Relatives Guide is likely to enable progress in this respect to be monitored by the manager and through company inspection under Care Home Regulation 26. Planning to enable all carers achieve the Certificate in Dementia Care is at an advanced stage. This is complementary to the introductory course on dementia care that most carers have attended. The very high support levels that residents need have been referred to earlier. The observation during an extended period in the morning of the inspection suggests that staff are hard pressed to deliver this support consistently. The dispersed nature of the premises and the numbers of residents remaining in their bedrooms (with perhaps 3-4 making independent decisions on voluntary isolation) places additional pressures on members of staff. Following requirements by the commission in late 2006 as a result of continuing failure by the home to care adequately for residents, many improvements have been made to improve the comfort and safety of residents. One such improvement was to increase the numbers of care staff in the morning to 5; however the afternoon/evening staffing complement remains at 4 carers (with this falling to 3 from 7-9pm). It is probably risky having a ratio of 1:7 (and 1:9 between 79pm) where the dependency levels are so high and the premises are so diverse. The Vale DS0000061139.V337576.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 35, 38. Quality on this outcome area is good. This judgement was made using available evidence including a visit to the service. Residents have the advantage of living in a residential home that is well conducted. EVIDENCE: The manager is undertaking the Registered Manager’s Award and the Certificate in Dementia Care. She is improving services and quality of life for residents. There is an increasing resident focus and the manager leads a strong staff team who are recruited and trained to an increasingly high standard. The manager is aware of current developments both nationally and by CSCI and
The Vale DS0000061139.V337576.R01.S.doc Version 5.2 Page 21 plans the service accordingly. She is addressing the requirements contained in the previous inspection report. The home has good policies and procedures that the manager reviews and updates in line with current thinking. Members of staff are positive in their approach to supporting residents and they understand the challenges faced by residents. Good procedures are in place to monitor staff adherence to policies and procedures during their practice. The home previously did not have a good record of meeting relevant health and safety requirements and legislation. Good progress has been made in addressing shortfalls and the manager is committed to maintaining this progress. Low staffing numbers in the afternoon/evening remain a concern. Records are of a good standard and are routinely completed. Some improvements to care plan records is advisable so that issues identified are acted upon successfully to ensure resident’s care is not compromised. Relatives have confidence in the safe working practices of staff. The manager and owning company have the skills and ability to deliver good business planning, effective financial controls and good monitoring processes. Residents are provided with facilities to keep their valuables and money safe but the homes’ insurance does not cover loss of any valuable items. This needs to be made clearer in the new edition of the Residents Guide. Where the home is responsible for resident’s money, records are routinely kept up-to-date and can be used to track individual residents finances. The manager understands the need to meet external requirements where it acts as appointee for residents. The Vale DS0000061139.V337576.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 x 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 x x x 3 x 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 x x 3 x x 3 The Vale DS0000061139.V337576.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Vale DS0000061139.V337576.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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