Inspection on 14/04/09 for The Victoria Residential Home

This inspection was carried out on 14th April 2009.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Victoria Residential Home 29/03/10

The Victoria Residential Home 11/01/10

The Victoria Residential Home 01/12/09

The Victoria Residential Home 06/10/09

The Victoria Residential Home 22/04/08

The Victoria Residential Home 06/06/07

The Victoria Residential Home 17/05/06

The Victoria Residential Home 14/12/05

The Victoria Residential Home 18/05/05

The Victoria Residential Home 08/10/04

The Victoria Residential Home 11/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Victoria Residential Home Thursby Road Burnley Lancashire BB10 3AU     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julie Playfer     Date: 1 5 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: The Victoria Residential Home Thursby Road Burnley Lancashire BB10 3AU 01282416475 01282441447 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Victoria Care Homes Limited care home 41 Number of places (if applicable): Under 65 Over 65 0 23 dementia old age, not falling within any other category Additional conditions: 18 0 The home is registered to accommodate up to 18 service users in the category of dementia - DE and 23 service users in the category of older people (aged over 65 years) - OP. Date of last inspection Brief description of the care home The Victoria Residential Home is registered to provide accommodation and personal care for 23 Older People and 18 Older People with a Dementia. The home is a converted hospital with a spacious layout. It is located approximately 2 miles from Burnley town centre and there is a main bus route nearby. There are car-parking facilities at the front of the home and there is a public park directly opposite. Accommodation is provided in 30 single bedrooms and 5 double bedrooms on three floors. There is a passenger lift linking the floors. Seventeen of the single bedrooms and one double room have ensuite facilities comprising of a toilet and wash hand basin. Care Homes for Older People Page 4 of 36 Brief description of the care home The home is split into three units and is staffed accordingly. The ground floor known as the Residential Unit and the second floor unit provide personal care for older people. The first floor provides personal care for older people who have a dementia and this part of the home is known as the Dementia Care Unit. There were no residents accommodated on the second floor. At the time of the inspection the scale of charges ranged from £386.50 to £463.50. Additional charges were made for hairdressing and chiropody. Information was made available to prospective residents in the form of a statement of purpose and service users guide. The service users guide was usually given to relatives and/or prospective residents on viewing the home or at the point of assessment. Previous inspection reports can be viewed in the home or obtained from the Commissions website at www.cqc.org.uk Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: A key unannounced inspection, which included a visit to the home was conducted at The Victoria Residential Home on 14th and 15th April 2009. The first day of the inspection was carried out by one inspector and on the second day the inspector was accompanied by a Local Area Manager. The report refers to we as it was written on behalf of the commission. We last inspected this service on 22nd and 23rd April 2008. At the time of the visit there were 28 residents accommodated in the home. During the inspection we spent time with the residents, looked round the home, read some of the residents care records and other documents and talked to the staff and the responsible individual and the acting manager. We also consulted our records about the service. As part of the inspection process we used case tracking as a means of gathering Care Homes for Older People Page 6 of 36 information. This process allows us to focus on a small group of residents living in the home, to assess the quality of the service provided. Prior to the inspection, the acting manager completed an Annual Quality Assurance Assessment known as AQAA, which is a detailed self assessment questionnaire covering all aspects of the management of the home. This provided us with useful information and evidence for the inspection. Satisfaction questionnaires were sent to the home for distribution to the staff and the residents. Fourteen questionnaires were returned from the staff and six were received from residents. The responses from the questionnaires were collated and used throughout the inspection process. What the care home does well: What has improved since the last inspection? Since the last inspection a brochure had been produced, which included photographs of the home. This provided current and prospective residents with an overview of the services and facilities available in the home. The acting manager had ensured that all prescribed medication had been entered onto the medication administration record, which meant that there was full list of record of the medication given to residents. The cook had taken over responsibility for planning the meals. This arrangement ensured that the residents preferences were incorporated into the main menu. A privacy lock had been fitted to one of the toilet doors on the Dementia Care Unit and the shower had been repaired. Suitable arrangements had been put in place to remove the laundry from the Dementia care Unit, in order to prevent unpleasant odours and the acting manager had carried out an audit of general repairs and maintenance to be carried out around the building. The home had been linked via a computer to the LWDP (Lancashire Workforce Development Plan), which was a live data base on the internet. The system displayed a training record for each member of staff and highlighted when mandatory training was due. This meant the acting manager could use this as a tool for future training. Care Homes for Older People Page 8 of 36 What they could do better: The care plans must include clear information about how the residents health and welfare needs are to be met. Wherever practicable the residents and/or their representative must be consulted following a revision of the care plans. This is to ensure that all the residents and or their representatives are able to participate in the care planning process and the residents needs are met. Some aspects of record keeping must be improved. The medication administration records must be more detailed. This is to ensure staff administer medication in line with the prescribers instructions. The records of food provided must be an accurate reflection of the food eaten by the residents. This is to ensure that each residents diet can be monitored and it can be demonstrated that the residents are served a varied and nutritious diet. A record must be made of all complaints received by a resident or their representative. This is to ensure that all complaints are thoroughly investigated and action is taken as appropriate in order to resolve any concerns. Any prescribed items including nutritional drinks must be clearly labelled and any items no longer required must be returned without delay to the pharmacy. There had been little progress to develop a programme of activities on the Dementia Care Unit, therefore following consultation with the residents an agreed schedule of activities must be developed on the Dementia Care Unit. This is to ensure that the residents have good access to a choice of meaningful leisure pursuits. Staff were not familiar with the safeguarding procedures associated with the protection of vulnerable adults. Hence, all staff must be made aware of and fully understand these procedures. This is to ensure the residents are fully protected from harm. Various rooms throughout the home had been fitted with bolts. These bolts must be removed from all communal rooms and rooms used by the residents. This is to ensure the residents have free access around the home. The furnishings on the Dementia Care Unit must be suitable for purpose. This is to ensure the dignity and comfort of the residents. The baths on the ground floor and first floor must be fitted with appropriate equipment to enable the residents to have bath safely. When recruiting new staff all appropriate records and checks must be obtained in line with legal requirements. This is to ensure the residents are protected and the staff are fully vetted before working in the home. All staff must complete specialist training courses including managing challenging behaviour and supporting people with a dementia. This is to ensure that the residents needs are met. The Responsible Individual must make a monthly report of his unannounced visits to the home. This is to enable the Responsible Individual to demonstrate that he is monitoring the quality of the service provided and is aware of the standard of the premises and any problems or complaints. The Commission must be notified without delay of any occurrence listed in the Regulations. This is so we can monitor events in Care Homes for Older People Page 9 of 36 the home and ensure such incidents are managed appropriately. As the home has been without a registered manager since December 2008. An application must therefore be made to register a suitably experienced and qualified manager with the Commission. This to ensure that a person is registered at home to take legal responsibility for the day to day running and management of home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 36 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents had their needs properly assessed and they were provided with appropriate written information to enable them to make an informed choice about where to live. Evidence: Written information was available for current and prospective residents in the form of a statement of purpose and service users guide. The guide had been distributed to the current residents and was available to view in each bedroom. Whilst some of the information was out of date, following the resignation of the registered manager, the responsible individual explained that he was in the process of updating and improving both the service users guide and the statement of purpose. The summary from the previous inspection report was included in the service users guide and the full report was available for reference purposes in the entrance hall. Since the last inspection, a brochure had been produced to provide the residents with an overview of the home. Care Homes for Older People Page 12 of 36 Evidence: This meant the residents had access to suitable and relevant information about the services and facilities available in the home. The residents who completed a questionnaire indicated that they had received enough information prior to moving into the home. The residents had been issued with written contracts, which included information about the level and payment of fees, their bedroom number and their rights. The contract was easy to read and was presented in a clear format. This meant the residents were aware of the terms and conditions of residence and knew what they could expect from the service. The case tracking process demonstrated that the residents had their needs assessed prior to admission by a social worker and/or the acting manager. The pre admission assessment was carried out at a convenient time and place for the prospective resident, to ensure they had the time and opportunity to participate in the assessment process. Copies of the preadmission assessments seen covered a range of individual needs including personal, social, health and cultural needs. It was evident that admissions were not made to the home in the absence of a full needs assessment. This meant the acting manager and staff had a good level of information about the needs of prospective residents needs before they moved into the home. Following the assessment of needs a letter was sent to prospective residents and their families to confirm that the residents needs could be met in the home. This meant residents could be assured that the home was a suitable place for them to live. The acting manager confirmed that prospective residents were invited to spend as much time as they wished in the home prior to making the decision to move in. This enabled the person to meet other residents and staff and experience life in the home. Following admission, the contract stated that a trial period of eight weeks was offered to every new resident, so both parties could make sure the placement was successful and the residents individual needs could be met. Care Homes for Older People Page 13 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some residents health and personal care needs were not fully monitored and documented, which meant that whilst staff had the best intentions there was sometimes a lack of information and guidance about how to care for the residents in a safe and dignified manner. Evidence: We looked at six residents files in detail as part of the case tracking process. All the files contained a care plan, which was based on the persons assessment of needs. Personal profiles had been incorporated into the care plan documentation, which provided details about past life experiences and important events. However, three of the profiles contained details, which were either out of date or inaccurate. It is important that such information is correct so that staff are aware of the residents current circumstances. The plans were supported by records of personal care, which provided information about changing needs and any recurring difficulties. The records had been made on a daily basis, to ensure staff were provided with ongoing details about the residents well being. Charts had been maintained for personal care and Care Homes for Older People Page 14 of 36 Evidence: hygiene, however, these had not been consistently completed. This meant it was difficult to determine the frequency of some personal care provided to the residents. The plans were easy to understand and included general guidance for staff on how best to meet the residents needs. Whilst the residents or their relatives had signed a care plan agreement form when the care plan was first developed, the relatives spoken to on the dementia care unit could not recall seeing or discussing a care plan. This meant that staff may have been missing important information about the residents ongoing wishes and preferences and the relatives had limited formal opportunities to influence the care of their family member. Written records seen on the residents files demonstrated that the care plans were reviewed each month and some were updated in line with changing needs. However, we noted that one residents plan had not been updated following a significant change in behaviour. This meant that staff were not provided with clear guidance on how to manage any future reoccurence of the behaviour, which in turn resulted in staff being unsure about how best to respond to prevent this behaviour escalating. These difficulties were compounded by a lack of staff training in how to manage challenging behaviour effectively and safely. Further to this, the acting manager explained that this deficit in knowledge and skills had been recognised and arrangements would be made for staff training. Health care needs were considered during the assessment process and there was some information within the various sections of the care plans. Residents had access to health care services and all were registered with a GP. Specialist advice was sought as necessary from health care professionals, such as the District Nursing Team. Chiropody and Optician services visited the home and residents were provided with support to attend hospital and community appointments. This meant that healthcare needs were monitored and action was taken in response to changing conditions. However, there was very limited information about the residents continence needs within the care plan and there were no plans seen to support the residents current level of skills to promote their independence and dignity. In addition, one residents nutritional needs were not closely monitored and despite losing weight, records had not been consistently maintained of this residents weight over the last 12 months. Advice from a Doctor had been sought and dietary supplements had been prescribed, but there was no record of when the supplements had been given. Hence it was not possible to determine whether this residents nutritional needs were being met or not. Risk assessments had been carried out and reviewed. However, risk management strategies had not always been drawn up in order to manage any identified risks in a safe and consistent manner. For instance, there were no details about how one Care Homes for Older People Page 15 of 36 Evidence: resident was assisted to move from her bed to a chair and as mentioned previously there were no strategies drawn up to manage the risks posed by one residents challenging behaviour. The residents spoken to felt the staff respected their rights to privacy and dignity and all made complimentary remarks about the staffs approach, for instance one person said, Theyre all very nice and treat people well and another person said They are caring and helpful. During discussions with staff, they demonstrated an awareness of treating people with respect and considering their dignity when providing personal care. Staff were also observed to encourage choice and help residents maintain their personal routines. However, we observed that many of the female residents on the dementia care unit were not wearing appropriate underwear and were not wearing socks or tights. This situation had the potential to impact significantly on the residents dignity and comfort. In addition, at the time of the inspection, there were no hoists or appropriate lifting equipment fitted in the main bathrooms on the ground and first floor. This meant that the majority of the residents living on the dementia care unit, who were not able to use the shower, had to use either the wet room on the ground floor or the bath on the third floor. As it was not always practicable to move the residents, staff were washing people whilst standing at the hand wash basin. This situation compromised both the residents safety and dignity. Policies and procedures were in place to cover the management of medicines and were available for staff reference in the medication files. The home operated a monitored dosage system of medication, which was dispensed into blister packs by a local Pharmacist. All staff designated to administer medication had received accredited training. Since the last inspection, the acting manager had ensured that all prescribed medication had been entered onto the medication administration record, which meant that there was full list of the medication given to residents. However, we noted that not all information from the prescription labels had been entered onto the medication administration record and there were no procedures seen for the administration of medication prescribed as necessary apart from for pain relief. This information is important so staff administer medication in a safe and consistent manner. We also noticed a large box full of nutritional drinks in the food storage cupboard by the kitchen. Such drinks are usually prescribed. There were no prescription labels on any of the drinks seen and none of the staff on duty had any knowledge about where the drinks had come from, who they were prescribed for and what they were being used for. It is essential that staff are aware of this information as it is illegal to give medication to any other resident other than for whom it was prescribed. Appropriate arrangements were in place for the management of controlled drugs and a random check of the stocks of drugs correspond accurately to records. Care Homes for Older People Page 16 of 36 Care Homes for Older People Page 17 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst residents benefited from flexible routines, the lack of meaningful activities and consultation on the Dementia Care Unit meant that residents were not provided with stimulating environment. Evidence: The daily routines were flexible and were primarily designed to meet the needs of the residents. The residents spoken to said they had a choice in the times they got up and went to bed. One person said, I like going to bed early. The staff were observed to seek the residents views throughout the inspection and the residents spoken to felt comfortable to comment on life in the home. Information about the residents preferences in respect of social activities were recorded and considered as part of the assessment and care planning processes. Activities arranged on the ground floor residential unit had been recorded and included bingo, games and nail care. Some residents also went out shopping to local shops. The residents had discussed their choice of recreational activities at Residents meetings, which were held approximately every four weeks. This meant the residents living on the ground floor were able to express their views and opinions in a formal setting and Care Homes for Older People Page 18 of 36 Evidence: thus influence the type of activities provided. All the residents spoken to including people living on the Dementia Care Unit enjoyed the concerts given by visiting professional singers. There had been little progress to develop a programme of meaningful activities on the Dementia Care Unit. The staff had received no specific training to enable them to develop suitable activities for people with a dementia and therefore lacked expertise in this area. Some activities had been recorded, but we noted that the same residents usually participated in the activities and there were was no evidence seen of individual time spent with residents who didnt want to or were unable to pursue the group activities. The relatives spoken to felt there could be more stimulation for the residents and one person described the Unit as the Forgotten Land. On the first day of the inspection, residents were observed wandering in the corridor or sitting in chairs. In the afternoon, a member of staff put rollers in some of the female residents hair. As there were only two staff on duty, there was limited interaction between the staff and residents. There were no Residents Meetings held on this unit, which meant that the residents had limited opportunities to influence the development of activities. A programme of activities which included monthly outings had been devised for 2008, but one person said that apart from a meal out, he had not been on any other outings out of the home. The residents religious beliefs were recorded during the assessment process and a representative from the Roman Catholic church visited the home weekly for prayers and communion. However, it was unclear how residents of other Christian Denominations were supported to practice their religion. There were no records seen relating to the celebration of Easter on the Dementia Care Unit, although a member of staff said Easter eggs had been purchased. The residents had the opportunity to develop and maintain important personal and family relationships. However, notices were seen restricting visiting times, which some relatives spoken to adhered to. This meant there were limitations placed on when the residents could receive visitors in the home. However, the acting manager explained these restrictions were no longer applicable and took the signs down. According to information in the AQAA, the cook had taken over responsibility for planning the meals, to ensure that residents preferences were Incorporated into the main menu. There was no information about the meals for the forthcoming day on the Dementia Care Unit, which meant that staff were not able to inform the residents about the meals until they arrived from the kitchen. The menu was clearly displayed on a white board in the corridor outside the dining room on the Residential Unit. All Care Homes for Older People Page 19 of 36 Evidence: residents spoken to said that enjoyed the meals, although one person said the meals were sometimes repetitive. The residents were offered a choice of food on the day of inspection. Both meals looked appetising and were well presented. Residents on the Dementia Care Unit were given appropriate support to eat their food. The records of food provided were completed by the cook in the kitchen, however, the cook was not aware of what meals the residents had eaten on the Dementia Care Unit, so the record seen may not have been a true and accurate reflection of the meals served to individual residents. Care Homes for Older People Page 20 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents had access to a clear complaints procedure. However, there was an inconsistent approach to recording and dealing with complaints and safeguarding issues, which meant the residents best interests were not always safeguarded. Evidence: The complaints procedure was included in the statement of purpose and the service users guide. It was also clearly displayed in each bedroom. The procedure contained the necessary information should a resident or their representative wish to raise a concern. The residents spoken to said that they could speak to any member of staff if they had a problem. All the residents who completed a questionnaire indicated they were aware of the complaints procedure. According to records held by the Commission, there had been four complaints made about the service during the last 12 months. There was no overall log of complaints, so it was not possible to determine if any further complaints or concerns had been raised or if there were any emerging themes. Details of three of the complaints were seen in separate files, however, information about a complaint received by the former registered manager from a residents family was not seen. We were therefore not able to assess whether the issues raised had been investigated or what actions were taken as a result of any investigation. Care Homes for Older People Page 21 of 36 Evidence: Policies and procedures were in place in respect to safeguarding vulnerable adults, which included details of the relevant agencies. The acting manager had developed links with external agencies including Social Services and the Commission and had worked with these organisations to resolve safeguarding issues raised. There had been two safeguarding referrals made since the last inspection. Staff spoken to were not familiar with the guidance and had a limited understanding in this area. This lead to inconsistent knowledge and practice about how to respond in the event of an alert. Consequently behaviours displayed by a former resident were not raised with the commission as a safeguarding issue and residents and staff were left at risk until the person moved from the home. Further to this, training on safeguarding procedures had been arranged for all the staff during the week following the inspection. Care Homes for Older People Page 22 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents were provided with spacious living accommodation, however, the lack of suitable bathing equipment had the potential to compromise to the residents dignity and safety. Evidence: The Victoria Residential Home is a converted hospital with a spacious layout. Accommodation is provided on three floors in 30 single bedrooms and 5 double rooms. Seventeen of the single rooms and one double room have an ensuite facility comprising of a toilet and hand wash basin. A large passenger lift provides access to all floors. Communal space is provided in lounges and dining rooms on each floor. All rooms provided sufficient space for the pursuit of recreational activities and the entertainment of visitors. We noted from a tour of the premises that residents had personalised their rooms with their own belongings, which included photographs, ornaments, furniture and televisions. All the residents spoken to said they liked their bedrooms, which they described as comfortable and warm. Since the last inspection, a privacy lock had been fitted to one of the toilet doors on the Dementia Care Unit and the shower had been repaired. Suitable arrangements had Care Homes for Older People Page 23 of 36 Evidence: been put in place to remove the laundry from the Dementia care Unit in the early morning and the acting manager had carried out an audit of general repairs and maintenance to be carried out around the building. As referred to previously, the bath hoists on both the ground and first floor had been removed two months previously, following a routine service. New hoists had been purchased but these had not been fitted at the time of the visit. This meant that the majority of the residents on the Dementia Care Unit who were not able to use the shower had to be assisted to use the wet room on the ground floor or the bath on the third floor. Given the needs of the residents living on this Unit, it was not always possible or practicable to move them in order to use different bathing facilities. Staff were therefore assisting the residents to have a wash whilst standing at the washbasins. This practice was not dignified and had the potential of placing the residents at risk from falling. Some of the arms on the chairs and sofas on the Dementia Care Unit were noticeably stained and some of the chairs were covered in an upholstery, which was not wipeable. This meant that the cushions had to be washed and dryed, which then left the chairs without a cushion to sit on. One relative was concerned about the chipped and scuffed paintwork on the doors and skirting boards. Various rooms throughout the home had been fitted with bolts, this meant that the residents were not able to have free access to all areas and there was the potential for a resident to be inadvertently locked in these rooms. The standard of cleanliness was generally satisfactory throughout the home. There was a designated laundry area in the basement of the building and all equipment was reported to be in good working order. However, the care staff on each unit were carrying out the laundry duties, which took time away from caring for the residents. Care Homes for Older People Page 24 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents were supported by a staff team who knew them well, however, the lack of specialist training in caring for people with a dementia impacted on their ability to fully meet the residents needs. Evidence: A staff duty roster was drawn up four weeks in advance and provided a record of the number of hours worked by the staff in the home. The roster indicated that there was usually three staff allocated to work on each unit and two staff were on waking watch duty on each floor. However, due to staff sickness, there were only two staff on duty on the Dementia Care Unit on the first day of the inspection. This impacted on the level of supervision of the residents and the scope to initiate activities. A checklist was used to track the recruitment records of new staff. We looked at the recruitment records of four members of staff who had been employed within the last 12 months. It was evident that all applicants had completed an application form and had attended the home for a face to face interview. Appropriate Police checks had been obtained prior to employment. However, one person had not provided a full working history along with a satisfactory written explanation of gaps and had commenced work on receipt of one written reference and one verbal reference, rather than two written references. Care Homes for Older People Page 25 of 36 Evidence: Arrangements were in place for all new employees to undertake an in house induction training programme and were encouraged to apply for NVQ training. According to information supplied by the acting manager 13 out of 23 care staff had achieved NVQ level 2 or above. This equated to 57 of the overall staff team. In addition, 2 members of staff were working towards this qualification. This meant that the majority of the staff team had achieved the necessary qualifications associated with caring for older people. All the staff who completed a questionnaire indicated that they were provided with training relevant to their role and all confirmed they met up regularly with the manager to discuss their work in the home. Most of the staff had been employed in the home for sometime and knew the residents well. However, staff spoken to during the inspection identified a need for further training and guidance in relation to caring for people with a dementia and managing challenging behaviour. As such they were not aware of how to develop meaningful activities and how to manage challenging behaviour in a safe and consistent manner. The acting manager agreed that staff required more training and had arranged a meeting with a training provider to discuss staff training needs. Since the last inspection the home had been linked via a computer to the LWDP (Lancashire Workforce Development Plan), which is a live data base on the internet. The system displayed a training record for each member of staff and highlighted when mandatory training was due. This meant the acting manager could use this as a tool to plan for future training. Care Homes for Older People Page 26 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was appropriate information to promote health and safety. However, the current management systems did not always ensure that the best interests of the residents were protected. Evidence: Since the last inspection, the registered manager had resigned and the deputy manager had taken over the role of acting manager. This arrangement was temporary until the Responsible Individual recruited a new manager. The acting manager had completed NVQ level 3 and was working towards NVQ level 4 in Management. Whilst the acting manager had experience of managing the ground floor residential unit, she confirmed she had limited experience and knowledge of caring for people with a dementia. This meant the Dementia Care Unit did not receive effective management oversight. Further to this, the acting manager acknowledged that she was not aware of the level and detail of a former residents behaviour on the Dementia Care Unit, which as mentioned previously, meant that ongoing incidents were not raised with the Care Homes for Older People Page 27 of 36 Evidence: commission as a safeguarding issue. There was a programme in place for staff supervision and the topics discussed during supervision were recorded on a suitable format. The acting manager had a programme in place to provide supervision six times a year. In addition to supervision, senior staff were given the opportunity to attend regular formal staff meetings. However, it was noted that there were no staff meetings held for the care staff and information was disseminated via letters and the senior staff. This meant that the care staff had limited opportunities to share experiences and discuss forthcoming developments. The service had been awarded a post recognition Investors in People Award in October 2007. This is a recognised quality assurance award. The acting manager had continued to monitor the quality of care in the home and had distributed satisfaction questionnaires in January 2009 to residents, their families and the staff. The results had been collated and a development plan had been developed from the outcome of the surveys. Residents meetings were held on a regular basis on the ground floor residential unit, but there were no meetings held for the residents on the Dementia Care Unit. This meant that there was limited formal consultation with the residents living on this unit and they had few opportunities to influence future plans for the home. Appropriate arrangements were in place for handling money, which had been deposited with the home by or on behalf of a resident. A random check of the records and monies deposited on the premises was found to be correct. This meant the residents financial affairs were safeguarded. Apart from one report dating back to May 2008, there were no reports seen of the unannounced visits made by the Responsible Individual. These reports are important so the registered person can clearly demonstrate that he is monitoring the quality of the service provided and is aware of the standard of the premises and any problems or complaints. There was a set of detailed health and safety policies and procedures, which had recently been updated. Staff received health and safety training, which included moving and handling, food hygiene, first aid, fire safety and infection control. Documentation seen during the inspection and information supplied in the AQAA indicated the electrical, gas and fire systems were serviced at regular intervals. The fire log demonstrated that the staff had received instructions about the fire procedures during their induction. Arrangements were in place to record accidents and incidents in the home. However, Care Homes for Older People Page 28 of 36 Evidence: we had not been notified of at least two incidents which had occurred in the home. This meant we were not aware of these incidents or how the occurrences were being managed by the responsible individual and acting manager. As mentioned previously staff were not aware of the safeguarding procedures, which meant that these procedures were not always followed. Care Homes for Older People Page 29 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Wherever practicable the residents and/or their representative must be consulted following a revision of the care plans. This is to ensure the residents and their representatives are able to fully participate in the care planning process and have some influence on the delivery of their care. 15/05/2009 2 8 15 The care plans must include clear information about how the residents needs in respect of their health and welfare are to be met. This includes details about how to meet continence needs and how to manage and respond to behaviour which challenges others and the service. This is to ensure that all the residents needs are met. 15/05/2009 Care Homes for Older People Page 31 of 36 3 9 13 All information from the 15/05/2009 prescription labels must be recorded on the medication administration record and clear procedures must be drawn up for the administration of medication prescribed as necessary. Any prescribed items such as nutritional drinks must clearly labelled and must be returned to pharmacy when they are no longer required. It is illegal to give these items to any other resident other than the resident for whom they were prescribed. This is to ensure staff administer medication safely with legislative requirements. 4 12 16 Following consultation with the residents a programme of activities must be developed on the Dementia Care Unit. This is to ensure that the residents have good access to a choice of meaningful leisure pursuits. 29/05/2009 5 15 17 The records of food provided 15/05/2009 must be an accurate reflection of the food eaten by the residents. This is to ensure that each residents diet can be monitored and it can be demonstrated that the residents are served a varied and nutritious diet. Care Homes for Older People Page 32 of 36 6 16 17 A record must be made of all 15/05/2009 complaints received by a resident or their representative. This is to ensure that all complaints are thoroughly investigated and action is taken as appropriate in order to resolve any concerns. 7 18 13 All staff must be made 15/05/2009 aware of and fully understand the safeguarding procedures. This is to ensure the residents are fully protected from harm. 8 19 12 The bolts must be removed from all communal rooms and rooms used by the residents. This is to ensure that the residents have free access around the home. 15/05/2009 9 20 16 The furnishings on the 15/05/2009 Dementia Care Unit must be suitable for purpose. This is to ensure the dignity and comfort of the residents. 10 22 23 The baths on the ground floor and the first floor must be fitted with appropriate equipment. This is to enable the residents to have bath safely. 29/05/2009 Care Homes for Older People Page 33 of 36 11 37 26 The Responsible Individual 15/05/2009 must make a monthly report of his unannounced visits to the home. This is to enable the Responsible Individual to demonstrate that he is monitoring the quality of the service provided and is aware of the standard of the premises and any problems or complaints. 12 38 37 The Commission must be 15/05/2009 notified without delay of any occurrence listed under Regulation 37. This is so the Commission can monitor events in the home and ensure such incidents are managed appropriately. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 The personal profiles should be updated in line with any changes and person cal care charts should be consistently completed. This is to ensure that staff have access to accurate up to date information at all times. Risk assessments including moving and handling assessments should be supported by risk management strategies. This is to ensure that any identified risks are managed safely and consistently. The residents and/or their representatives must be consulted about their personal preferences about what to wear. This is to ensure that the residents dignity and comfort remain paramount. Residents should consulted to ensure appropriate support is 2 8 3 10 4 12 Care Homes for Older People Page 34 of 36 offered to them to continue to practice their relgious beliefs. 5 13 The visiting arrangements should be clearly explained to relatives, to ensure they are aware they can visit the home at any time convenient for the residents. The menu should be clearly displayed in the dining room in the Dementia Care Unit. This is to inform residents of the forthcoming meal and the choices available. A overall log of complaints should be maintained. This will enable the manager to track complaints and address any emerging themes. Group and individual discussion should be arranged on the Dementia Care Unit. This is to enable the residents to express their views and opinions on the quality of life in the home. 6 15 7 16 8 38 Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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