Inspection on 29/05/07 for Vale House

This inspection was carried out on 29th May 2007.

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

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

Other inspections for this house

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Vale House Vale House Vale Avenue Horwich Bolton BL6 5RE Lead Inspector Judith Stanley Unannounced Inspection 29th May 2007 08:00 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 Vale House DS0000068829.V341123.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. Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Vale House Address Vale House Vale Avenue Horwich Bolton BL6 5RE 01204 699292 01204 699292 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) Vale Residential Limited Mrs Angela Owen Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 15 service users to include: *up to 15 service users in the category of OP (Older People). New registration. Date of last inspection Brief Description of the Service: Vale House care home is registered to offer care and support for 15 older people. The home is a large detached property and is set in own grounds with mature gardens. Car parking is available within the grounds. The home is close to the Horwich and Blackrod town centres and other local amenities and public transport. The home offers five shared rooms and five single rooms; there are no rooms that offer en suite facilities. There are two communal lounges and a separate dining room. Bathrooms and toilets are available on both floors and in close proximity to resident’s accommodation and communal areas. The current scale of fees ranges from £330 to £370. Additional charges are made for hairdressing, newspapers and for private chiropody. Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection of Vale House took place on 29 May 2007 and included a site visit. The home did not know that the inspection was due to take place. One inspector carried out the inspection from 08.00 am until 3.00pm. The inspector looked at records the home holds on residents (care plans) and other records the home needs to keep to ensure that the home is being run properly. The inspector looked around the home alone and with the home’s manager and the companies business manager also accompanied the inspector to check certain areas of the home. To find out more about the home the inspector spoke with two residents and three visitors. The manager and care staff were spoken with throughout the course of the inspection. Comments cards, asking residents and relatives what they thought about the home and the care provided were sent out at the time of the inspection. There has been no returned residents comment cards, four relatives and one doctor have returned comment cards. The doctor is generally satisfied with the care his patients receive and states, “ The manager is quite efficient and does respond to any criticisms/problems when discussed”. However, comments made to him from relatives mention, that some of the care staff could be more attentive to the needs of patients e.g. toileting etc. One relative said, “They are always friendly and if I have any problems I go straight to the manager and get it is sorted. I think it would be nice if part of the garden were fenced off so residents could sit out and still be safe. It was mentioned before the new owners took over. I also think as relatives we should have meetings with the staff every so often so that if we have a problems or any concerns we can air our views to management and staff”. Another relative states, “ I would like to see more staff in the home, they all work very well but don’t seem to get breaks properly”. One relative was complementary about the food served, stating, “ The meals always look good and the cook always makes nice home made cakes.” However further comments were made about the environment looking tired and that the home wants bringing up to date. The relative said, “In three years all that’s been done is the walls in the dining room have had a coat of emulsion. Hopefully now the new owners have taken over some improvements will be made. They did say that fencing was being put up around the garden, but nothing has been done”. I think it would be good to have meetings with the new owners about every six weeks, we used to have them before”. One relative said about the home. “ The staff are very nice and caring, but there are not always enough staff on duty”. A resident when speaking with the inspector also reiterated this comment. Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 6 The manager said there had been one complaint made to the home regarding oral healthcare. This was suitably addressed by the manager and the outcome documented. No complaints about the running of the home had been made to CSCI. It has been brought to the attention of the CSCI that Bolton Social Services had been contacted about an alleged incident that had recently occurred, which included issues of care practice and medication issues. This is currently being investigated under the Protection of Vulnerable Adults. The CSCI pharmacist inspector had been asked to visit the home to check all the medication and practices within the home. This visit took place on 23 May 2007. A total of 5 immediate requirements were made at the end of the inspection. Immediate requirements are something that the home must to quickly or inform the CSCI within 48 hours of how and when they will be addressed. The five immediate requirements include: - Copies of the Regulation 26 monthly visits must be on site and available for inspection. - A copy of the Service User Guide and the Statement of Purpose must be available to all residents, prospective residents and available - for inspection. - The home is in need of redecoration and refurbishment including the renewal of the dining room furniture, the dining room carpet which is a potential tripping hazard to residents and staff. - To comply with the outstanding requirements from the Fire Safety Officer (April 2006). - To ensure that sufficient numbers of staff are on duty at all times to care for the residents, which precludes them from domestic duties, i.e. washing up after meals and preparing and cooking the tea. What the service does well: The home provides different lounge areas for residents to have a choice as to where they sit and with whom they choose to spend time with. Visitors are welcome at any time and made to feel welcome by staff when visiting relatives and friends, and are offered refreshments on arrival. Staff at all levels had taken part in training to update their knowledge and skills. Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The home must have a Statement of Purpose and a Service User Guide; to ensure that current information is there to help residents and their relatives to make a proper choice about the home and what it offers. The home’s manager must act on the requirements and recommendations made the pharmacist inspector following her visit on 23 May 07. (A separate report has been sent to the registered provider and to the home). The homes manager and staff must ensure there is a plan that delivers a wide, fulfilling range of activities that are appropriate and to suit the capabilities of the residents. The daily menus must be displayed in a suitable format for residents with the alternatives to the main meal clearly shown. The overall appearance of the home is ‘tired and shabby’ looking. The décor is old fashioned and the paintwork is chipped and scuffed. The dining room furniture needs replacing, the carpet in the dining room is rucked and in one area the seams have come apart. This is unsafe for residents who could trip up and hurt themselves. The lounges are in need of decorating and chairs are old and scratched and in need of replacing. There areas of the home for example the moulding on walls and above the picture rails that need to be cleaned. This would not be safe for the cleaner to reach, as it is very high and requires outside cleaners with appropriate equipment to deal with this. The downstairs bathroom is of a domestic style, therefore is not accessible for residents to get in and out of safely. The bath needs to be fitted with a suitable hoist or bath aid to allow residents in the rooms downstairs to be able to bathe in a bath closest to their own room. Attention is required to the refurbishment of bedrooms. The curtains in one resident’s room are hanging off the rail. The commodes in rooms are old and some were broken, residents would benefit with these being replaced with Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 8 more modern type commodes that look more like a chair than a toilet and would the room less cluttered. Divans /mattresses need to be replaced as these were seen in most rooms to be shabby or stained. The kitchen floor requires attention as it is lifting particularly in one area and will harbour bacteria. The home must comply with the outstanding requirements made at the Fire Safety Officers last inspection of April 2006. Whilst the gardens at the home are very pleasant, consideration needs to be given to a safe area for residents to be able to access when they chose as currently residents could be at risk for cars coming in to the grounds and that residents could, if unaccompanied wander out on to the main road. The cupboard door in the kitchen next to the oven is badly scorched and apart from looking unsightly, the inspector had concerns of how this had happened and could this be a fire risk. The manager must ensure that there are an adequate number of staff on duty at all times to ensure the needs of the residents can be met. There must be at least two staff covering the floor at all time and not cooking and washing up after meals. The kitchen staff hours need to be reviewed to ensure it’s the resident’s needs that are being met and not those of the staff. The homes quality assurance systems need to be improved to show that the home is being run in the best interests of the residents. The registered provider or an appointed person of the company must visit the home monthly and produce a written report on his finding. The manager must ensure that staff have the knowledge of how to deal with accidents and health emergencies, and that there is always a qualified first aider is on duty The manager is asked to check that in the interest of health and safety that staff wear appropriate footwear, for example a full shoe. 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. Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 9 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 Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 10 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 and 3 were assessed. Standard 6 does not apply, as the home does not provide intermediate care. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had no Statement of Purpose or Service User Guide, therefore there is no information to offer prospective residents, their supporters and residents already living at the home to inform them of how the home can meet their needs and what facilities are available. Pre admission assessments are carried out in such a way as to ensure the care needs of the prospective resident can be met. EVIDENCE: A Statement of Purpose and a Service User Guide was not available for inspection. The new owner took over the registration of Vale House in February 07 and these documents should be readily available within the home and to Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 11 offer prospective residents. An immediate requirement was made regarding this lack of information. The manager, prior to any new resident moving into the home carries out pre admission assessments. The assessment is carried out at the most convenient place for the prospective resident, either in their own home or at hospital or at Vale House. The assessment covers, residents general well being, skin tact, mobility, history of falls, medical care, nutrition, use of bathing equipment, foot care, sight etc. The purpose of the assessment is to ensure that the home and staff can meet the individual needs of the residents and forms the base line for the drawing up of the care plan. The inspector looked at three care plans and there was evidence to show that pre assessments had been carried out. Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 12 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plans are satisfactory and provide staff with the information they need to meet the resident’s needs. There are some areas in the medication system that need to be improved ensuring that all medication procedures and practices are adhered to and the safety of the residents is protected. EVIDENCE: Three care plans were chosen for inspection. The plans contained satisfactory information to inform staff of the individuals care needs. The information includes personal needs and support, physical well being, diet and known allergies, sight, hearing, mental and cognitive state, medication needs, social interests, personal safety, family involvement, oral care, foot care, falls and continence. The resident’s daily routine is also recorded, for example, what Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 13 time they like to get up, what they like to do in the afternoon and in the evening. Daily progress notes were also maintained. In the three files inspected there was no social profile, which provides staff with information about the residents life experiences, such as where they went to school, first job, family and grandchildren etc. Two of the files examined showed that the home was waiting for information from the family. Where possible the resident would be the best person to ask. In the third file there was no information, however when the inspector discussed this with the manager, the manager confirmed the resident gets very upset when talking about his past. This information is equally important to alert staff to be tactful when speaking with this resident and this information should be documented to avoid any distress. On checking other care plans a social profile was included. The care plans had been updated monthly as required, however, there needs to be evidence that demonstrates that the resident and/or their supporters had been or have continued to be involved in the drawing up and maintaining of the care plan. There was evidence to demonstrate that the home works along side other agencies, for example the district nurse team, chiropodist, and the continence advisor. One resident who is mainly cared for in bed at the time of the inspection was seen to have the right equipment including a pressure-relieving mattress to help prevent any pressure areas developing. It was discussed with the manager about the use of turning charts and nutritional charts and the manager confirmed these were not required at this time, but would act on any advice given by the district nurse. The medication was inspected on 23 May 2007 by the CSCI pharmacist inspector prior to this key inspection. The inspector found the systems for dealing with the medication to be adequate. A full report has been submitted to the home. The main areas of where the home needs to improve are: - All medication must be given and recorded as directed by the prescriber. The dose of each preparation must be clearly recorded so that staff can administer the medication safely. - Accurate records of medication received into and disposed of by the service must be maintained in order to account for all medication. - There must be an effective system in place to audit medicines management within the service in order to ensure that people who use this service are receiving the correct medication. - There must be adequate supplies of all medication available for each resident. - Medication should only be administered by trained staff who have been assessed as competent to perform the task. Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 14 - Verbal dose changes should be clearly recorded and confirmed in writing by prescriber where possible. Staff were heard speaking with residents in a respectful and friendly manner, it appeared that good relationships had been formed between them. Residents were seen to be clean and well -groomed ladies had had their hair done and gentlemen were clean-shaven. Resident’s clothes were nicely washed and ironed. Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 15 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, 13, 14 and 15 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not plan and provide a wide and varied range of activities to meet the capabilities and expectations of the residents living at the home. The meals served at the home are satisfactory, however some of the meals need to be reviewed to ensure their nutritional value and that they are well balanced. EVIDENCE: During discussion with the homes manager it was apparent that activities is an area that needs to be improved. The manager said that these are carried out on a more ad hoc basis than properly planned. The home has an activities coordinator who needs to plan and develop more structured activities indoors and include some trips out of the home. The manager said the activities including dominoes, bingo, one-to-chats, reading the newspaper, painting and that someone comes in the home to do gentle keep fit exercises. On the day of the inspection there was no evidence of any activities taking place and there Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 16 was not enough staff on duty to be able to carry any out. There was no recording to evidence that any activities had taken place and which residents had been involved and if whether or not if they had enjoyed the activity. The home has no restrictions on visiting times and when visitors to the home were spoken with said that they were always made welcome and that the staff were very friendly and brought them refreshments. Residents spoken with said they could get up when they wanted and went to bed when they were ready. One gentlemen spent a lot of time in his room, the resident said, I like the peace and quiet and enjoy reading my bible”. The inspector asked if the resident would like to attend church, the resident said he would and he knew that staff would help him get there, but at this time he did not feel well enough to go. The menus were available for inspection. Meals are planned on a four-week cycle. On examination of the menus the inspector noted in the main the lunchtime meals were satisfactory and offered a wide variety. The teatime menus need to be reviewed. It appears that meals of convenience are offered as staff are expected to cook the tea, for example potato cakes and fruit cocktail with carnation for tea is not sufficient. Potato cakes would be better served with something else or offered at suppertime. On one weeks menu residents are offered turkey drummers and beans. Apart from the inspector questioning whether this is the sort of food people of this age group would chose to eat, residents had been offered turkey salad the day before. On another week residents are offered at least six courses made with pastry, and on one day for tea is sausage roll and peas, followed by mince tarts (both pastry) and on two days running baked beans are offered as an accompaniment. The menus state that a cooked breakfast is available on request and that an alternative to the main meal is available. Residents should be made fully aware of the alternatives and should be asked if they would like a cooked breakfast and what they would like for lunch. The full days menus including alternatives should be clearly displayed. On the day of the inspection the cook was making turkey casserole in a leek sauce, with potato wedges and peas and sweet corn followed by lemon mousse. The meal was nicely presented and portions were of a good size. Residents spoken with after lunch said they had enjoyed the meal. One resident, of his own accord follows a strict diet and will not eat protein and carbohydrates together. The cook ensures that the resident’s wishes are Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 17 adhered to and alternatives are available. The resident has also written his teatime menu, which all staff are aware of and make sure the resident gets his choice of food. The inspector spoke with the resident who confirmed he got the diet of his choice. Staff were seen sitting and assisting those residents who required help in a discreet and sensitive manner. An immediate requirement was made regarding the dining room. Residents should able to dine in a congenial setting. Currently the standard of décor is poor, the tables are scratched and worn and in need of replacing, the dining chairs do not match and some are office chairs, all chairs must be replaced to provide appropriate seating. The dining room carpet needs replacing as it is rucked and could be dangerous to residents, especially those using a zimmer frame and in one area the seams have come apart. It was discussed with the manager that the time lunch is served was too early. Lunch is served at 11.45 am. The cook does not serve out the lunch, a carer does. This allows the cook to clean up and finish her shift. The cook’s hours need to be reviewed to allow her time to serve out the lunch and not have staff in the kitchen that have been providing personal care. Staff are expected to cook and serve the teatime meal and wash the dishes. As there are only two members of staff on duty this practice leaves the floor being covered by one person. This practice must cease and there must be at least two members of staff covering the floor at all times. It was discussed with the manager and the business manager that it would be better if a third person came on duty earlier to cook and serve the meal before going out on the floor providing care. An immediate requirement was made about there being sufficient staffing levels. The inspector discussed with the manager and the business manager about the flooring in the kitchen, which appeared to be lifting at one side. This requires attention, as it will harbour bacteria. It was also noted that the cupboard door next to the oven is badly scorched; this needs replacing. The inspector has concerns as to how this is happening and checks need to be made to decide if the cooker is safe or if the cupboard next to the oven a fire hazard. Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 18 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 and 18 were assessed Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure in place to ensure that any complaints or concerns are acted upon. Staff are competent to detect and refer on potential abuse in order to protect residents. EVIDENCE: The home has a satisfactory complaints procedure in place. The complaints file was examined to find that only one complaint had been made to the manager of the home and this was about the loss of a resident’s dentures. The manager promptly dealt with the issue and corresponded with the complainant. The CSCI has not received any formal complaints. Most staff have undertaken training in the protection of vulnerable adults. The home has a copy of the vulnerable adults procedures for Bolton Council available in the office. Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 19 It has been brought to the attention of the CSCI that Bolton Social Services had been contacted about an alleged incident that had recently occurred, which included issues of care practice and medication issues. This is currently being investigated under the Protection of Vulnerable Adults. Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 20 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, 21, 24 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The standard of décor within the home is poor in places, with little evidence of improvement through maintenance. Infection control procedures need to be reviewed to ensure the residents are protected from the risk of infection. EVIDENCE: Vale House has recently been registered with a new owner approximately three months ago and has inherited several outstanding issues from the previous owner. Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 21 It has been discussed on numerous occasions that the home is ‘shabby and tired’. There has been no financial input into decorating and refurbishment for a number of years. The lounges are in need of decorating and new chairs and occasional tables are required. The dining room as previously stated needs new furniture, a new carpet and decorating. The paintwork mainly downstairs is scuffed and chipped and requires attention. There needs to be a rolling programme for the decorating of bedrooms and refurbishment of fittings. The chairs in several bedrooms are in need of replacing as do the old fashioned commodes. The mattress/divans in some bedrooms were stained and old and need to be replaced. In one room the curtains were hanging off the rail. Rooms were clean and tidy, however as the building is old and has high ceilings that the cleaner cannot or should not be expected to reach, the mouldings and picture rails that are in need of cleaning. The business manager agreed that the company’s maintenance team would address this. The home has two bathrooms, however the downstairs bathroom cannot be used as there is no hoist or bath aid to help residents get in and out the bath safely. Residents should be able to bathe in a bathroom of their choice and preferably in the one nearest to their own room. There is a bath on the first floor with a suitable hoist. The bedrooms as stated were clean but in need of modernising. It was evident that residents had been encouraged to personalise their rooms with belongings brought with them from home and with photographs and mementoes. It was noted that in one room in particular that the electric sockets were not suitably fitted; this requires attention. A qualified electrician must check all extra sockets. In rooms that are shared, a curtain across the room provides some privacy for residents. Infection control procedures need to be reviewed. Staff were seen wearing different aprons and gloves for different tasks. However the practice of staff going in to the kitchen to prepare and cook meals after providing personal care in the same uniform does not promote good hygiene procedures. Throughout the home there was no offensive odours detected. The laundry is sited away from food preparation and food storage areas and does not intrude on the residents. Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 22 The outside grounds of the home were tidy and the home looked externally well maintained. Consideration should be given to making parts of the grounds a safe area for residents to sit or walk around in. The porch leading into the home had recently been decorated and looked clean and bright. Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 23 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): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager must ensure that there are sufficient numbers of staff on duty at all times to meet the needs of the residents living at the home. EVIDENCE: On the morning of the inspection there were sufficient staff on duty. The duty rosters indicted that the home had enough staff on duty, including the manager, the cook and domestic. The problem occurs in the afternoons when only two carers are on duty. Currently care staff are expected to prepare and cook the teatime meal. This practice must stop and a cook or a carer (who has not provided personal care) must be available to cook the teatime meal. There must always be two carers working the floor to ensure that the residents are being properly cared for. The dependency levels of some of the residents appeared high. There was one resident who up to recently has been bedfast and some residents need two staff to assist them to the toilet. Only one member of staff covering the floor is potentially placing residents at risk. An immediate requirement was made for the manager and business manager to ensure that staffing levels are maintained. Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 24 It was also discussed that in the absence of the manager and the deputy that a nominated senior carer must be responsible for taking charge of the home and be able to deal with the day-to-day running of the home, this includes the night shift. Both a resident and a relative brought insufficient staffing levels to the attention of the inspector. Not all staff had completed first aid training; there must be a suitably qualified first aider on each shift including nights. Staff training is progressing well. The home is just under the 50 mark of having staff trained to NVQ level 2. Nine staff had done training in medication, the manager and four staff hold a current first aid certificate, apart from two new starters all staff have completed moving and handling and protection of vulnerable adults training. Most staff have completed basic food hygiene training and those staff who have not have enrolled on a distant learning course. All staff have watched a fire safety video and further fire training is planned for July 07. Two staff files were chosen for inspection. Both had a written application form, 2 written references and Criminal Records Bureau disclosure numbers were recorded. In one file there was no other form of identification. Staff inductions had been completed. Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 25 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): 31,33,35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is suitably experienced to manage the home and ensure the needs of the residents are met. Residents and staff can be sure that their health, safety and welfare will be promoted and protected. EVIDENCE: The home’s manager has a significant number of years experience in working with elderly people and has regularly updated her skills and knowledge. The manager has recently completed the Registered Managers award and is waiting for her certificate. Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 26 The way in which the home is managed is open and transparent. The manager operates an ‘open door’ policy so that she may be approached at any time by staff or residents or their families. The office is organised so that staff have access to all the paperwork and contact information they need during the shift. There is no administrative support provided to the home, other than the companies’ main office. The systems for continuous self-monitoring of the services within the home needs to be improved. The manager has recently sent out satisfaction questionnaires and in the main the responses were positive. The manager should make available the results of any surveys to all interested parties. Consideration needs to be given for residents and relatives meetings to be held on a regular basis. Staff meetings are held, the last on being 25 April 07. The registered provider must ensure that he or an appointee of the company carries out the monthly monitoring visits as required and ensure that a copy of his findings are on site and available for inspection. An immediate requirement was made regarding the monthly visits. Some of the residents living at the home have handed over the responsibility for their financial affairs to their families but keep a small amount of money with the manager for safekeeping. A sample of residents’ monies was checked and found to be in order and matching the written record. Records kept and required by regulation were satisfactory and were kept up to date. The records show that staff are trained in safe working practices and that training is updated at regular intervals. Equipment and systems used in the home are serviced and maintained and records and certificates were available to verify this. A random check of showed that the following checks have taken place for: Gas: 18/ 07/06 Lift: 25/05/07 Fire equipment: 08/09/06 Nurse call, fire alarms and emergency lighting: 19/01/07 Electrics 25/01/07 Legionella and water testing: 11/06 Environmental Health: 01/06 Any accidents, injuries and incidents are properly recorded in the homes accident book. The inspector queried that the CSCI had not been made aware of some recent accidents. The manager assured the inspector that the accidents had been faxed to CSCI, however these appear not to have reached Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 27 the intended person and could have been misplaced when the CSCI moved offices. Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 28 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 1 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 1 x 2 x x 2 x 2 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 3 x 2 x 3 x x 3 Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? New registration 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 OP1 Regulation 4 (1) Requirement Timescale for action 29/06/07 2 OP1 5 3 OP12 16 (2) (n) 4 OP19 23 (2) (d) The registered person must compile in relation to the care home a Statement of Purpose, which shall consist of the aims and objectives of the home, the facilities provided by the home and matters listed in Schedule 1 of the Care Homes Regulations 2001. The registered person must 29/06/07 produce a Services User Guide detailing all matters listed in Schedule 1 of the Care Homes Regulations 2001. The registered person must, 29/06/07 having regard to the size of the care home and need of the service users, and consult with the service users about the programme of activities arranged by on behalf of the care home and provide facilities for recreation including, having regard to the needs of the service users, activities in relation to recreation, fitness and training. The registered person must, 31/05/07 having regard to the size of the DS0000068829.V341123.R01.S.doc Version 5.2 Vale House Page 30 care home and the number and needs of the service users ensure that, all parts of the care home are kept clean and reasonably decorated. Specifically: a) an assessment of the whole of the premises must be undertaken in respect of painting and decorating required, with a plan of works be provided to the CSCI with 48 hours of the inspection . (plan of work received within the timescale given) 5 OP19 23 (4) (a) ( c ) ( 1) The registered person must after consultation with the fire and rescue authority take adequate precautions against the risk of fire, and for detecting and containing fires. (Outstanding requirement from the fire officers visit in April 2006) The registered person shall ensure that external grounds which are suitable for, and safe for use by, service users are provided and appropriately maintained. The registered person shall ensure suitable adaptations are made, and such support, equipment and facilities. Specifically: With regard to a suitable hoist or appropriate bath aid in the downstairs bathroom. The registered person must having regard to the size of the care home and the number and needs of the service users – ensure that at all times suitably qualified, competent, and experienced staff are working at the care home in such numbers as are appropriate for the health DS0000068829.V341123.R01.S.doc 31/08/07 6 OP19 23 (2) (o) 31/08/07 7 OP21 23 (2) (n) 31/08/07 8 OP27 18 (1) (a) 29/06/07 Vale House Version 5.2 Page 31 9 OP33 26 and welfare of the service users; Specifically; With regard to care staff having to cook and prepare meals leaving the residents at potential risk of harm. The registered person or an 29/06/07 employee of the organisation must visit the home at least once a month and prepare a written report on the conduct of the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations The registered person should ensure all residents’ interests are recorded and they are given the opportunity for stimulation through leisure and recreational activities inside and outside the home to suit their needs. The registered person should ensure all residents know what activities are on offer. The registered person should ensure all residents are offered three full meals a day. The teatime menus should be reviewed to offer residents less convenience foods. The registered person should ensure all residents are provided with details of the menus each day in writing or verbally. The registered person should ensure that residents are offered and are aware of the choices at mealtimes. The registered person should ensure that all residents are provided with supportive, suitable and comfortable seating at the dining tables. The registered person should ensure that enough plug sockets are suitably fitted in resident’s rooms. The registered person should ensure that staff providing personal care are not expected to work in the kitchen in the same uniform. The registered person must ensure that copies of quality assurance questionnaires are published. DS0000068829.V341123.R01.S.doc Version 5.2 Page 32 2 3 4 5 6 7 8 9 OP12 OP15 OP15 OP15 OP15 OP24 OP26 OP33 Vale House 10 11 OP33 OP38 The registered person shall ensure external stakeholders are consulted about how the home meets the residents’ needs. The registered person should ensure that all staff wear appropriate footwear. Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 © 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 Vale House DS0000068829.V341123.R01.S.doc Version 5.2 Page 34 - 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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