Inspection on 03/05/05 for Vallance Rest Home

This inspection was carried out on 3rd May 2005.

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

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

Other inspections for this house

Vallance Rest Home 16/10/07

Vallance Rest Home 11/05/06

Vallance Rest Home 25/11/05

Vallance Rest Home 07/10/04

Vallance Rest Home 18/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Vallance Rest Home 7/9 Vallance Road Hove East Sussex BN3 2DA Lead Inspector Jane Jewell Unannounced 3rd May 2005 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 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. Vallance Rest Home H59-H10 S14259 Vallance Rest Home v220058 030505 stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Vallance Rest Home Address 7/9 Vallance Road, Hove, East Sussex, BN3 2DA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01273 326053 Vallance Organisation Ltd Mrs Maria Mirza Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (OP), 19 of places Vallance Rest Home H59-H10 S14259 Vallance Rest Home v220058 030505 stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1. The number of service users accommodated must not exceed nineteen (19). 2. The service users accommodated must be aged sixty-five (65) years or over on admission. Date of last inspection 7th & 12th October 2004 Brief Description of the Service: Vallance Rest Home is a privately owned residential home, which has been owned and managed by the same family since 1980. The home is registered for up to nineteen older people over the age of 65 years. The premises consist of two Victorian houses converted into one. The home is presented across two floors ground and first floor, with access to the first floor via chair lifts or stairs. Resident accommodation consists of eleven single and four shared bedrooms with three bedrooms having an ensuite. Communal facilities including two interlinked lounges and a dinning room. There is a small rear garden with the front mainly paved to provide some off road parking. The home is located within walking distance of Hove sea front, Hove local amenities and bus routes into Brighton. The homes literature describes the homes overall wish is to provide a comfortable and secure home where residents independence and dignity is maintained and wishes are respected. The owners are active members of the Registered Care Homes Association (RCHA) and the National Care Homes Association. Vallance Rest Home H59-H10 S14259 Vallance Rest Home v220058 030505 stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection, which took place in order to establish the progress made towards meeting the significant number of outstanding requirements made from previous visits to the home. Two additional visits have been made by the inspectors to the home since the last inspection and two visit made by a pharmacy inspector. The inspection was undertaken by two Regulation Inspectors and took place between 10am and 5pm. There were eighteen residents residing at the home on that day. The inspection involved a tour of the premises, examination of the homes records, discussion with management, and consultation with five staff on duty, thirteen residents and one relative. In addition twenty-five feedback cards were received prior to the inspection which had been completed as part of the homes quality assurance programme. In order that a balanced and thorough view of the home is obtained, this inspection report should to be read in conjunction with the previous inspection reports. The Inspector would like to thank the residents, staff and management for their assistance during the inspection. What the service does well: What has improved since the last inspection? The manager has made significant progress towards meeting the number of outstanding requirements and has improved their working knowledge of the current legislation and is developing a fuller range of administrative skills. This Vallance Rest Home H59-H10 S14259 Vallance Rest Home v220058 030505 stage 4.doc Version 1.20 Page 6 has improved practices at the home and the quality of life for those living there. Medication practices continue to improve to enable a safer system of medication administration. The procedures for the recruitment of staff are more robust and provide the necessary safeguards to protection residents. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Vallance Rest Home H59-H10 S14259 Vallance Rest Home v220058 030505 stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Vallance Rest Home H59-H10 S14259 Vallance Rest Home v220058 030505 stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3 and 4 Prospective residents have the information they need to help make an informed choice about the home. The staff have a good understanding of resident support needs. This is evident from the positive relationship, which have been formed between the staff and residents. EVIDENCE: The manager was previously required to update the homes statement of purpose to include all areas listed in the National Minimum Standards. This was completed during the inspection. The manager reported that a variety of information including the Statement of Purpose, Service Users Guide and the homes brochure is provided upon request to any interested parties and current residents. These documents contain clear basic information on the services and facilities at the home. Residents are provided with a written statement of terms and condition with a signed copy maintained in resident’s files. For new admissions to the home contracts had not yet been signed. The manager stated that the residents and their representative had been verbally informed of the terms and conditions in the interim. Vallance Rest Home H59-H10 S14259 Vallance Rest Home v220058 030505 stage 4.doc Version 1.20 Page 9 Documents were examined relating to two recent admissions, these showed that copies of social services needs assessments were obtained prior to admission. The manager reported that she also visited both residents at their previous location in order to assess them. Although notes were taken during these visits these were not available in the individual’s documentation to evidence the home’s capacity to meet their needs. It is recommended that a written format for the assessment of prospective residents be developed in line with the homes admission criteria and that of the National Minimum Standards. There is a range of needs amongst residents including some who have high dependency needs. The home is working closely with a variety of health care professionals to support these placements. To further support this there remains a need for staff to undergo specialist training in Alzheimer’s and dementia. Residents looked relaxed and comfortable in their environment and continue to speak positively about the care they received with particular reference to the food and the friendliness of some staff. Through observation and improvements to the care planning process it is clearer that the home is meeting the needs of most residents. Vallance Rest Home H59-H10 S14259 Vallance Rest Home v220058 030505 stage 4.doc Version 1.20 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and 10 Care planning continues to improve with resident’s health, personal and social care needs set out in the individual plan of care. Some improvements have been made to the management of medication since previous visits. However, further work is still needed to ensure that a safe system of medication administration is operated. EVIDENCE: Four Individual plans of care were inspected and were found to be sufficiently detailed, up to date, and contained information to support staff to meet the needs of residents. Care plans showed evidence of being reviewed on a monthly basis. The standard of daily recording was noted to be good with a clear account of actions and events that had occurred. In line with previous recommendations shift leaders now sign the daily notes to indicate that they are aware of information handed over to them. Very few residents consulted were aware of their care plan or felt that they had been actively involved in their development or review, despite most care plans being signed by the individual. Some residents stated that they were not interested in being involved in their care plan where others wanted to know what was written about them. All stated however that they felt their care needs were being addressed by staff in ways that ensured that their privacy Vallance Rest Home H59-H10 S14259 Vallance Rest Home v220058 030505 stage 4.doc Version 1.20 Page 11 and dignity was respected. In order to ensure that residents are active participants in the planning their care the manager has been required to ensure that residents are consulted regarding the development and review of their care plan and are notified of any revision to the plan. Personal care information was displayed which did not promote the privacy or dignity of residents. The manager was immediately required to address this. In line with previous requirements personal risk assessments have been undertaken on each residents. These provide basic information on the risks faced and posed and the actions needed to manage identified risks. All residents consulted indicated the way in which there health needs were being met by the home. The home works closely with health care professionals including GP’s, District nurses, chiropodists, opticians and dentists to ensure residents receive the necessary health care intervention and support. To address the major shortfalls in medication practices noted during previous visits the manager has recently changed the system of medication administration and supply pharmacy. Although still in the early stages of implementation not all of the previously made requirements and recommendations were assessed as being fully met. Those that remain outstanding include: • To maintain controlled drugs records in accordance with the Misuse of Drugs Act 1971 and it’s regulations 1973. • That a record is maintained each time medication is administered to a resident. • That additional instructions are provided for staff on the administration of “As required” or PRN medication. • That a policy be developed on medicine key management. Improvements made to the medication practices include staff training, increased lighting by the medication cupboard, changes to nighttime medication practices and records of medication disposed off. Vallance Rest Home H59-H10 S14259 Vallance Rest Home v220058 030505 stage 4.doc Version 1.20 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13,14 and 15 The home provides a gently and quiet lifestyle which suited the current residents accommodated. Some flexibility in the routines of daily living was noted. Further review of the catering arrangements are needed to ensure that choice is promoted and food safety practices are adhered to. EVIDENCE: The majority of residents stated that they felt they had some choice regarding their daily lives, including times for bathing, bed and rising. Residents consistently spoke of a quiet and contented life at the home. Residents consulted stated that their visitors can visit at any time and that they are made to feel welcome and offered hot drinks. Staff are employed three afternoons per week to undertake organised activities. Residents stated that this includes gentle exercises and bingo. Staff and residents have recently helped celebrate a residents birthday, at a nearby pub. Some residents prefer to occupy their own time and remain in their own bedrooms and do not participate in organised events and staff respected this. A new cook has recently been employed who undertook food safety training four years ago. They were reminded of the need to update this training in line with food safety guidelines. The meal served on the day of inspection did not correspond to the menu displayed. None of the residents consulted were aware Vallance Rest Home H59-H10 S14259 Vallance Rest Home v220058 030505 stage 4.doc Version 1.20 Page 13 of the change or the choices available at meal times. It was previously recommended that the day’s menu be displayed rather than the week’s menu, which for some residents would be hard to understand, this had not been undertaken. It was also discussed with the cook that they needed to include on the menu a list of alternative choices to help residents know what choices are available. The majority of residents consulted stated that they enjoyed the food although one resident did not feel that the food was suitable for his medical condition. Although the cook has considerable catering experience they stated that they did not have any training and would not be aware of the different types of diets required. It is recommended that training be provided on the catering needs of older people and advice sought from a nutritionist on this individuals needs. Although a record of food served is kept during the week, this has not been continued when the cook is off duty. The kitchen is small and since the previous inspection has undergone some refurbishment including the fitting of a dishwasher, replacement of work surfaces and wall coverings. The manager reported that previously made requirement of a join in the kitchen floor needing re-sealing was about to be addressed. In general the kitchen was noted to be clean. It was previously recommended that a cleaning schedule be made available to kitchen staff. A cleaning schedule was made available to the inspectors but had not been completed and staff were not aware of its existence. Not all records required for be kept for the promotion of food safety are being maintained and up to date in line with previous requirements made. It was previously required that staff entering the kitchen area must wear appropriate protective clothing. Staff were observed not complying with this nor were they wearing different clothing when serving meals to clothing worn when undertaking personal care tasks. A small laundry store/ironing cupboard is located off the kitchen and the inspectors were assured that no dirty laundry is carried through the kitchen area. The dinning room forms part of the corridor between the two houses and does not have the capacity to seat all residents at once, in comfort. In addition a small dinning table has been set up in the lounge. Several residents have chosen to eat their meals in their bedroom. Vallance Rest Home H59-H10 S14259 Vallance Rest Home v220058 030505 stage 4.doc Version 1.20 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 There is a formal complaints procedure in place with residents feeling confident to approach some staff with any concerns or complaints. Systems and practices have improved in relation to the protection of vulnerable adults. EVIDENCE: The complaints procedure is displayed within the home and contained within the homes literature. There have been no recorded complaints made to the home. The manager reported that in the event of a complaint then the homes complaints procedure would be followed including a record of the outcome. Residents stated that they felt confident to approach some staff with any concerns or complaints they had. There have two anonymous complaints raised and investigated by the CSCI in the last twelve months. Elements of the complaints found to be partially substantiated were poor night time care practices, inadequate staffing levels and poor standards of kitchen hygiene. Action has been put into place to address these shortfalls in practice. In line with previous requirements the adult protection procedures have been updated. The home now uses the local council guidelines on adult protection as guidance for staff, which includes a flow chart on reporting suspected abuse. Staff have not yet attended a protection of the vulnerable adult course although this has been addressed in some of the open learning modules some staff have recently undertaken. The manager reported that they plan to undertake a refresher course in adult protection in the near future. Since the previous inspection an adult protection investigation has been undertaken into the poor standards of managing residents personal monies. The requirements made from this investigation have all been actioned with the Vallance Rest Home H59-H10 S14259 Vallance Rest Home v220058 030505 stage 4.doc Version 1.20 Page 15 exception of maintaining suitable records including receipts of expenditure made on a resident’s behalf. Vallance Rest Home H59-H10 S14259 Vallance Rest Home v220058 030505 stage 4.doc Version 1.20 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,24,25 and 26 Vallance provides a homely atmosphere, which in the main provides accommodation, which is light, airy and clean. All bedrooms inspected were found to be in good order and personalised by the residents. Some poor infection control practices were noted which placed residents and staff at risk. EVIDENCE: The home is located near to Hove high street and is convenient to local amenities such as shops, transports link and the sea front. Communal space consists of a dinning room, main lounge and smaller lounge. These rooms form the corridor in between the two houses and therefore are subject to a lot of through traffic. These rooms are pleasantly decorated with furnishings being domestic in character. There is a small rear garden, which has a raised lawn area, flower beds and some seating. The home is not registered to offer a service to people with physical disabilities and the access arrangements within the home would make it unsuitable for residents with significant permanent restricted mobility. Some aids are Vallance Rest Home H59-H10 S14259 Vallance Rest Home v220058 030505 stage 4.doc Version 1.20 Page 17 provided including grab rails and chair lifts to support independence. The home has recently been assessed by an occupational therapist who’s report stated that the homes environment meets its resident’s functional needs. Bedrooms are provided with domestic style furniture and fittings, together with bedding carpeting, curtains and decorated to a good standard. Not all bedrooms have a lockable facility for residents to be able to store valuables within. It is recommended that such a facility be provided. Although there are adequate number of toilets around in the home, including three bedrooms which have ensuite facilities. Their location often means that one toilet on the ground floor is mainly used during the day which can result in residents having to wait. There is an assisted bath and a newly installed assisted shower. Suitable locks are fitted to bathroom and toilet doors to provide privacy but can be overridden by staff in an emergency. Maintenance issues of the ground floor toilet and kitchen floor sealant had not been addressed in accordance with previous requirements. In addition there is a need to eliminate the risk to safety and infection control from the chipped mirror in the first floor bathroom. The home continues to work hard to manage unpleasant odours and at inspection this was confined to one bedroom. Laundry facilities are sighted in an outhouse building, including an outside sink used to soak clothing. Resident’s clothes are often left outside whilst waiting to be laundered. This arrangement remains unsatisfactorily. There remains a need for hand washing facilities to be prominently sited in areas where soiled material is being handled. The manager is still planning to relocate the laundry facilities, which would enable a hand basin to be installed near to laundry equipment and appropriate sluicing facilities to be provided. Several areas of poor infection control practices were noted, these were: • Creams and shampoos, belonging to individual residents left in bathrooms in unlocked cupboards and could therefore easily be used for communal use. • There are no red alginate bags provided for soiled linen. Soiled linen was being sluiced by hand placing staff at risk of cross infection. • Eight bags of clinical waste were stored in the garden awaiting removal. This was not only unattractive to look at but presented potential risks to health. Suitable arrangements must be made for these to be securely stored whilst awaiting removal. • Communal toilets and bathrooms must be provided with liquid soap dispensers, in line with infection control guidelines. • A urine bottle was being stored and cleaned in a bath. The manager has been required to address these areas immediately. Vallance Rest Home H59-H10 S14259 Vallance Rest Home v220058 030505 stage 4.doc Version 1.20 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 There continues to be sufficient numbers of staff on duty to meet needs of resident’s along with the cleaning and cooking tasks. Since the last inspection the standard of recruitment practices has improved. Staff training has improved but has further to go to meet the standard but has benefited from better planning and resources. EVIDENCE: Residents consulted stated that they were happy and felt well cared for, and that the staff were kind, they felt that the staff had time to talk to them. However, some staff consulted felt that they did not have enough time to talk to the residents but this was disputed by the manager. The staffing rota is organised for two-care assistance, plus either the manager or senior carer to be on duty throughout the waking day. In addition there are domestic, cook and administrator working until early afternoon. Night cover is provided by one staff on waking night duty with the manager providing “on call” off site and within five minutes of the home. This staffing level is appropriate to meet the needs of the current residents, although this will need to be reviewed in the light of any new admissions or changes in needs. None of the current staff have completed an NVQ qualification. The manager stated that they are currently focusing on core training requirements prior to addressing NVQ. It was not possible to fully assess the individual training undertaken by staff as there was no evidence of attendance ie certificate for all training undertaken or individual training records maintained. Vallance Rest Home H59-H10 S14259 Vallance Rest Home v220058 030505 stage 4.doc Version 1.20 Page 19 The core staff employed have worked at the home for a number of years and have considerable experience in caring for older people and it was clear some make a positive contribution towards the quality of life of residents. Although they do not have the range of formal training required it was clear that they do possess some of the personal qualities needed to work with residents. For newer staff they stated that they have received an induction course through a (TOPPS) workbook. These workbooks could not be located at the time of inspection for three new staff. The manager reported that these were currently with the staff member. Further work is still needed to ensure that staff receive the training necessary to undertake their roles. Training outstanding from previous visits include Adult protection, first Aid, palliative care and Dementia and Alzheimer’s. Five staff have been recruited since previous visits to the home and the recruitment documentation sampled showed that the required practices and documentation was being maintained. This includes undertaking police checks prior to staff members commencing employment. The manager has been advised subsequent to the inspection that risk assessments should be regularly reviewed for a specific member of staff. Vallance Rest Home H59-H10 S14259 Vallance Rest Home v220058 030505 stage 4.doc Version 1.20 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,35,37 and 38 The manager has made significant progress towards improving their working knowledge of the current legislation and is developing a fuller range of administrative skills. Systems have been introduced to enable residents and visitors to feedback on the quality of the services at the home. Not all systems are in place to support fire safety or prevent accidental scolding. EVIDENCE: The manager/provider has more than two years experience in the management of care provisions. There are currently no plans for them to undertake an NVQ level 4. Since the last inspection the acting manager has left and the manager has resumed their role as the registered person. Since resuming this role they have made significant progress in improving their working knowledge of the National Minimum Standards and towards meeting the significant number of outstanding requirements. Although further work is still needed to ensure that all previous shortfalls in practices are fully met it Vallance Rest Home H59-H10 S14259 Vallance Rest Home v220058 030505 stage 4.doc Version 1.20 Page 21 was clearer to the inspectors that steps are now in place to address them and maintain good practices at the home. In line with previous requirements feedback questionnaires have been developed for residents and visitors on the services provided and the performance of the home. Many have been completed by relatives and sent to the inspector independent from the home. The vast majority spoke positively about the home with particular reference to the kindness of staff. It was previously recommended that a record of residents meetings should be undertaken. The manager reported that although residents meetings have been held no record has yet been maintained. A more organised system of policy and procedure guidance has been implemented to help inform and guide staff in their work with residents. Further work is still needed to ensure that these are regularly updated in accordance with changes in legislation. It is recommended that staff sign to say they have read policies and procedures. Fire alarms and emergency lighting checks were recorded and up to date. Service contracts are in place for the fire detection and fighting equipment. A comprehensive fire risk assessment has been undertaken in conjunction with an external fire safety officer. The manager reported that all recommended works from the assessment have now been completed. The inspector continues to express concern regarding a first floor fire exit, which requires residents to climb out of a fire escape window onto the fire escape. The manager has been previously required to obtain written confirmation from a fire safety expert or fire brigade of the suitability of the fire exits above ground level. This had not yet been fully addressed. Previous concerns were raised by the inspector regarding the confusion in the homes fire evacuation policy. Although the policy had been clarified staff and residents consulted were not clear on what to do in the event of a fire. This emphases the need for regular fire drills which had been previously required but had not yet been implemented. This must be addressed as a matter of priority. Some doors have been fitted with acoustically activated door guards to enable them to be left open to aid ease of movement around the home. However during the course of the inspection it was noticed that in spite of notices on every door to keep the door shut, some were propped open with cushions or other items by residents. There is a need to ensure that appropriate mechanisms are in place if a resident requires their bedroom door to remain open and that they are not propped open using non-automatic closure mechanisms. Hot water mixer values have been fitted to hot water outlets accessible to residents. One bath delivered hot water slightly above the safe recommended Vallance Rest Home H59-H10 S14259 Vallance Rest Home v220058 030505 stage 4.doc Version 1.20 Page 22 temperature and the manager agreed to address this immediately. It was previously required for a record of hot water checks to be maintained to ensure that hot is consistently delivered within the safe temperature range. No record had been maintained but the manager reported that regular checks had been undertaken. The boiler/hot water storage tank door, on the first floor was unlocked in spite of notices saying for it to be kept locked at all times. This posed a risk of accidental scolding as it housed hot water pipes. The door was unable to be closed and therefore could not be locked. In spite of previous assurances that this would be dealt with immediately this had not yet been undertaken. Subsequent to the inspection the manager confirmed that the door has now been locked. A new accident book has been obtained to record information in line with the Data Protection Act. Once completed the accident record had been filed away with no reference made as to who the accident related to. Therefore the manager was unable to monitor accidents and ensure that appropriate action had been undertaken to prevent it happening again. The inspectors were also unable to assess whether all accidents had been recorded. The manager has been required to address this immediately. Vallance Rest Home H59-H10 S14259 Vallance Rest Home v220058 030505 stage 4.doc Version 1.20 Page 23 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 3 3 3 3 x 3 2 1 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x 3 x 2 x 2 1 Vallance Rest Home H59-H10 S14259 Vallance Rest Home v220058 030505 stage 4.doc Version 1.20 Page 24 YES Are there any outstanding requirements from the last inspection? 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 7 Regulation 15(2)(c) Requirement That unless it is unpractical to do so residents are consulted regarding the development and review of their care plan and are notified of any revision to the plan. To maintain controlled drugs records in accordance with the Misuse of Drugs Act 1971 and it’s regulations 1973. (Outstanding from visit of the 17/12/04) That a record is maintained each time medication is administered to a service user. (Outstanding from inspection of the 7&12/10/04) That additional instructions are provided for staff on the administration of “As required” or PRN medication. (Outstanding from inspection of the 17/7/03) That personal care information is not displayed and kept secure at all times That advice and guidance is sought on the specialist dietary needs of a service user and food provided accordingly. That staff entering the kitchen, and serving food wear suitable Timescale for action 30-7-05 2. 9 13(2) Immediate 3. 9 17(1)(a) Sch 3(i) Immediate 4. 9 13(2) Immediate 5. 6. 10 15 12(4)(a) 16(2)(i) Immediate 30-7-05 7. 15 13(3) Immediate Page 25 Vallance Rest Home H59-H10 S14259 Vallance Rest Home v220058 030505 stage 4.doc Version 1.20 8. 15 13(3) 9. 18 13(6) 10. 19 23(2)(b) 11. 26 13(3) 12. 26 13(3) 13. 30 18(1)(c) (i) 14. 30 13(4) 15. 30 18(1)(c) (i) 16. 35 17(2) Sch protective clothing. (Outstanding from visit of the 17/12/04) That records required for be kept for the promotion of food safety are maintained and up to date. (Outstanding from inspection That staff receive training on Adult Protection guidelines and a record of attendance maintained of the training. (Outstanding from inspection of the 15/12/03) That the maintenance issues, of: Kitchen floor and ground floor toilet floor sealant be undertaken. (Outstanding from visit of the 17/12/04) That the risk to safety and infection control from the chipped mirror in the first floor bathroom is eliminated. That suitable arrangements are in place to prevent infection, toxic conditions and the spread of infection by addressing all areas of poor infection control practices noted at inspection. That hand washing facilities are prominently sited in areas where infected material is being handled. (Outstanding from inspection of the 17/7/03) That individual training records, or evidence of attendance be maintained so that a profile of the training undertaken by staff is available. That staff receive training in First Aid, and that a record is maintained of this training. (Outstanding from inspection of the 15/12/03) That staff receive training in Dementia and Alzheimer’s and a record maintained of this training. (Outstanding from inspection of the 15/12/03) That clear records are maintained of expenditure made Immediate 30-7-05 Immediate Immediate 30-8-05 30-7-05 30-8-05 30-8-05 Immediate Page 26 Vallance Rest Home H59-H10 S14259 Vallance Rest Home v220058 030505 stage 4.doc Version 1.20 4(9)(a) 17. 38 13(4)(c) 18. 38 13(4)(c) 19. 38 23(4)(a) 20. 21. 38 38 13(4)(a) 17(2) Sch 4 (15) 22. 38 17(1)(a) Sch 3 (3)(j) 23. 38 23(4)(b) 24. 38 23(4)(e) & Sch 4 (14) on behalf of service users including appropriate receipts. (Outstanding from inspection of the 7&12/10/04) That regular recorded hot water checks be undertaken. (Outstanding from visit of the 17/12/04) That the boiler room door is kept locked on the first floor landing when not in use. (Outstanding from visit of the 17/12/04) That fire doors are not wedged open using none automatic fire door closure mechanism. (Outstanding from inspection of the 7&12/10/04) That hot water is delivered to all outlets assessable to service users at around 43°c. That the procedure on what to do in the event of a fire or on the alarm sounding reflects the policies of the home. (Outstanding from inspection of the 7&12/10/04) That a record of any accident affecting the service user and of any other incident which is detrimental to the health or welfare of service users, which records the nature, date, time, whether medical treatment was required and the name of the persons who were respectively in charge of the home. That written confirmation is obtained from a fire safety expert or fire brigade of the suitability of the fire exits above ground level. (Outstanding from inspection of the 18/5/04) That fire drills are held a frequent intervals and a record maintained of the outcomes and staff attending. (Outstanding from inspection of the 17/7/03) Immediate Immediate Immediate Immediate Immediate Immediate 30-7-05 Immediate Vallance Rest Home H59-H10 S14259 Vallance Rest Home v220058 030505 stage 4.doc Version 1.20 Page 27 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 3 Good Practice Recommendations That a written format for the assessment of prospective service users be developed in line with the homes admission criteria and that of the National Minimum Standards. That a policy be developed on medicine key management. (First made during visit of the 17/12/04) That a cleaning schedule is made available to kitchen staff. (First made during visit of the 17/12/04) That the days menu be displayed. (First made during inspection of 7&12/10/04) That training is provided on the catering needs of older people. That bedrooms are provided with a lockable facility. That staff receive training in palliative care. (First made during inspection of 12/12/03) That a record of service users meetings be maintained. (First made during inspection of 12/12/03) That staff sign to acknowledge that they have read policies and procedures. 2. 3. 4. 5. 6. 7. 8. 9. 9 15 15 15 24 30 32 37 Vallance Rest Home H59-H10 S14259 Vallance Rest Home v220058 030505 stage 4.doc Version 1.20 Page 28 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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