Inspection on 25/07/07 for Valley View Residential Home

This inspection was carried out on 25th July 2007.

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 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

Valley View Residential Home 11/07/06

Valley View Residential Home 07/10/05

Valley View Residential Home 26/05/05

Valley View Residential Home 28/09/04

Valley View Residential Home 20/05/04

Similar services:

The Highlands

Turret Villa Retirement Home

Moor House

Blenheim House

1 Lanark Close

Mendip House

Beaconsfield Court Care Home

Ann Charlton Lodge

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

CARE HOMES FOR OLDER PEOPLE Valley View Residential Home Burn Road Winlaton Blaydon Tyne & Wear NE21 6DY Lead Inspector Clifford Renwick Key Unannounced Inspection 9:30 25 /26 July & 1st August 2007 th th 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 Valley View Residential Home DS0000007382.V340161.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. Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Valley View Residential Home Address Burn Road Winlaton Blaydon Tyne & Wear NE21 6DY 0191 414 0752 F/P 0191 414 0752 pttrsln@aol.com 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) Valley View Residential Homes Limited ** Post Vacant *** Care Home 41 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (41), of places Physical disability over 65 years of age (4), Sensory impairment (2) Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th July 2006 Brief Description of the Service: Valley View provides personal care for up to forty-four older persons, with care staff available at all times over the twenty-four hour period. Nursing care is not provided at the home. It is a two-storey building, the first floor being accessed by stairs and a passenger lift. Car parking is available to the front of the home. A large grassed area is available to the rear of the building, which is not yet fully landscaped. Valley view is situated in a semi-rural area on the outskirts of Winlaton Village, close to the shops, bus route and local amenities. However access to the Home from Blaydon is at the top of a steep bank. Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced Key Inspection took place over two days on 25th & 26th July 2007, and was completed with a further half-day visit on 1st August 2007. • • • • • • The judgements made are based on; the evidence available to the inspector before and during the inspection The Annual Quality Assurance Assessment (AQAA) supplied by the registered owner Discussions with several residents, four members of staff Discussion with the owner and deputy manager Examination of residents and staff files Discussion also took place with 2 relatives of residents. The inspector walked around the building looking at communal rooms, bathrooms, toilets and a sample of resident’s bedrooms. And on 2 days had lunch with residents in both the ground and first floor dining rooms. The people who live in this home prefer to be known as residents; therefore this term of reference is used throughout the report. The registered provider is referred to as the owner in this report. At the time of the inspection the acting manager was on holiday for 4 weeks. What the service does well: The building is well maintained and has good access to all facilities offering a safe environment for the residents to live there. The owner deals with any repairs quickly and a record of maintenance carried out in the home is maintained to confirm this. Discussions with residents confirmed that they are satisfied with the services in the home; comments made were as follows, “Nice food but at times too many sandwiches for tea” Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 6 “The staff take you out and your key worker helps you with personal things such as shopping” “I like to have all of my meals in my room and staff arrange this for me” “When I was ill the staff were very good, always popping in to see me to check that I was ok”. Residents confirmed that they always get a choice of meal and it was always “piping hot”. Those residents who were spoken to confirmed that the meals provided in the home were nice. None of the residents were able to confirm what meals were available on the day of the inspection, apart from one resident who had a copy of the menu in their bedroom. As noted in the last inspection report the residents now have use of a garden and summer house, which is a nice area to sit in when the weather is good. Residents used this during the inspection and they confirmed that they like to sit out in the garden, especially one resident who likes to go outside for a cigarette. Residents spoke highly of the activities coordinator who arranges the social activities in the home. One resident had recently been helped to go to the local church by the activities coordinator and also to a christening service of a neighbour’s relative. They stated that this has been very enjoyable as they were able to see a number of old friends while out. Staff have good knowledge of the residents individual needs and this assists them when helping the residents. What has improved since the last inspection? The building is well maintained and has good access to all facilities offering a safe environment for the residents to live there. The owner deals with any repairs quickly and a record of maintenance carried out in the home is maintained to confirm this. Discussions with residents confirmed that they are satisfied with the services in the home; comments made were as follows, “Nice food but at times too many sandwiches for tea” “The staff take you out and your key worker helps you with personal things such as shopping” Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 7 “I like to have all of my meals in my room and staff arrange this for me” “When I was ill the staff were very good, always popping in to see me to check that I was ok”. Residents confirmed that they always get a choice of meal and it was always “piping hot”. Those residents who were spoken to confirmed that the meals provided in the home were nice. None of the residents were able to confirm what meals were available on the day of the inspection, apart from one resident who had a copy of the menu in their bedroom. As noted in the last inspection report the residents now have use of a garden and summer house, which is a nice area to sit in when the weather is good. Residents used this during the inspection and they confirmed that they like to sit out in the garden, especially one resident who likes to go outside for a cigarette. Residents spoke highly of the activities coordinator who arranges the social activities in the home. One resident had recently been helped to go to the local church by the activities coordinator and also to a christening service of a neighbour’s relative. They stated that this has been very enjoyable as they were able to see a number of old friends while out. Staff have good knowledge of the residents individual needs and this assists them when helping the residents. What they could do better: The acting manager needs to ensure that requirements for improvement made in inspection reports are met within the agreed timescales. Quality assurance checks by the acting manager must be developed further to cover all areas of practice within the home as this will then help identify any shortfalls, resulting in the acting manager being able to put matters right more quickly, especially with records that relate to care and medication. Though care planning is improving, these are still basic and do not include enough detail to show how staff are helping residents. A written record of care needs to be in place that clearly shows how staff are helping residents with their individual needs. Care plans should also be linked to a risk assessment, which identifies any potential risks to residents and how staff will deal with this. Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 8 Staff should be involved in writing evaluations of how a resident is progressing, and the acting manager should support this. An updated life history that includes information about a resident’s previous lifestyle should be developed with staff involvement. As this will help staff in how they communicate with residents. Though training has been arranged for staff, the acting manager must produce an overall training plan to demonstrate how training is planned in advance. This should be linked to formal staff supervisions that identifies individual training needs and demonstrates how staff can develop their skills in this work. The acting manager needs to start formal structured supervisions with staff and these should take place at least 6 times a year with a record being kept. Steps should be taken to ensure that their are no unpleasant odours in the home. The dining room and the mealtime arrangements should be kept under constant review, and steps taken to make the dining room look more appealing at mealtimes. Overall the dining room experience could be improved by better use of care staff during the mealtime. The introduction of menus on the table and on display will help to inform residents of what meals are available at each time of the day. The staggering of meal times will also help to make sure that sufficient staff are available in both dining rooms at all times to help those residents who require staff support to eat their meals. Better use could also be made of catering staff during mealtimes in order that care staff can give assistance to those residents who need it. In addition to this the timing of the meals should be reviewed in order to make good use of staff resources. This was discussed with both the owner and the deputy manager who were positive about the advice that was offered. In order to assist those residents with dementia and orientation around the building Street names have been placed on the corridors. Though these are helpful there would be benefits in changing the décor/colour scheme between lounges, corridors and dining rooms so that each area has a distinct identity. The acting manager needs to make a formal application to the Commission to be the registered manager. The acting manager must undergo training appropriate to this work. Throughout the inspection discussion was held with the owner who confirmed that he would address all of the requirements made during this inspection. Consideration needs to be given to providing the management staff with an office where all care records can be stored. This office could also be used for seeing people in private and for carrying out staff supervisions. Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 9 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. Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 10 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 Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home have a Statement of Purpose and service user guide which offers information on the services provided and this assists potential residents in choosing a home. On admission each resident is issued with a copy of the terms and conditions of residence this ensures that they are aware of the fees to be paid and what services are offered. All prospective residents’ needs are assessed prior to the person being offered a place. This helps to ensure that residents are offered the right type of care and no one is admitted inappropriately Intermediate care is not provided. EVIDENCE: Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 12 The home has a detailed Statement of Purpose/Service User Guide, which is made available to prospective residents and their families when they are considering moving into the home. The Statement of Purpose sets out the homes aims and objectives, services and facilities available and the type of care the home intends to provide. This information, along with a visit to the home, helps prospective residents and their families to make an informed choice about the suitability of Valley View. Four residents files were examined and these confirmed that each resident has a contract that includes the terms and conditions of residence and also what fee is payable to the home. Residents or their representative sign the contracts to confirm that they are in agreement with the homes terms and conditions of residence. Examination of the files also confirmed that pre admission assessments are carried out prior to admission into the home. Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individual residents care plans do not provide sufficient information about a person’s care needs to ensure independence is maintained and support is given to continue a full and valued lifestyle. The absence of risk assessments as part of the care planning process makes it difficult to assess how areas of risks are dealt with. This could leave residents vulnerable. Residents have good regular access to health professionals to ensure healthcare is promoted but this is not always recorded in the care plans Records of medication administration are not managed appropriately to promote the health and well being of residents. EVIDENCE: Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 14 Since the last inspection care plans have continued to be developed and these set out how individual resident needs are to be met by staff. The deputy manager continues to take responsibility for the development of the care plans. Four care plans were examined and this confirmed that only basic details are included in the care plan. The monitoring sheet, which is used to record individual progress, does not offer sufficient information. Therefore it is difficult to determine what progress if any, individual residents have made. The personal hygiene sheets, which are used to record individual bathing needs need revising to include more information about the type of care offered by staff. As the inspection progressed the deputy manager devised a suitable recording sheet, which was being implemented by staff and would be used for all areas of personal hygiene. Daily records, which are used to record day-to-day life in the home, do not offer sufficient information and do not always link to the care plan. Discussion with individual staff confirmed that they have a good understanding of individual resident needs and they could clearly demonstrate how they were meeting them. Similarly, discussion with a relative confirmed that the care being offered by staff to their mother was good and though a structured care plan was carried out in practice this was not recorded in the residents file. More detail is needed in care plans which confirms that staff are assisting residents in the most appropriate way. Risk assessments are not always in place especially for those residents who rely upon specialist equipment such as bedrails and also for those residents who choose not to wear any footwear. For one resident a risk assessment had been carried out 8 months ago for malnutrition and a record of weight was being maintained on a monthly basis. However there was no evidence of ongoing nutritional screening in order to ensure that all needs are being met in this area. Since the last inspection the home have acquired a set of weighing scales which can be used while sitting a in a chair. Residents are weighed monthly and record is maintained and this now needs to be developed further as part of the overall care plan with attention being paid to any significant weight loss/gain. Fluid balance charts, which are in place for one person, are not always completed and one was on display in a public area. This needs to be addressed as part of the ongoing plan of care. The home continues to support residents to access various healthcare professionals. Records show details of visits to G.P, Opticians and Hospital. The community nurse visits the home on a regular basis to offer support to those residents who have health needs. Records are maintained of all visits by Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 15 health professionals however where bedrails had recently been supplied by the community nurse, no risk assessment was in place. The deputy manager took steps to obtain this during the inspection. A sample audit of the homes medication system was carried out and medication practices generally ensure that residents are assisted to take their medication in a manner which promotes their health and well being. Medication is handled and administered by senior care staff in the home; all staff have completed training in Safe Handling of Medicines to ensure competence when dealing with medicines. A monitored dosage system is used, whereby the dispensing pharmacist supplies medication in individual blister packs. Printed ‘medication administration records’ are also supplied by the pharmacist giving details of medication prescribed and dosage. However some practices in relation to administration and recording of medicines does not ensure the safekeeping and management of medicines in the Home. Examination of administration records for several residents confirmed that on several occasions when medication had been administered by staff they had not signed the administration sheet to confirm this. Similarly when using the codes on the administration sheet to record whether someone has declined to take their medication a letter (F) was being used but with no definition of what this meant. This was noted in the last inspection report of this service and it is a legal requirement that the records of administration must be completed correctly. The deputy manager has introduced an audit system for stock control and this is used to ensure that staff follows the correct procedures for the recording and storage of medicines. This was discussed with the deputy manager who was advised of the appropriate immediate actions to take with regards to staff not signing administration sheets and how the checking of administration sheets should be included within the regular audit system. In addition to this when medication is received in the home this must be checked against the prescription issued by the doctor. The deputy manager was advised that in order to achieve this, a copy of the prescription must be retained in the home. A list is now in place about the medication being taken by individual residents and also what it is for and what possible side effects there may be. This assists staff in their knowledge of the medicines they are administering. An audit of controlled drugs was carried out with the deputy manager and this confirmed that good arrangements were in place with appropriate records and secure storage. Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 16 The home is in the process of changing their pharmacist and will be using a local pharmacist who they have stated will be offer a more personal service to the home. Staff ensure residents are treated with respect and support is given sensitively and discreetly. Assistance with personal care is carried out in the privacy of a person’s room or bathroom. Observations confirmed that staff knock on their bedroom door before entering and that they speak to residents in an appropriate manner. Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 17 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 & 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents are able to follow their own daily routines, to a certain degree, which satisfy their social, cultural and religious needs. There are no restrictions on visiting the home and friendships with people outside and inside the home are encouraged, this helps to maintain contact with friends and family. Staff encourage residents to take control and make choice in their lives, which helps to promote independence though this in not recorded in detail in individual records of care. Residents are offered a variety of wholesome and nutritious meals in comfortable surroundings, which can promote health and well-being. EVIDENCE: Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 18 Residents are encouraged to follow their daily routines and this is supported by staff. Relatives and visitors are welcome at any reasonable time throughout the day and evening. A lot of residents have visiting relatives on a regular basis. Visitors will usually meet with their relatives in the privacy of their own room or in the home’s lounges or dining room. One relative spoken with during the inspection was happy with the overall care of her relative and stated that during a recent illness the staff had been very good. As noted at the last inspection, the home has appointed an activities coordinator to plan and participate in activities with residents each day. The coordinator is employed to work four hours each day Monday to Friday. The coordinator plans activities on a weekly basis with residents via an informal meeting and once the activities are chosen the coordinator displays them in a weekly activity plan. There is still a need to develop appropriate activities for people with dementia in order to ensure that appropriate stimulation is offered. As identified during the previous inspection staff need to receive training in caring for people with dementia. Training dates have now been arranged and this should initially assist staff in having a better understanding of dementia. However once initial training has taken place further training opportunities in caring for people with dementia should be ongoing. The activities coordinator has also been involved in taking one resident to church as part of a planned activity and which is special to that person. Discussions with the resident confirmed that they had enjoyed this and it had been an enjoyable activity. Discussion with the activities coordinator confirmed that as well as planning activities for a group of residents she is now looking at individual activities based on resident’s choice and interest. Activities previously enjoyed by residents include bingo, flower arranging, gardening trips visiting the local pub and village and excursions to places of interest. In discussion with one resident they spoke of a trip to the discovery museum where they saw the Turbinia ship and they said that this had been an interesting day out. At the time of the inspection the residents took part in a Karaoke afternoon in the upstairs lounge. Lunch was taken on two days of the inspection and in different dining rooms on each day. Staff practices were observed throughout the mealtime period paying particular attention to the meals on offer and how support was offered to residents if needed. Some residents also choose to have meals in their room and on the third visit to the service time was spent with a resident in their room while they had their lunch. Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 19 Two choices of meals were available for lunchtime with also a choice of dessert. Hot drinks are also available and are served by staff. The majority of residents spoken with said that meals provided in the home ‘Were good’. “Menus are good” “I have put weight on since I moved into the home”. When asked about the choice of meals on offer residents said that staff go around the night before and ask you what you want from the menu for the following day. A record is then kept and used the following day when meals are served. Some residents said that they often forget what they have chosen. None of the residents with the exception of two who were spoken to knew what the choice of meal was on the day of the inspection but said, “ Whatever it was it would be good”. There are no menus on display in the dining rooms so it can be difficult to know what is available until informed by staff. This does not assist people who have dementia or poor memory recall. One resident had a copy of the three-week menu plan in their bedroom and they confirmed that they used this daily so they knew what meals were being offered. This they said assisted them with remembering what choice they had made when selecting their meals. Another resident always asked the staff each day what was available at mealtimes and made their choice from the information available Some residents said that they thought there were to many sandwich meals at teatime. A check of the menus confirmed that there are a variety of meals offered in addition to sandwiches. . The cook, on a daily basis, freshly prepares meals. Fruit and vegetables are encouraged in meal choices to ensure a healthy diet is maintained. The lunchtime meals were well presented and tasty. One member of the care staff served the meals from a ‘hot lock’ trolley while other care staff takes the meals to the table. There were some practice issues observed during lunchtime, which limit residents’ independence, choice and dignity. The absence of alternative cold drinks and having teapots on the table does limit some of the issues around choice and independence for residents. On one day of the inspection the meals being offered would have benefited from having bread as a side dish. In addition to this as all meals are served plated it does restrict residents from having some control over the size of portion. Discussion with staff indicated that they use their knowledge of individual residents preferences. Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 20 It was good to see an assortment of sauces on the table, which could be used with the meals. Staff offered support to a resident to eat their meal, however they spent the entire meal crouching on the floor beside the resident as opposed to sitting at the table. Two residents who required encouragement from staff at the mealtime would have benefited from constant staff presence and support at the table. This would have ensured that residents had the assistance they needed to eat their meal. Refreshments are served throughout the day and in each lounge there is a cold-water dispenser. In addition to this bottles of “pop” were available to residents. Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives have information about how to make a complaint and are confident that any complaints will be acted upon immediately. All Staff are aware of the POVA (Protection Of Vulnerable Adults procedure). And most staff have received training in protection of vulnerable adult procedures. Further training is arranged and this will ensure that all staff is aware of how residents must be protected from abuse. EVIDENCE: The home has a complaints procedure in place giving details of who to contact should anyone want to make a complaint. Details of the process and how any complaints will be dealt with are also documented in the procedure. Residents and relative spoken to stated that they knew who to go if they had a complaint. The deputy manager confirmed that the majority of the staff team have received training in Protection of Vulnerable Adults procedures. The most Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 22 recent training was held in April 2007 when 4 new staff were employed in the home. The deputy manager was able to confirm that Gateshead Social Services are providing further training from September 2007 until April 2008 and more staff from the home will be attending POVA training throughout this period. Once this has been achieved all staff employed in the home will have received appropriate training. The home has now obtained a copy of Gateshead’s Protection Of Vulnerable Adults policy and procedures. The home has a whistle blowing policy, which sets out the values and principles that underpin the homes approach to whistle blowing. Staff spoken with during the inspection showed an awareness of the procedure to follow in the event of an alert. Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 23 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): 19,25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well-maintained, clean, safe and warm offering residents a homely and safe environment in which to live. EVIDENCE: The owner takes responsibility for carrying out all areas of maintenance in the home. All individual bedrooms with the exception of one have en suite toilets and are nicely decorated and reflect residents’ individual taste. The owner has taken steps since the last inspection to address any safety issues, which were identified which included boxing off hot water pipes in ensuite bedrooms. Similarly some areas of the home where there was a slight Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 24 incline/ramp in the corridors it has been rectified by the fitting of a different coloured carpet strip in order to avoid people tripping. Hot water temperatures are tested on a monthly basis and a record is kept. In one bedroom there was no water supply to the cold tap. The owner took immediate action to rectify this. Works are carried out as part of ongoing maintenance within the home on a daily basis. However as noted in the last inspection report the owner does not have an annual maintenance plan. This was discussed with the owner and a maintenance plan for the home was developed and given to the inspector during the inspection. This demonstrated that areas of maintenance throughout the home are highlighted, followed up and monitored on a daily basis. As noted in the last inspection report two areas of the corridors in the home near bedrooms are dark when the lights are switched off. The deputy manager confirmed that staff have been instructed not to turn lights off in this area. This will ensure that consistent lighting levels are in place at all times. A number of bedrooms, bathrooms and all communal areas were viewed during the inspection and this confirmed that the home was clean and well maintained. There were no noticeable hazards on the day of the inspection. However it was noticeable that there was an unpleasant odour in both the ground floor large lounge and the upstairs lounge. Discussion with the owner and the deputy manager confirmed that this was attributed to the type of chairs in use in which the fabric covering could not be cleaned effectively. Consequently as part of ongoing refurbishment the owners have ordered new chairs for both lounges. An invoice was produced to confirm how many chairs had been ordered and when they would be delivered. The garden area developed last year provides a pleasant additional space for residents to enjoy in the summer months. . Easy access by use of a ramp is in place for those residents who have a physical disability. The garden is well stocked with flowers and shrubs and there is a small open summerhouse that offers a nice safe outdoor area to sit in. Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 25 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by the home’s recruitment procedures, which are implemented to a good standard. This helps ensure that unsuitable candidates do not gain employment in the home. Members of staff receive regular mandatory training to ensure residents are appropriately supported and protected. EVIDENCE: On the first day of inspection, the deputy manager, six care staff, three domestic staff and 4 catering staff and an administrator were on duty. The homes rota shows there should have been 7 care staff on duty throughout the day. The deputy manager confirmed that they were one staff member down for the morning shift and due to short notice could not cover this shift. However the activities coordinator commenced work in the afternoon and was able to offer additional support to staff. In situations such as this the deputy manager also works alongside staff to make up for the missing person. Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 26 Discussion took place with the owner and also the deputy manager about the need to have a planned process in place. Whereby shortfalls on the staffing rota such as sickness/holidays could be covered immediately without relying on the use of the management staff. The owner confirmed that in the past they had used agency staff but were now considering employing more staff in order to address this issue. As noted in the last inspection report the staff rota does not easily identify members of staff designation. The deputy manager was advised that the rota must clearly demonstrate not only the name of each staff member, but their designated role and the hours that they are working. A laundry assistant has now been employed to ensure that care staff do not have to deal with laundry. Many of the staff team have worked in the home for a long time and they have a good range of knowledge about individual resident needs. This was clear from the discussions with staff who also indicated that they wanted to become more involved in writing the care plans, which set out how resident’s needs would be met. At present there is no evidence to confirm how the acting manager involves staff in care plans. All staff employed in the home have achieved NVQ Level 2, 10 staff have achieved NVQ Level 3 and a further 3 staff have enrolled on NVQ Level 3 training. As previously stated in this report the residents spoke positively about the staff stating that they give you all of the help that you need. Relatives to were positive about the staff and confirmed that they were always welcoming when you visited the home. The homes recruitment procedures are robust and ensure that all of the necessary checks and references are received before someone is employed in the home. Staff records were examined for the 6 new staff that has been employed since the last inspection and these were satisfactory. Since the last inspection care staff have completed mandatory training such as Moving and Handling. Discussion with the deputy manager confirmed that training in Food Hygiene had been arranged over 2 days in August and all staff would attend this. Training in Dementia as part of a distance-learning course is due to start in September. And all care staff will undergo this training. Training has also been arranged in medication and infection control and this too will take place in September. Though the deputy manager was able to confirm what training had been completed and also what was organised. The absence of an overall training plan/matrix made it difficult to determine how training was planned for the following 12 months. Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 27 Discussion held with staff confirmed that they would like further training opportunities to be made available. Staff spoke of dementia and challenging behaviour as being the area of training they wanted to more of. The acting manager is not carrying out formal staff supervisions therefore it is difficult to see how individual staff development is promoted. Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 28 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, 36, & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The acting manager is experienced in her role however staff do not receive formal supervision which limits best practice being followed when caring for residents. Good procedures are in place to ensure that residents’ financial interests are safeguarded. The health, safety and welfare of residents is generally promoted and protected. Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 29 EVIDENCE: The acting manager who was in post at the last inspection has not yet applied to the Commission for registration. This was discussed with the owner who was advised of the requirement that a person who manages the home must be registered. The owner confirmed that he would be meeting with the acting manager on her return from holiday and following this an application for registration would be submitted to the Commission. Both the acting manager and the deputy manager have achieved NVQ Level 4 in care and both have enrolled on the Registered Managers Award, which commences in September 2007. In addition to this the owner has made enquiries with a training agency to look at other specific courses that will be of benefit for both managers. Tasks in the home have been divided between the managers and the deputy manager has responsibility for care plans and fire safety training with staff. As noted in the last inspection report a quality assurance audit around measuring quality in the home has been developed. However the current audits in place are not picking up on some of the shortfalls identified in areas of care plans and medication. This was discussed with the owner and the deputy manager who were advised as to how these could be developed further. A questionnaire is ready to be sent out to families and residents seeking their views about the service in the home. The owner confirmed that they would act upon any comments received in order to improve the service. Monthly records are kept of visits carried out by 2 persons on behalf of the owner. Who visit the home to check on the services being offered. This meets the requirement that was made in the last inspection report. Advice was offered as to how these visits could focus on a range of other areas, which in turn would then assist the owners in improving services. Records of all accidents in the home are maintained and evidence is available to confirm that support is obtained from the relevant health services when appropriate. The deputy manager was advised that the accident records should also include the actions taken by staff and also the outcome. Appropriate written notifications as required by regulation are made to the commission when required. Bed rails were in use without the appropriate risk assessment being in place. This was discussed with the deputy manager who following advice obtained copies of guidance on the safe use of bed rails. The deputy manager was also Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 30 advised that a copy of the assessment by the community nurse who supplied the bedrails must be made available. By completion of the inspection all appropriate documentation was in place. Fire training, drills and checks are up to date and this promotes the safety and welfare of residents. One bedroom where oxygen is being used had appropriate signage to alert staff residents and visitors. Good safety audits of the premises are in place and hot water systems are checked daily so that residents are not at risk. Financial records are accurate with two signatures being obtained for all transactions. Receipts are kept as evidence of monies spent on behalf of residents. As noted in the staffing outcomes standards 27 –30 the acting manager is not carrying out staff supervisions and this was noted in the last inspection report. Information available in the home confirmed that the last formal supervision sessions for staff had been held in June 2006. Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 2 X 3 Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 32 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 OP7 Regulation 15 Requirement Care plans must continue to be developed to reflect the current strengths/needs are to be met by staff. (Previous timescale of 30/10/06 not met) . Care plans must include an evaluation of any progress/regression that has been made. (Previous timescale of 30/10/06 not met) When developing the care plans they must include an updated life history of residents. Residents must have comprehensive plans in place for any medical conditions. (Previous timescale of 30/08/06 not fully met) Risk assessments must be completed for any specialist equipment that is used by residents. And also for any residents seen to be at risk as discussed within this report. Risk assessments must be linked to DS0000007382.V340161.R01.S.doc Timescale for action 30/11/07 2. OP7 15 30/11/07 3. OP7 15 30/11/07 4. OP7 13 (1) (b) 30/11/07 5. OP7 13 (1) (b) 01/08/07 Valley View Residential Home Version 5.2 Page 33 6. OP9 13(2) the care plan. (Previous timescale of 15/09/06 not fully met) Medication administration records must be managed as required in legislation and good practice guidance. (Previous timescale of 19/08/06 not fully met) A review of mealtime arrangements should be carried out to address the issues identified in the body of this report. All staff as identified by the manager must attend the planned training in POVA procedures. (Previous timescale of 30/09/06 not fully met) Steps must be taken to eradicate the unpleasant odour in lounges. The duty roster of persons working at the home must state their designated role. All staff working with people with dementia must attend appropriate training to enable them to understand and meet the needs of residents. (Previous timescales of 28/02/06 & 30/10/06 not fully met) A record of planned training for staff must be available at all times. The homes quality assurance system must be developed to include an audit checklist for all care and medication records. Formal supervisions for all staff must be carried out at least six DS0000007382.V340161.R01.S.doc 01/08/07 7. OP15 16 (2) (i) 30/11/07 8. OP18 13(6) 31/12/07 9. 10. 11. OP26 OP27 OP27 23 (2) (d) 17 (2) Schedule 4 (7) 18 31/08/07 31/08/07 30/11/07 12. 13. OP30 OP33 18 (1) (c) (i) 24 30/09/07 31/12/07 14. OP36 18(2) 30/10/07 Page 34 Valley View Residential Home Version 5.2 times per year. (Previous requirement of 30/10/06 not met) 15. OP32 9 An application for registered manager must be submitted to the commission. 31/10/07 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 OP31 Good Practice Recommendations The manager should be located in an office of their own to enable them to conduct their management duties and to meet with people in private. Valley View Residential Home DS0000007382.V340161.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection South Shields Area Office 4th Floor St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. 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