Inspection on 01/10/07 for Venn House

This inspection was carried out on 1st October 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Venn House 02/10/08

Venn House 04/04/07

Venn House 02/08/06

Venn House 01/03/06

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

CARE HOMES FOR OLDER PEOPLE Venn House Lamerton Tavistock Devon PL19 8RX Lead Inspector Anita Sutcliffe Unannounced Inspection 1st October 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Venn House DS0000065984.V348805.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. Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Venn House Address Lamerton Tavistock Devon PL19 8RX 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) 01822 612322 0870 1270388 info@venn.org.uk www.venn.org.uk Venn Care Ltd Mr Paul Victor Rielly Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category- Code OP The maximum number of service users who can be accommodated is 25. 4th April 2007 Date of last inspection Brief Description of the Service: Venn House is a Grade 2 listed house set in its own grounds on the edge of the village of Lamerton. The home is registered for older people who may need assistance with personal care. Health care needs are met through the district nursing service. The property consists of the main house that accommodates 16 people and a converted Coach House, a short distance away that accommodates 9 people. The main house is of great character, with slate floors and gothic windows, however there are some steps between some rooms. The majority of rooms are en suite or have a bathroom close by. The Coach House Annexe is a short walk from the main house. It has its own lounge and dining room with a small kitchen for snacks and drinks. Like the main house there are bedrooms on the ground and first floor. Meals are brought over from the main house to the Coach house and eaten in the dining room. There are some bath adaptations in some bathrooms and there is a stair lift in the main and coach house. Venn House is not suited nor registered for people who have a significant level of disability. Many rooms look out over the gardens or surrounding countryside. The home is staffed 24 hours per day and has waking night staff. The Statement of Purpose and Service User Guide, which provide information about the home, are available in the office, and copies are in the entrance hall. The fees are between £420 and £760 per week. Items not included are: Chiropody, toiletries, activities, holidays, magazines, newspapers, transport, and hairdressing. Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the last key inspection was completed on the 4th April 2007 Random Inspections were carried out on the 9th July and 9th October. Random Inspection reports are not published but are available on request from the Commission. Reference to the findings of Random Inspections is made within this report. The purpose of this inspection was to assess the homes compliance with Key National Minimum Standards for Older People. The manager provided up to date information about the service at Venn House. The inspection included two unannounced visits, one during late evening. Prior to the visits people who use the service (residents) had the opportunity to complete anonymous survey about the home. We received eight. Staff opinion was also surveyed. We received only four replies. During the inspection visits we met and spoke with two people resident at the home, one who was a recent resident, two night and three day staff. We spoke with a district nurse in regular contact with the home. Care, recruitment, training, medicines and complaints records were examined. All areas of the home were visited. Discussion was held with the registered manager Mr. Paul Rielly who was helpful throughout. What the service does well: What has improved since the last inspection? Confidence at the home has increased and the home is a much safer place. This is due to the knowledge and commitment of the now registered manager. He has worked hard to improve standards. Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 6 Literature about the home has been reviewed and updated, and now includes a disc version and larger type. However, some additional clarity is necessary to prevent misunderstandings of who may or may not be admitted. People are now admitted following an adequate assessment of their needs and their care is then properly planned. People are involved in the planning of their care where able, and the plans are reviewed and updated when necessary. There is continual upgrading of the home by the registered provider, which is appreciated by both people using the service and staff. The standard of organised activities has improved. This, plus the improved atmosphere at the home, has increased people’s feelings of well being. There is much less negativity about the service. The handling of complaints has improved and people say the registered manager has been helpful to them. Currently staffing numbers reflect the needs of people using the service and where recently additional staff numbers were required this was provided. People still lack confidence in the language skills of some staff, but their level of understanding is checked by the registered manager and all staff met during the inspection understood questions and provided detailed responses. Additional staff are always available through the home’s ‘on call’ system of which the registered manager is an addition. Both people using the service and staff are now able to meet regularly to discuss aspects of the home and make their wishes known. Staff also receive one to one supervision of their work. Quality assurance systems are now being put in place so that the home runs in people’s interests can be better met. What they could do better: Although now much safer, the handling of medicines still requires some improvement. Despite there being insufficient space on the medicines record to record the weekly medicines into the home, this must non-the-less be done. Otherwise a full audit is not possible. Where ‘as necessary’ or ‘as required’ medicines are prescribed it must be described within the plan of care under what circumstance they may be administered by staff. Without this there will be inconsistencies, which might affect people’s health. The Controlled drugs book should have numbered pages so that it will be obvious if a page is removed. This reduces the likelihood of mishandling. Complaints records need to be more detailed so that they include the full investigation, outcome, actions taken and follow up. There should be no inconsistencies in the complaints procedures available to people. This will Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 7 further ensure confidence in the service. The registered manager also needs to continue and expand the steps already taken toward a system of monitoring quality at the home. The standard of laundry equipment may or may not meet the necessary guidelines and requirements to ensure safe, hygienic handling. This must be checked so that people can be sure the laundry system in place protects people from cross infection. Policies and procedures for this should be updated and include more detail, so that staff are fully informed of best practice. One person who uses the service said: “It is not always readily apparent who is the responsible body”. The Registered Provider, Venn Care Ltd. must make themselves available to receive feedback from people using the service and staff. The Registered Provider should have arranged for monthly-unannounced visits to the home to take place, these have not happened. The registered manager must ensure that all events, which might affect the well being of people using the service, are reported to the Commission. He has not yet achieved an adequate understanding of when this should occur. 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. Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3 (6 does not apply to Venn House) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are able to make an informed decision as to whether the home is suitable for them through the literature available and discussion with the registered manager, who will ensure they are not admitted unless their needs can be met. EVIDENCE: Copies of the Service Users Guide and Statement of Purpose, information to inform prospective residents about the home, were made available to us. They were updated May 2007 and are also available on computer disk or in enlarged version. Although now up to date, and containing much factual information, it is not clear who the home may or may not admit, under its current registration. In addition, the complaints procedure does not make it clear that the Commission can be contacted ‘at any stage’ of a complaint. (Also see Standard 16). Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 10 Each of the eight people whose opinion was surveyed said they had enough information from which to decide if the home was suitable for them. We examined the assessment and admission of a person who, although not new to the home, was readmitted. She said that she was perfectly satisfied with the way the home provided her care and support. She praised the staff. The registered manager had visited her in hospital so as to be sure the home could meet her needs should she come to Venn House. His assessment was sufficiently detailed to inform staff what care would be needed. He had confirmed in writing that the home could meet her assessed needs. This protects both the person and the home. Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can be assured that their personal and health care needs will be understood and met and the management of medicines at the home has improved. EVIDENCE: Five people who use the service said they always received the care and support they need and three said they usually do. Comment included: “I am very well cared for here”. Seven people who use the service said they always receive the medical support they need and one said they usually do. A district nurse, who has regular contact with the home, thought the standard of care at the home was good, adding: “They’re good at calling us in. I have no concerns about the care provided at the home”. Health care appointments are made appropriately. Records of this were seen and people talked of a visiting podiatrist/chiropodist. Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 12 We looked at the care records of one person recently deceased, one recently admitted and one who is very frail. They were sufficiently detailed and no inconsistency was found between the written plans and care delivered. The registered manager said: “I keep an eye on people with greater need and update their plan of care more frequently”. We found this to be true. A person using the service said they are consulted and have involvement in their care planning. We looked at the home’s arrangements for handling medicines. People are supported to look after their own should they wish. We saw that risk from this is assessed by the home and arrangements agreed with the person. The registered manager said individual secure storage is provided which protects against mistakes or mishandling. We found storage arrangements were adequate for those who rely on the home to administer medicines. Records of medicines were orderly and clear. However, due to the weekly delivery of medicines the home is not always recording the amounts brought into the home. They must be recorded on arrival at the home so that a full audit of medicines in always possible; this protects people from mistakes or mishandling. We found that staff did not have clear information as to when ‘as necessary’ and ‘as required’ medicines should be given. This must be clearly recorded within the person’s plan of care so that medicines are given in a consistent way. Where previously there was no evidence that staff were trained and competent to give insulin and monitor blood sugar levels, this is now confirmed by the medical professional (district nurse) with the responsibility for this aspect of health care. Staff who administer medicines at Venn House have undertaken training. The registered manager said he personally ensures that all staff, but especially those whose first language is not English, understand how to handle medicines properly. There is also a daily check to ensure that medicine records are completed properly. Controlled drugs are now recorded in a bound book. The pages are not numbered which they should be to reduce the likelihood of mishandling. Staff were observed knocking on people’s doors before entering. Since the previous inspection door locks have been fitted to newly decorated rooms, and are available to existing residents at their request. There is lockable storage space provided for people to keep items of value. Privacy and dignity are upheld. Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are supported to lead a fulfilled life and they receive a wholesome and tasty diet. EVIDENCE: A person using the service said: “Activities have improved and the food is good”. Two people asked if there are activities they can take part in, said always, one said usually and one said sometimes. Comments included: “We have an enthusiastic carer who battles constantly to provide activities for people”. “There is usually a DVD shown on a weekly basis in the afternoon” and “Owing to my disabilities I am unable to join in activities. It does not worry me”. The home has extensive and well-kept grounds with outside seating. A carer confirmed that people sit out in good weather and a person who uses the service said: “I do a lot of walking around here. It is a very pleasant”. Other activities organised at the home include: Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 14 • • • • • • • Summer Fayre, held this July Regular library service Family and friends can eat at the home when visiting. Film on Tuesdays, with ice cream served. Monthly quiz Twice monthly gentle exercises. Birthday celebrations The registered manager showed a weekly newsletter he has produced which informs people of planned events. There are regular residents meetings, providing the opportunity for people to influence what activities take place. We found that plans of care now include better information about people’s preferences, interests and important family history. This helps staff understand how to meet people’s social and emotional needs. Some people using the service have friends who live in the nearby Orchard Cottages; some come to the home for the film event. This means that there is an added sense of community. People who use the service are able to manage their own finances at Venn House, and the majority of people choose to do this. Where the staff at Venn House manage any cash for people there is a record of those transactions. People are also able to handle their own medicines if they so choose, and many individuals have brought their personal possessions including items of furniture with them. Staff aim to provide a person centred service and there were no negative comments concerning choice and self-determination. We enjoyed a very tasty meal whilst at the home. Of the people surveyed four said they always like the food and four said they usually do. Comments include: “We are fortunate in having a varied and appetising diet”. “The quality of food is very good and I do enjoy it. We also have fresh fruit available” and “I am vegetarian and well catered for”. Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can be confident that the registered manager will handle concerns or complaints properly but written information and records need to be improved. EVIDENCE: Six people who use the service asked if they knew who to speak to if you are not happy said always and one person said usually adding: “It is not always readily apparent who is the responsible body”. Seven people who use the service asked if they knew how to complain said yes. Comments include: “I haven’t done this but I certainly would make it known” and “I would talk to my daughter and ask her to make the complaint”. A complaints procedure is clearly displayed in the home and is also included in the home’s literature. They differ slightly in that the one on display meets the necessary standard: the available policy information should be consistent. We looked at the records of complaints at the home. Where the complaint was minor there was sufficient detail, but generally there was insufficient record of how the complaint had been investigated and the outcome. Two people spoken with at the home said that the registered manager makes Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 16 himself very available to them, listens and does his best in their interest. The registered manager says that he needs to be more efficient at keeping people up to date regarding complaints and is intending to produce a faster system. We have received one complaint against the home since the last key inspection. As it concerned actions taken by the Registered Provider we instigated a random inspection to investigate. We concluded that the complaint was justified; the level of service provided to a particular person using the service, was adequate but the Registered Provider was misrepresenting what had occurred. Concerns raised previously included staff ‘mistreating’ people who use the service. Those particular staff no longer work at the home. The four staff who completed surveys said they knew what to do if any person had concerns about the home adding: “Inform manager” and “Kindly ask them to refer to the complaints policy to alert the person in charge; the manager, or to the Commission – address is on the message board”. Staff said, and records support, the fact that all staff will have received training in protecting vulnerable adults from abuse by the end of December. The registered manager is aware of how to properly handle any allegations of abuse. Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 17 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 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a comfortable clean home, but hygienic handling of laundry remains to be proven. EVIDENCE: As part of this Key Inspection we toured most of the two buildings (the Coach House and the Main House). The home is generally well decorated; many of people who use the service have been able to bring in items of their own furniture and belongings. The registered manager said there was a lifting hoist in each house and staff know to use them. Each of the two houses has a stair lift. However, there are steps within the Coach House making it difficult for both staff and people using Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 18 the services if they have mobility difficulties. The new ramp in the main house provides easier access to some bedrooms. Currently an entire staircase is being renewed through necessity. This does not seem to have impacted negatively on people at the home. Bedrooms close to the stairs are currently unoccupied. The registered manager confirmed that wash hand basins are being put into all rooms, but this has not yet been completed due to complications associated with the age and design of the home. Staff made positive comments about the redecoration and upgrading at the home. The newly decorated and furnished rooms retain their interesting features but include safety measures, such as radiator covers (to prevent contact burns) and window restrictors (to reduce the likelihood of falls). The registered manager says that all redecorated rooms have a door lock with safety override, people are issued with a key if they wish and if requested a lock is fitted for existing residents. No concerns were raised regarding the laundry during this inspection as there have been previously. The laundry was visited both during the late evening in the morning. Both times it was fairly orderly and, with the exception of an old boiler and associated pipe-work, reasonably clean. There was liquid soap and paper towels so that staff could effectively wash their hands. We discussed current laundry arrangements and the degree of laundry use. We found that seven people using the service have continence problems, but that soiled laundry is “an unusual event”. Where there is an increased likelihood of cross infection laundry is kept separate from the general laundry. Within the laundry room clean and ‘dirty’ laundry is separated. There is new laundry equipment. Unfortunately this is of a domestic nature, not commercial, and it was not known if it has the specified programme ability to meet disinfection standards or comply with the Water Supply Regulations, which it must. We looked at the home’s policies and procedures regarding laundry, hygiene and infection control. We found that there was insufficient detail and they did not adequately reflect current guidelines. They do not therefore provide staff with sufficient information. Of people asked through survey if the home was clean and fresh seven said always and one said usually. Staff have protective clothing to reduce the likelihood of cross infection and the home was clean and pleasant during both inspection visits. Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 19 Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. People can be assured that staff recruitment, training and competence have improved at Venn House. EVIDENCE: One person who uses the service said: “I have nothing but praise and gratitude for the long-standing staff”. Five people who use the service said staff are always available when needed and two said they usually are. Two staff surveyed said there are enough staff to meet the individual needs of people who use the service and two said there usually are. One added: “There are always enough staff to cover the needs of residents”. However, concern was voiced that existing staff time is spent shadowing new members of staff. The registered manager said that he makes arrangements as necessary to increase staffing numbers. Staffing records, and discussion with staff, support this. People who use the service are concerned that there is only one member of staff at night per building and that, as the first language of some staff is not English, they may not understand what is needed, especially in an emergency. Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 21 We therefore visited during late evening. Both staff were able to hold a conversation and provide us with detailed information toward the inspection. Both have now worked at the home since the spring 2007. Both knew how to contact the ‘on call’ senior carer, and the manager, as necessary. The registered manager said he asks questions of staff when they are given instruction or training so that he can judge their comprehension. He says that now he is exclusively responsible for recruiting new staff he can ensure their understanding of English is satisfactory. A member of staff said: ”In the future staff from abroad need to be integrate better. Unfortunately, nobody had experience with the foreign staff and in the beginning was really very different”. The home employs twelve care staff. Of these there are two qualified as nurses in their country of origin (but not practicing as nurses at Venn House). One has achieved National Vocational Qualification (NVQ) level 2 in care and is undertaking level 3, and five are undertaking level 2. The cook has achieved NVQ 2 in Food Safety. These qualifications are indicators of staff competence. The last two staff employed at Venn House, which was in March and April 2007 have previously had their recruitment records examined during an inspection visit. Both had started employment once the list of people unsuitable to work with vulnerable adults had been checked but prior to full checks. Both had testimonials instead of named references. They did not have a named supervisor, required until all necessary checks are in place. The registered manager, although clear that the senior on duty would have been the supervisor, said that there was no record that they undertook that responsibility. We consider this standard cannot be fully tested until new staff have been employed. Night • • • • • • staff listed the training they had received since spring 2007: Mediation Dementia care Fire safety Moving and handling people Food hygiene Use of the hoist One staff member said: I did not feel confident with the “fire procedures and fire drills” at first whilst another gave a detailed account of what to do if the fire alarm sounds at night. There have been no new staff at Venn House to receive induction since spring 2007 and so the standard cannot be properly tested. However, the registered manager is now promoting training at the home. Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 22 Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 37, & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are now living and staff working in a much safer home, run by a competent manager, who has a good understanding of his responsibilities and how to run a home well. The Registered Provider, Venn Care Ltd, does not meet its statutory responsibilities. EVIDENCE: Paul Reilly was registered as manager in June 2007. The Commission therefore believes him to be competent and suitable to run a Care Home. There have been continuing improvements in the day to day running of Venn Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 24 House. The home is better organised and managed and generally people are happier. We believe people at the home are now safe. The relationship between the Registered Manager and the Registered Provider is an important one, each has different a different role and responsibilities. It is of importance that decisions, such as the appointment of staff and staffing numbers, are now in he hands of the registered manager, who has day-to-day responsibility for the home. There are now the beginnings of a quality assurance system in place at Venn House. This includes meetings for people who use the service and staff. The four staff surveyed said they received regular supervision from the registered manager and supervision records were seen to support this. There are also systems for monitoring staff practice including regular checks of medicine records to ensure that they are complete. The registered manager states that more improvement is still needed, for example, anonymously surveying opinion form people using the service, staff and health and social care professionals. The way the home manages people’s money was examined. Most look after their own finances. Where money is spent on their behalf, for example a hairdresser visiting, people are invoiced. A small amount of money was being kept for two people with a record of the balance. The Registered Provider for Venn House is a company: Venn Care Ltd. As a company there is a requirement that a representative from that company should visit the home (unannounced) each month, and report on the running of the home. As part of this visit the person must consult with Service Users. A copy of the report made as a result of this visit must be sent to the Company and to the Commission. Requirements have been made with regard to these visits at previous inspection, however the Commission has still received no reports. The Regulations also place a duty on the Registered Provider to inform the Commission of certain types of incidents: this includes any allegations of misconduct by staff or events that adversely affect the well being of any Service User. Not all such incidents have been reported to the Commission. These include misconduct. This was discussed with the registered manager who is still unsure when he should and should not report. He is advised to do this where there is any doubt. As part of this inspection some of the health and safety documents were looked at. We found these to be satisfactory. The registered manager is starting to update the home’s policies and procedures now that other priorities have been met. These must be in line with legislation and in the best interest of people using the service. Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 25 Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 26 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 3 2 2 Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES 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 OP9 Regulation 13(2) Requirement All medicines must be checked into the home on arrival, with records kept, so that full audit is possible at any time. This protects people from mistakes or mishandling. There must be a record of when medicines, prescribed to be taken ‘as necessary’ or ‘as required’, may be administered. This must be part of care planning and risk assessment so that medicines are given in a consistent and safe way. The Registered Provider must confirm in writing to the Commission that foul laundry at the home can be washed at 65 degrees for 10 minutes and the home’s washing machines have the specified programming available to meet disinfection standards and comply with the Water Supply (Water Fittings) Regulations 1999, so that people can be assured the risk of cross infection is properly managed. Before a prospective member of staff starts work at the home DS0000065984.V348805.R01.S.doc Timescale for action 31/10/07 2. OP9 13(2) 31/10/07 3. OP26 16(2)(j) 30/11/07 4. OP29 19 (1) (b) 01/10/07 Venn House Version 5.2 Page 28 5. OP30 19(11) 6. OP31 26 7. OP38 37 checks must be made to ensure their suitability. These checks must include obtaining: - a complete work history, with no gaps. - and verifying two pertinent work references. - a POVA First Check if the person is to start before their Criminal Records Bureau check has been returned. (A similar requirement was made on 2/8/06 to be met by 6/9/06, and on 4/4/07 to be met by 1/5/07). Not tested as no new staff employed. New staff who have a completed 01/10/07 POVA First Check but who do not have a Criminal Records Bureau check must only work with a named supervisor. (A similar requirement was made to be met by 6/9/06, 1/5/07 and 01/08/07) 31/10/07 The Registered Provider must arrange for unannounced monthly monitoring visits to establish the conduct of the home, this must include consulting with Service Users. Copies of reports made during these visits must be forwarded to the Commission. (A similar requirement was made to be met by 1st. October ‘06 and 1st. June ’07) Reports of all incidents, specified 31/10/07 in the regulations, such as allegations of staff misconduct or serious incidents that adversely affect the well being of staff must be supplied to the Commission so that people using the service are fully protected. (A similar requirement was made to be met by 01/06/07) DS0000065984.V348805.R01.S.doc Version 5.2 Page 29 Venn House 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 OP1 Good Practice Recommendations The Statement of Purpose and Service User’s Guide should Make clear as who may or may not be admitted to the home under its current registration. This will prevent misunderstandings and disappointment. The controlled drugs book should have numbered pages so that it will be obvious if pages are removed. This will reduce the likelihood of misuse of drugs. There should not be inconsistencies in the complaints procedures, which should correctly inform people using the service how to make a complaint. Records of complaints should be more detailed so that, whether considered minor or more serious by the manager, the person can be assured it has been dealt with thoroughly. The home’s policies and procedures, on the safe handling of laundry and prevention of cross infection, should be reviewed in line with the Department of Health Infection Control Guidance for Care Homes 2006. All people using the service, including staff and health and social care professionals, should be able to give opinion about the home anonymously and there should be an annual development plan for the home, based on a systematic cycle of planning –action – review. This will then ensure the home is run in the best interest of people using the service. 2. 3. 4. OP9 OP16 OP16 5. OP26 6. OP33 Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Venn House DS0000065984.V348805.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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