Inspection on 20/09/05 for Vermont House

This inspection was carried out on 20th September 2005.

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

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

Other inspections for this house

Vermont House 14/08/07

Vermont House 29/09/06

Vermont House 20/06/05

Vermont House 12/11/04

Vermont House 09/06/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Vermont House 16 Anchorage Road Sutton Coldfield West Midlands B74 2PR Lead Inspector Jill Brown Unannounced Inspection 20th September 2005 09:20 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 Vermont House DS0000016919.V253381.R01.S.doc Version 5.0 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. Vermont House DS0000016919.V253381.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Vermont House Address 16 Anchorage Road Sutton Coldfield West Midlands B74 2PR 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) 0121 354 5060 0121 354 5060 vermonthouse@freenetname.co.uk Vermont Trust Vacant Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10) of places Vermont House DS0000016919.V253381.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20 June 2005 Brief Description of the Service: Vermont House is a detached home situated in a residential area of Sutton Coldfield, close to bus and train routes to both Birmingham and Lichfield. It is a large property that is in keeping with the neighbourhood and can accommodate up to 10 elderly people. The home is owned and run by Vermont Trust Ltd and is exclusively for older people who are Christian Scientists. This faith is probably best known for its reliance on prayer alone for the healing of sickness and disease rather than medical treatment. The aim of the home is to provide long term personal care to Christian Science men and women, almost exclusively over 65 years of age, who rely solely upon the Bible-based method of spiritual healing, Christian Science.” On the ground floor there is a lounge, dining room, sun lounge, good-sized kitchen and two residents bedrooms. On the first floor there are a further eight bedrooms for residents, which are accessible via either a shaft lift or stairs. The second floor of the property is solely for staff use. All of the bedrooms have en-suite facilities. There are toilets & bathrooms on all floors. To the front of the property there is an area of hard standing with room for cars to park, and at the rear of the property there are large private and wellmaintained gardens accessible via a ramped pathway. Vermont House DS0000016919.V253381.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection took place over 4 hours on a day in September. This inspection took place in part as a response to two anonymous complaints. The inspector looked at a resident’s care records and some maintenance records, toured parts of the building, viewed moving and handling of residents and interviewed staff. As the inspection was unannounced not all the standards were assessed, some were partly assessed and some previous requirements were brought forward. What the service does well: What has improved since the last inspection? The assessment information held on residents had improved with clear information coming from previous hospital stays where appropriate. The care plans for residents were improving and the daily assessment and record of residents well being was an improvement on previous information kept. This information ensures that residents are given the care in the way they want. Although moving and handling issues were not always identified before they caused concern, appropriate responses were made to improve situations. The manager had continued to arrange training for staff to meet the required training level. The home continued to improve on its physical environment making all but one bedroom into full en suites. The final bedroom was not being changed at the request of the resident. The home had installed an adapted basin and small area for hair washing. Vermont House DS0000016919.V253381.R01.S.doc Version 5.0 Page 6 What they could do better: 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. Vermont House DS0000016919.V253381.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Vermont House DS0000016919.V253381.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 Residents were appropriately assessed prior to admission into the home and good information is given to residents. This ensures that residents can make an informed choice and the home can meet resident’s need. EVIDENCE: The homes statement of purpose and service user guide were together in one document and the home had evidence that this had been given to the most recent admission. A number of minor changes were needed for this document to meet the requirements. The home’s manager does an assessment of new resident’s need prior to admission into the home. Where the resident has had a stay at the Christian Scientist hospital an assessment from the hospital followed the resident to the home. This assessment contained the information required by the standard. A moving handling assessment from the previous placement, the homes own assessment and risk assessment were present on the case notes. It was confirmed by a staff member and from the inspector’s observation that this moving and handling assessment was correct. Residents in the home met the home’s condition of registration although one resident was seen to have varying needs and this must be monitored. Vermont House DS0000016919.V253381.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7&8 The home had improved on its care planning and monitoring of residents. Some further development of risk assessments would ensure that residents remain safe. EVIDENCE: There was evidence of a care plan, which had been shared with the resident. The care plan reflected the needs outlined in the assessment. The home had developed a daily record system that checked resident’s abilities on a daily basis and had space to record daily events. This recording system met the requirements and was an improvement on previous methods of daily recording. One resident was seen to have difficulty standing on the day of the inspection but the inspector noted that time was given and the resident achieved standing without any unapproved lifting. The home has a moving handling belt and slide sheets available for residents where needed. The inspector also saw from the resident records that the resident had been referred for an assessment from an occupational therapist. The inspector was given a copy of the training chart and all care staff were to receive refresher training in moving and handling in the next week. Vermont House DS0000016919.V253381.R01.S.doc Version 5.0 Page 10 During the visit the inspector saw that a medium to large sized dog came with its owner to visit the home. The dog was not under control and allowed to wander where it chose. It is noted that a number of residents had impaired mobility and this presented an unacceptable risk. While residents beliefs may mean that food intake and weights are not routinely recorded, the manager must ensure that issues of residents being underweight and overweight are addressed in the way care is given and in case of falls. An anonymous complaint stated that a risk assessment pointing out difficulties with moving and handling had been removed and that a bed and a chair were not suitable and had broken. These had been replaced by the time of the inspection. Vermont House DS0000016919.V253381.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not assessed on this occasion. Vermont House DS0000016919.V253381.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Grumble and complaint management were unsatisfactory in the home and this has a poor effect on residents and the service they receive. EVIDENCE: Complaints recorded in the home since the last inspection were from staff about other members of staff and were trivial in nature and need to be managed via supervision, staff meetings and performance management rather than through the complaints system. The manager was said not to handle complaints however a number of staff said that the manager was always pulling them up about things. The Commission has received two anonymous complaints about moving handling issues (described in standard 3 and 8), management (standard 27), fire safety (standard 38), risk assessment (standard 7), equipment (standard 8 and 22), laundry tasks (standard 27), size of rooms (standard 23) and job descriptions (standard 29). Whilst the inspector found elements of these upheld it was clear that this was symptomatic of rigid practices, staff conflict, poor communication and poor change management. Requirements were made for the elements upheld. A number of these matters appear to be based in differing perceptions and personalities rather than inherent poor practices. Unless the matters are dealt with by both the responsible individual and manager it is the inspectors view that is only a matter of time before this seriously effects the good running of the home and service delivery. All homes have received a new edition of the multi agency guidelines for adult protection. These meet the Commission’s requirements. Vermont House DS0000016919.V253381.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 23, 24, 25, 26 The facilities for residents were being improved, however until this work was completed a number of previous requirements could not be met. These still pose risks to residents and must be attended to as soon as the refurbishment is complete. EVIDENCE: The home was clean and fresh on arrival and remained so through the parts of the building inspected. Improvements to the building have been continuous since the last inspection. Residents’ rooms that had toilets in cupboards were now having them changed into proper en suite facilities. A complaint stated that these en suites do not have alarms fitted despite work continuing. The home stated that individual residents have pendent alarms. Where the pendent can be fixed to the wall in the en suite when the resident is bed this will meet the standard. The room with the en suite shower must have a full alarm call sited. A toilet stand must be placed around the toilet identified and shower chairs must be provided. Vermont House DS0000016919.V253381.R01.S.doc Version 5.0 Page 14 Residents’ rooms were individual in nature reflecting residents’ interests and history. One residents’ room had a lot of electrical equipment and not enough electrical sockets although the manager stated that this work is planned a risk assessment on the use of socket gangs must be undertaken to maintain safety. A room was said to be too small to provide the care this was not the experience of all the staff. The resident’s condition is thought to be improving and the room has the benefit of extra facilities the resident wants. Not all rooms have the space for bedside tables due to the en suites. A sidelight was available to allow the resident to read in bed. The home looked into providing a small shelf for residents but the inspector agreed that would provide more risks to the resident. The requirement about providing lockable stores for residents was not assessed on this visit. The home stated that the bedroom with the fire escape is only going to be used for visitors to the home. As the plumbing work in the home still continues some of the hot water outlets remain unrestricted and this is to be resolved when the work is finished. The assisted bathing facility has a probe thermometer to ensure that water is not too hot in the meantime. The requirements to ensure that the seal was repaired around the assisted bath, that hot pipes are boxed in and the laundry floor is repaired, remain outstanding. A hair washing facility has been added to the home since the last inspection. Vermont House DS0000016919.V253381.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30 Arrangements for staffing, management and lines of accountability in the home were not clear. Staffing levels needed to be reviewed to meet the needs of the increasing number of residents. These issues potentially put residents at risk. EVIDENCE: It became clear from the complaints issues that have been raised before with the Commission and during this inspection that staffing of this home was a most contentious issue. The complaint that the manager is not available at weekends is not upheld every person is allowed full days off and is not always on call. The board must determine what arrangements are made at these times such as designated shift leaders, and designated levels of responsibility. The home’s staffing levels must have the capacity to respond to the dependency and numbers of residents. Two sleeping in staff is not safe given the number of inherent risks. In future there must be one waking night staff and one on call as the number and dependency of residents are increasing. The current arrangements fail to safely manage resident’s needs on a night. Extra duties on ‘Board days’ mean extra staff have to be on the rota and there must be a clear separation of management time and care time for the home’s manager Monday to Friday. Vermont House DS0000016919.V253381.R01.S.doc Version 5.0 Page 16 Staff must have job descriptions, it is not necessary for staff to only do care or laundry or kitchen in most small homes multi-tasking is essential. Set times and procedures must be in place for those staff multi-tasking. The rotas of staff on duty must be profiled to the time care is needed by the resident. The inspector did not assess the number of staff that had reached the NVQ2 or check all the staffs Criminal Record Bureau checks on this occasion and these requirements are brought forward. It was clear that staff believed some tasks were outside their job descriptions these must be reissued. The manager was able to show that a remedial programme of training was being undertaken with staff. Vermont House DS0000016919.V253381.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 & 38 Arrangements for auditing the home both by the provider and by monitoring systems were poor and this could lead to residents being left at risk. EVIDENCE: The care manager is a registered general nurse and used to working in pressured environments. She maintains Christian Scientist beliefs. She has applied to the Commission to be the registered manager. There was evidence that the manager had some recent training to ensure that her nursing pin number remained valid. The Commission has received an application from the manager to become the registered manager. The inspector did not assess a quality assurance system in the home or staff supervision records and these requirements were brought forward. The inspector has not received reports of the monthly visit by the responsible individual and these requirements remain outstanding. Vermont House DS0000016919.V253381.R01.S.doc Version 5.0 Page 18 Fire records were inspected these were not organised in a way that confirmed that all routine checks were performed appropriately. There had been a fault in the fire alarm and this is not unexpected with extensive building work. Records from the home’s fire maintenance firm showed that the firm had been called out on several occasions. The home did not have an adequate fire risk assessment. Some required plans of maintenance work had not been sent to the Commission as required. Vermont House DS0000016919.V253381.R01.S.doc Version 5.0 Page 19 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 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 N/A 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 3 X X 2 2 3 X 2 2 STAFFING Standard No Score 27 1 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 1 1 X X X 2 2 Vermont House DS0000016919.V253381.R01.S.doc Version 5.0 Page 20 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 OP1 Regulation 4(1)&5(1) Requirement The homes statement of purpose and service user guide must be revised to ensure it meets the regulations. A formal review must be carried out after the trial period to ensure the placement is appropriate. (This requirement was not assessed on this occasion and is brought forward.) All resident’s risk assessments must detail strategies to manage the risk. Animals brought into the home must be subject of a risk assessment and must be under the control of the owner. They must not be in bedroom, bathroom, dining or kitchen areas. Risk assessments must detail actions to be taken if residents, that have a history of falling, fall. The manager and responsible individual must ensure that systems for dealing with staff complaints are dealt with effectively and within the staff DS0000016919.V253381.R01.S.doc Timescale for action 30/11/05 2 OP5 12(1)(a) 30/11/05 3 4 OP7 OP8 13(4)(c) 13(4)(c) 31/10/05 30/09/05 5 6 OP8 OP16 13(4)(c) 12(5) 14/10/05 31/10/05 Vermont House Version 5.0 Page 21 7 OP21 23(2)(c) 8 OP22 23(2)(c) consultation process. The seal around one bath must be replaced. (This requirement was outstanding since 30/06/05) Call alarms must be available in toilet areas used by residents. En suite facilities must have a call alarm or have the facility for the use of secured pendent alarms on a night. (This remained outstanding since 31/07/05) A toilet stand must be provided in the en suite identified and shower chairs in all showers. All residents’ bedrooms must be provided with a lockable store for valuables. (This was not assessed on this occasion and was brought forward.) All bedrooms must be risk assessed for the use of extension leads and electrical gangs. (This remained outstanding since the 31/07/05) All hot water outlets that residents have access to must have a restrictor that restricts the water temperature to 43 degrees centigrade. (This remained outstanding since 31/07/05) Exposed pipes that get hot must be boxed in. (This remained outstanding since 31/07/05) The laundry room floor must be repaired. (This remained outstanding since 31/07/05) The home must have an awake member of night staff. The managing body for the home must ensure the manager has allowed enough time to fulfil her DS0000016919.V253381.R01.S.doc 31/10/05 30/11/05 9 10 OP22 OP24 23(2)(n) 12(1)(a) 31/10/05 31/10/05 11 OP25 23(2)(c) 13(4)(c) 21/09/05 12 OP25 23(2)(p) 13(4)(c) 31/10/05 13 OP26 13(4)(c) 31/10/05 14 OP26 23(2)(b) 31/10/05 15 16 OP27 OP27 18(1)(a) 18(1)(a) 31/10/05 31/10/05 Vermont House Version 5.0 Page 22 17 OP28 18 OP29 19 20 OP29 OP32 21 OP33 22 OP37 23 24 OP38 OP38 role. 18(1)(a)(c 50 of care staff must be ) trained to NVQ 2 level. (This standard was not inspected on this occasion and was brought forward.) 19 sch 2 All staff and volunteers must have an enhanced CRB check relevant to this home. An application for the relevant people must be made. (This standard was not assessed on this occasion and this requirement was brought forward) 12(5)(a) The home must ensure that all staff have a current job description 12(5)(a) The responsible person and 21 manager must review the structures within the home to ensure effective communication and response to staff concerns. 24 The home must devise a quality assurance system. (this requirement remains outstanding 31/10/04) 26 The responsible individual must visit at least monthly and write a report in relation to the conduct of the care home. These reports must be sent to the Commission. (this requirement remains outstanding from 31/07/04) 23(4) The home must undertake all the fire checks and risk assessments required. 23(2)(b) Work on the five-year wiring certificate must be evidenced as completed. (This requirement was not assessed and remained outstanding from 20/07/05) 31/12/05 31/10/05 31/10/05 31/10/05 31/12/05 31/10/05 15/10/05 31/10/05 Vermont House DS0000016919.V253381.R01.S.doc Version 5.0 Page 23 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 OP29 Good Practice Recommendations It is recommended that the home validate references from the previous employer by either requesting headed paper or a company stamp to accompany the reference. This recommendation was not assessed and will be checked at the next inspection. It is recommended that the cook undertakes the intermediate level food hygiene course. This recommendation was not assessed and will be checked at the next inspection. 2 OP38 Vermont House DS0000016919.V253381.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Vermont House DS0000016919.V253381.R01.S.doc Version 5.0 Page 25 - 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. 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