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Inspection on 21/09/05 for Verulam House Nursing Home

Also see our care home review for Verulam House Nursing Home for more information

This inspection was carried out on 21st September 2005.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home`s environment is always well maintained and attractive and there is enough space for residents to choose where they will spend their day and to be able to vary their surroundings. A high importance is given to food provision in the home and menus continue to offer choices of meals, which are planned to high standards and use only fresh produce. Residents are given monthly information of the activities, which have been planned, and these are imaginative, varied and stimulating. A high score has been given to the areas of food and activities in this report. Residents and staff are able to express views about the running of the home, and are listened to. Staff training was not formally assessed on this occasion but it is apparent that this is another area which is maintained at a high level and Verulam has achieved the target, set out in the National Minimum Standards, of having at least 50% of care workers trained to NVQ level 2 or above in 2005. Currently 64% of care staff in the home are trained to this level. Verulam is a home where residents have high expectations for their day-to-day lives and where the staff and management work to provide these high standards.

What has improved since the last inspection?

The system for care planning has been changed and improved and work is continuing to include all aspects of individual needs in these plans. Residents and staff have been consulted about staffing arrangements and new shifts and work patterns have been introduced and praised by staff and residents. The new manager has introduced a Team Building Committee for staff where representatives from all staffing groups can discuss issues and plan social events. Activities for residents are now provided on two evenings each week as well as during the day, which has been welcomed by many of the more able residents in the home.

What the care home could do better:

Any areas where improvements to care provision could be made, appear to be in hand, such as more detail of social history and risk assessing. Consequently, no requirements or recommendations have been made in this report.

CARE HOMES FOR OLDER PEOPLE Verulam House Nursing Home Verulam Road St Albans Hertfordshire AL3 4DH Lead Inspector Pat House Unannounced Inspection 21st September 2005 10:00 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 Verulam House Nursing Home DS0000019601.V254508.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. Verulam House Nursing Home DS0000019601.V254508.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Verulam House Nursing Home Address Verulam Road St Albans Hertfordshire AL3 4DH 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) 01727 853 991 01727 855 059 Verulam Health Care Limited Anne Schofield Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50), Terminally ill over 65 years of age (5) of places Verulam House Nursing Home DS0000019601.V254508.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Within the overall capacity, this home may accommodate up to 5 service users, 55 years of age of over, who require Terminal Care. Within the overall capacity, this home may accommodate 50 older people who require nursing or convalescent care. Within the overall capacity, this home may accommodate 5 service users between the ages of 55 and 64. 15th April 2005 Date of last inspection Brief Description of the Service: Verulam House provides nursing and personal care to older people and is registered to provide terminal care for 5 people over 65 and 5 people aged between 55 and 64 years. The home is a three storey listed building, with a passenger lift and most of the 50 bedrooms have en-suite facilities. The building was formerly the Bishop’s Palace and has been extended to provide a high standard of accommodation, whilst retaining many original features. There are two main lounges, an activities room, a large dining room and a converted Chapel, all providing spacious communal areas on the ground floor. The residents’ bedrooms are all individual in style and size although most are large. There is parking to the front and side of the building and there are large, well maintained gardens to the rear and patio areas near to the house. Verulam House is situated in the heart of St. Albans and is within walking distance of all the shopping, leisure and transport facilities, which are available in the city. Verulam House Nursing Home DS0000019601.V254508.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day with two inspectors. Residents, one visitor and staff were spoken to and all areas of the home were visited briefly. Care plans and some staff records were checked and some administration of medication and the mid-day meal were seen. A new Manager and Deputy have been appointed since the last inspection and the Manager has been registered with the CSCI. During the visit staff and residents praised the new Manager and senior staff and said they felt confident in these appointments. Currently there is one on-going investigation being conducted under the Protection of Vulnerable Adults procedure. The management at the home have handled all issues appropriately and the home’s procedures comply with Hertfordshire County Council guidelines. What the service does well: What has improved since the last inspection? The system for care planning has been changed and improved and work is continuing to include all aspects of individual needs in these plans. Residents and staff have been consulted about staffing arrangements and new shifts and work patterns have been introduced and praised by staff and residents. The new manager has introduced a Team Building Committee for staff where representatives from all staffing groups can discuss issues and plan social events. Activities for residents are now provided on two evenings each week as well as during the day, which has been welcomed by many of the more able residents in the home. Verulam House Nursing Home DS0000019601.V254508.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. Verulam House Nursing Home DS0000019601.V254508.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 Verulam House Nursing Home DS0000019601.V254508.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): 3. Standard 6 does not apply to this home. Full assessments are in place for all service users who enter the home so that staff can ensure that all individual needs are met. EVIDENCE: Records were seen for a resident who had recently entered the home. A full assessment had been received from the referring Local Authority, and a detailed assessment and care plan had been produced by staff at the home. The resident had initially received respite care at Verulam and had subsequently decided to become a permanent resident. Verulam House Nursing Home DS0000019601.V254508.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 and 9. All service users in the home have detailed care plans in place and their health care needs are fully met. The systems for administering medication ensure that service users’ well being is promoted. EVIDENCE: A new system for individual care planning has been introduced by the new Manager. These new records contain greater detail and include improved risk assessments for social activities. All new plans are being reviewed as they are completed and staff will be gradually involving the residents in these and obtaining new signatures as they are agreed. The care plans checked had appropriate risk assessments in place, including those for bed rails. Moving and Handling risk assessments are kept discreetly in residents’ bedrooms to ensure that all staff are aware of the up to date plan for each individual. Evidence was seen of regular health checks taking place and residents confirmed they saw dentists and chiropodists. One resident had had new teeth fitted the previous day and was awaiting an appointment for a hip operation. Residents confirmed they had their own individual zimmer frames and wheelchairs. Some residents spoken to confirmed that they maintained their own personal care and one lady said she also liked to make her own bed and that staff supported her wishes. Verulam House Nursing Home DS0000019601.V254508.R01.S.doc Version 5.0 Page 10 The administration of medication was observed and records were checked. There were no errors found and the Manager said that the supplies of drugs not included in the pre-packed blister system were continually audited. A new contract was being set up with a company who will be dealing with the return of such medication. Staff confirmed that only seniors administer medication in the home and that there is on-going training for these staff. One member of staff had completed a BTEC course in Advanced Medication and said that more staff training was planned. Verulam House Nursing Home DS0000019601.V254508.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): 12, 14 and 15. Service users are offered stimulating recreational interests in the home and are supported by staff to maintain control over their own lives. The meals provided are of an extremely high standard and help to promote the well being of service users. EVIDENCE: There are two Activities Organisers employed at the home and they produce a monthly Activities Programme, which is distributed to all residents. Copies of these programmes were seen in residents’ bedrooms and those spoken to said there was a wide range of events, which they could join in with if they chose. Activities include gentle exercises and ball games, quizzes and mentally stimulating games, flower arranging, film shows, painting and drawing and trips out. Lectures and group discussions are arranged and Holy Communion takes place during the month. There was a quiz in progress in one of the lounges during the visit. The range of activities offered is imaginative and varied and the Organisers now also arrange events on two evenings each week after supper. The Organisers have a shopping trolley from which residents can purchase small items and will assist care staff to escort residents to hospital appointments if there is no family member available. Most residents have families who handle their financial affairs, but one resident currently manages their own money and two residents maintain their own benefit books. Verulam House Nursing Home DS0000019601.V254508.R01.S.doc Version 5.0 Page 12 Most of the bedrooms have been personalised by the residents, many of whom have brought their own furniture with them to the home. There had been a recent talk given to all residents who were interested, by an external agency, explaining the Advocacy services available. All residents have been given an information leaflet about Advocacy and how to access this resource. Staff were aware that residents could have access to personal records on request, subject to the Data Protection Act. Residents spoken to said there were residents’ meetings held at the home where they could raise any issues they wanted to. They all felt there were no restrictions on how they spent their days and said their personal choices were always respected by staff. Those spoken to also praised the meals provided at the home and confirmed they had a choice of food at each meal. Menus are planned on a four weekly cycle and a selection of these records were seen during the visit. The meals offered are varied and of a high standard. The chef uses fresh produce and vegetables in season and puddings and cakes are all home made. During the visit the main meal was enjoyed in a very relaxed atmosphere and was clearly enjoyed by the residents. Verulam House Nursing Home DS0000019601.V254508.R01.S.doc Version 5.0 Page 13 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. The home’s policies and procedures ensure that all complaints and concerns are listened to and dealt with appropriately. EVIDENCE: The residents spoken to confirmed they were aware of the home’s Complaints Procedure and said they would not hesitate to voice any concerns they might have. One relative who was visiting the home said she had a copy of the home’s Service Users’ Guide, which had details of the Complaints Procedure included. Residents also said they could raise issues of concern at the Residents’ Meetings which were held in the home. There had been two complaints made in the last twelve months, which had both been investigated and dealt with in accordance with the home’s written policies. Verulam House Nursing Home DS0000019601.V254508.R01.S.doc Version 5.0 Page 14 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. The home provides a safe, pleasant and well-maintained environment for the benefit of all the home’s residents. EVIDENCE: The home has a programme of continual maintenance and decoration and rooms were all well presented, especially the communal rooms, which looked very attractive. All areas of the building were clean and accessible to residents and the grounds looked very attractive. The refurbishment of the shower room on the first floor has been completed and this facility is now being used by residents. The laundry has had air conditioning installed and there are plans to replace one of the home’s freezers. The bath in the top floor bathroom is still chipped, however, but the Manager said that there are plans to refurbish this room in the near future. Verulam House Nursing Home DS0000019601.V254508.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, 28 and 29. Staffing numbers and levels of training in the home are good and, together with the thorough recruitment procedures, ensure that residents are appropriately cared for and protected at all times. EVIDENCE: There have been on-going reviews of staff numbers and staff deployment since the last inspection and residents generally felt that there were sufficient numbers on duty and that their care needs were all being met. Those staff who were spoken to confirmed that staff numbers and rotas had been discussed at their regular meetings and that they were very happy with the present shift patterns. Extra care staff are now employed at the two busiest times of day and all staff have chosen to work mainly in particular areas of the home, although this work pattern is flexible. The domestic staff spoken to confirmed that they were always included in the regular staff meetings, and all staff said they felt supported by the seniors and management in the home. The new Manager has established a Team Building Committee, which consists of representatives from all sections of staff, including night staff and domestic staff. This committee will look at any issues that arise for staff and will also arrange social functions. The home has achieved the training target set out in the National Minimum Standards, which recommends that at least 50 of care staff are trained to NVQ level 2 or above by 2005. Currently 20 of the 31 care workers in the home are trained to this level or above. A sample of recruitment files were examined during the visit and all appropriate checks were in place and good procedures were being followed and recorded. Verulam House Nursing Home DS0000019601.V254508.R01.S.doc Version 5.0 Page 16 One new staff applicant was interviewed during the visit and she was also given a thorough tour of the home and given details of day-to-day procedures. Verulam House Nursing Home DS0000019601.V254508.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): 38. Policies and procedures in the home ensure that the health and safety of the residents is promoted at all times. EVIDENCE: Residents in the home confirmed that fire alarms are tested weekly and that there are regular fire drills. All hazardous substances were locked away during the visit and any fire doors, which were open, had fire safety devices fitted. An oxygen cylinder seen in one room was placed on an appropriate stand and there was a warning notice displayed on the door, as regulations require. Hot water was being delivered at safe temperatures but staff were reminded that bathrooms should not be used for storage, and some zimmer frames were removed from one bathroom. Call alarms were all seen appropriately place near to residents who were in their bedrooms. One resident activated her alarm during the visit, and this was answered promptly. Verulam House Nursing Home DS0000019601.V254508.R01.S.doc Version 5.0 Page 18 One resident currently uses a recliner chair in her bedroom and there is a similar chair for the residents’ use in one lounge. The Manager will risk assess both these chairs in accordance with current guidelines. Verulam House Nursing Home DS0000019601.V254508.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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 x 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 3 x x x x x x x STAFFING Standard No Score 27 3 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x x x 3 Verulam House Nursing Home DS0000019601.V254508.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Verulam House Nursing Home DS0000019601.V254508.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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