Inspection on 06/03/07 for Verulam House Nursing Home

This inspection was carried out on 6th March 2007.

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

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

Other inspections for this house

Verulam House Nursing Home 24/02/06

Verulam House Nursing Home 21/09/05

Verulam House Nursing Home 15/04/05

Verulam House Nursing Home 29/06/04

Verulam House Nursing Home 25/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Verulam House Nursing Home Verulam Road St Albans Hertfordshire AL3 4DH Lead Inspector Lysette Butler Key Unannounced Inspection 6th March 2007 09:45 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.V332044.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. Verulam House Nursing Home DS0000019601.V332044.R01.S.doc Version 5.2 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) of places Verulam House Nursing Home DS0000019601.V332044.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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. 24th February 2006 Date of last inspection Brief Description of the Service: Verulam House provides nursing and personal care to older people and 5 people aged between 55 and 64 years, to a total of 50 residents at any one time. The home is a three storey listed building, with two passenger lifts and the majority of the 47 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 with a third on in the residential unit. There is also a separate activities room, a large dining room and a converted Chapel, all providing spacious communal areas on the ground floor. The residents’ bedrooms are 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. Current Fees: Residential - £750-£850 Current Fees: Nursing - £850-£1000 Verulam House Nursing Home DS0000019601.V332044.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection that included: a site visit on 6th March 2007, which lasted 7 hours. Inspectors reviewed evidence supplied by the proprietor, residents, visitors to the service and the staff; resident, visitor, healthcare professionals and staff surveys; and undertook discussions with the registered manager, senior carers, care staff, ancillary staff, residents and relatives. During the site visit the premises were inspected, including inspection of the grounds. Samples of records and residents care plans were also reviewed. The home was clean, airy and well maintained. The overall care and well being of the residents was the focus of the inspection. Staff and residents were welcoming and happy to speak to the inspector at the site visit. This inspection covered all twenty-two key standards and nine of the remaining standards. The manager, proprietors and their staff approached the inspection in a positive and cooperative manner that was focused on achieving best practice to meet the needs of the residents. What the service does well: What has improved since the last inspection? This inspection was a full key inspection, undertaken by two inspectors who had no previous knowledge of the home. Therefore comparisons with the service previously are not applicable to this report. Verulam House Nursing Home DS0000019601.V332044.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Verulam House Nursing Home DS0000019601.V332044.R01.S.doc Version 5.2 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.V332044.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessment of prospective residents’ needs is detailed and uses all information available about each individual. The home has an effective pre-admission process that ensures that it can meet the individual’s needs, and ensures that appropriate admissions are made. EVIDENCE: The inspectors reviewed the Statement of Purpose and a Resident Guide as part of this inspection process. Both documents are detailed and user-friendly. There is also cross-referencing with specific policies as appropriate throughout both documents. Details of what services are provided as part of the weekly fee are extensive and make it clear what extras residents and their families will need to pay for. However the Commission for Social Care Inspection is not correctly named within the statement of purpose. (Appropriate changes were made to both documents before this report was published.) Verulam House Nursing Home DS0000019601.V332044.R01.S.doc Version 5.2 Page 9 Five resident care plans including the two newest admissions to the home were sampled. All five care plans contained the information required for an appropriate and effective admission into the home. Comprehensive hospital discharge assessments/nursing needs assessments were found on the files along with the home’s own pre-admission document. The home’s preadmission assessment document included information covering all aspects of the resident’s care needs both present and future. One of the residents commented that they were fully involved in the pre-admission planning process, and stated that the staff had been very “….supportive and asked me what I needed,” and that “…..since I moved here my health has been changing and I need more help, the staff are up to date with everything”. The care plans are generated by the pre-admission information resulting in the care plans being full of detail, directive to staff and provide a holistic picture of the individual. Intermediate care is not offered at this home. Verulam House Nursing Home DS0000019601.V332044.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 - Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Health, personal care, social and emotional needs are set out in individual care plans, and satisfactorily cover all key needs and provide sufficient details of the action required by staff. Medication procedures ensure the safety of the residents in this home. Staff treat residents with dignity and respect their privacy. EVIDENCE: Five care files were examined on the day of the inspection. All contained detailed information regarding the resident’s needs, the action to address the needs, and the long-term aim of the care given. The care plans covered all aspects of a resident’s physical, mental and social needs, and evidence indicated that they are reviewed on a monthly basis. The care plans are comprehensive and detailed, the level of information is good, well written, informative and directive to staff. All but one of the care plans contained a detailed risk assessment that enabled staff to identify and manage individual Verulam House Nursing Home DS0000019601.V332044.R01.S.doc Version 5.2 Page 11 risks. The one care plan that did not contain a risk assessment did identify the risks throughout the file, the deputy matron agreed to have a risk assessment drawn up immediately. There was evidence that residents signed care plans and were involved in the planning process. Residents spoken with confirmed that the staff in the home provided them with a good level of support and assistance. They commented “I trust the staff to give me what I need” and that staff “…..do a great deal to look after all of us”. Staff were observed treating residents with care and sensitivity, addressing residents appropriately and demonstrating a genuine level of care. All of the residents spoken with commended the staff with regard to the treatment they received in Verulam House. The residents stated that their privacy and dignity was maintained in a variety of ways, including the way staff provided personal care, toileting issues, respect for visitors, and the provision of specific areas in the home that enabled residents to see visitors in private. Observation of staff during the inspection indicated that staff are friendly, considerate and respectful toward residents. Residents commented that the “….staff are wonderful” and “….respect me as a person,” they “…..treat me with respect at all times”. The residents confirmed that the home’s routines were relaxed and that this made them “….feel even more at home”. Health-care needs of residents at this home are met on all levels. Some of the registered nurses in this home have separate responsibilities with regard to health care issues. One has recently undertaken a tissue viability course, as there is no local specialist nurse available in the St Albans district. Other nurses have undertaken continence training and there are six moving & handling trainers within the home, including the manager and training director. At the time of the site visit one of the registered nurses was undertaking a degree in palliative care, which was particularly relevant to this home, as the number of new admissions with palliative care needs had been rising. A number of the nurses at this home are able to take bloods as necessary to reduce the number of trips to hospital residents have to make. At the time of this visit there were was only one resident with a pressure sore, which they were admitted with. Pressure relieving equipment was seen in use throughout the home. Mattresses were predominantly owned by the home however can also be rented in if there is a need. Care plans for wounds are detailed and instructive; they are updated regularly, the frequency or review dependant on progress. Verulam House Nursing Home DS0000019601.V332044.R01.S.doc Version 5.2 Page 12 Every resident is registered with one of the local GPs. If a new resident moves into the home from out of the local area and does not have a current GP the local PCT is contacted for a list of GPs accepting new patients. A chiropodist regularly attends the home and sees all residents on a regular basis. However if individual residents want to see a different chiropodist either they or the home can arrange this for them. The care assistants compile a list of who needs or wants to see the chiropodist for each of their visits. There is no local community dentistry available therefore any residents who need dental care and does not have a dentist locally are referred to St Albans Hospital dental service. However a dental technician who fits and maintains the dentures of all those residents who need them, regularly visits the home. Opticians come into the home on request and offer a good service to all those residents who require it. The home’s medication policies & procedures, and risk assessments, are good and are followed well by all staff involved with medication administration. One resident was self-administering medications at the time of this visit. The matron keeps a current list of signatures of the nurses and care assistants, who administer medications. (Care assistants only administer medication in the residential unit.) No omissions in medication administration records were noted during a review of documentation. All medication administration records contain a picture of the individual resident, however none of the pictures were dated and the inspectors recommended that this be done to indicate how fast any deterioration in health has occurred. Non-administration and changes to treatment were all signed and dated appropriately. During this visit the inspectors spoke to the head of care on the residential unit, who was very knowledgeable about the medications prescribed and was happy with the level of support she was offered by the registered nurses, deputy manager and manager. The nurses take blood tests for Warfarin levels and the results are faxed to the home. The amount of Warfarin to be given is then documented on the medication administration records, dated and signed. Copies of the faxed results are kept in the medication administration records file, for reference. Documentation showed that pulses were taken for all residents on Digoxin, before it is given. Blood sugar levels are taken before insulin is given to diabetic residents. Warfarin and insulin doses were on separate charts to ensure clarity and safe administration. Temazepam is kept in the controlled drugs cupboard and records were complete when reviewed. There was only one controlled drug in the home at the time of this visit, which was correctly documented when reviewed. Verulam House Nursing Home DS0000019601.V332044.R01.S.doc Version 5.2 Page 13 Residents spoken to said that their privacy and dignity was preserved at all times by the nursing and care staff. They stated that all staff were friendly, happy in their work and “……did not bring their problems to work with them.” Verulam House Nursing Home DS0000019601.V332044.R01.S.doc Version 5.2 Page 14 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 excellent. This judgement has been made using available evidence including a visit to this service. The home provides an environment that meets the social and recreational preferences of the residents. There is a full range of activities to meet the residents’ varying needs. It provides the residents with flexibility and choice with regard to their daily lives. Their expectations and preferences with regard to lifestyle are well met. Residents are provided with a wholesome, nutritional and appetising diet. The residents are enabled to exercise choice over what they eat. EVIDENCE: The home’s activity programme offers a variety of social activity that is appropriate to the needs of the residents. The care plans sampled detailed the social and leisure needs of the residents and identified the history of interests and social activity. The residents were observed spending time in various parts of the home, communal areas and in their bedrooms. Residents confirmed that they were consulted regarding the entertainment brought in from the outside and that they were consulted prior to any changes being made. They also confirmed that the home provided a variety of activities in line with their Verulam House Nursing Home DS0000019601.V332044.R01.S.doc Version 5.2 Page 15 preferences. On the day of inspection staff provided one to one nail care and in the afternoon the residents’ could participate in a word game activity. The activity co-ordinator confirmed that the home was planning a week of activity that included reminiscence activities, ‘war time’ recipes being used at mealtimes and a trip to a London museum. The four residents spoken with confirmed that “there was always something to get involved in” and that the home provided “fantastic range of activity for all the people living here, but if you did not want to participate it was your choice.” Activities were offered seven days a week and on two evening each week. The evening activities included card games, trips to the theatre and cinema. Residents spoken to confirmed that they felt that they had choices in their daily lives (e.g. where and how to spend their day, what to eat, when to go to bed, etc.). On the day of the inspection, as previously noted residents spent time in the communal area of the home with their relatives and the staff. Residents commented that there “….are no restrictions on me”. Resident choice is observed throughout the day and the staff were supporting choices made by residents rather than making choices for individuals. Staff are very clear regarding this issue and stated that the policy of the home is that the care is “….resident led”. The staff are genuinely caring, polite and professional in their dealings with the residents and provide care in a discreet and quiet manner. On more than one occasion the staff were observed taking time to speak with residents, having a laugh and chat and were obviously aware of the individual needs of the individuals. The atmosphere in the home was calm and soothing and was suitable to the residents’ needs. The four-week menu was reviewed and reflected that the home provides residents with a variety of well-balanced, nutritional and high quality meals. The kitchen was well organised, the food stocks were substantial and of a high quality. Meals are freshly prepared and cooked by the chef who has a great deal of experience. The chef and the assistant are knowledgeable and skilled; they were committed to providing good wholesome meals to the residents. The meal presented on the day was appealing and was served with a range of refreshments. The home also offered a choice of meals and an alternative. The residents and relatives stated that the quality of food in the home was “excellent”. Residents confirmed that the meals provided in the home were “….good, appetising and more than enough” and “….fantastic, great choice and well cooked”. Fresh fruit, chocolates, biscuits, and cakes are available throughout the day, and residents confirmed that they could have a drink or snack at any time. When required, meals are served ‘softened’ and special dietary needs are catered for. The chef stated that the home has always endeavoured to provide high quality meals for residents and used a Verulam House Nursing Home DS0000019601.V332044.R01.S.doc Version 5.2 Page 16 combination of mainly fresh and frozen ingredients. The chef confirmed that the meals are made ‘from scratch’ and this was in evidence on the day. Verulam House Nursing Home DS0000019601.V332044.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The policies and procedures followed in his home ensure that all the residents are protected and safe. EVIDENCE: Since the last inspection there has only been one complaint made to the manager, which was regarding the poor quality of food over a specific weekend. The reviewed documentation demonstrated a good response by the manager who had interviewed the resident concerned and spoke to the agency chef. All residents reported that the food was good at all times. (See Daily Life and Social Activity section.) There have been no Protection of Vulnerable Adults issues in the home since 2005. The manager, on questioning, was clear about her role in any investigation, but was concerned about the poor response from the local Adult Protection Service at the previous incident. There is a copy of the Hertfordshire Protection of Vulnerable Adults policy in the home and the inspector discussed the fact that the response would probably be better now to any issues that arise. Every employee is given a copy of the homes own Protection of Vulnerable Adults information booklet, which covers prevention and recognition of abuse. All staff training regarding Protection of Vulnerable Adults was up to date at the time of the site visit. Verulam House Nursing Home DS0000019601.V332044.R01.S.doc Version 5.2 Page 18 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, 20, 21, 22, 23, 24, 25 & 26 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Verulam House is highly maintained and provides a homely, warm and welcoming environment. The accommodation is of a comfortable and safe standard with excellent levels of hygiene. Specialist equipment and aids are available to promote optimum independence and well-being. EVIDENCE: The home is clean, bright and airy and has a homely feel. A running redecoration and maintenance programme to maintain and improve the environment is in place and is evident when touring the premises. The home has a maintenance person; both he and the manager oversee the maintenance and safety of the premises. Communal lounges are homely and the home has a secure garden area, which is both well maintained and laid out. On the day of inspection all areas of the home were warm and inviting. Verulam House Nursing Home DS0000019601.V332044.R01.S.doc Version 5.2 Page 19 The home is well decorated and furnished, which enables residents to feel at home. The home smells clean and fresh; the cleaners observed and spoken with on the day take a great deal of pride in their work. One resident said that “…..this is my home, I’m allowed to layout my things as I wish to and I have such a lovely view.” All but three rooms are ensuite in this home. The temperature of the hot water from the taps is being recorded on a weekly basis. The staff spoken with reported that they had received infection control training and had found this helpful in identifying risks. The home provides staff with policies and procedures and training regarding levels of hygiene and safe care practice. The laundry area is clean and well maintained; the washing machines have appropriate wash cycles to prevent cross infection. The sluices used in the home are well maintained and were secure on the day. The home has succeeded in providing residents with a ‘home from home’ environment. The proprietors and manager are committed to the residents and provide them with comfortable and homely surroundings. Verulam House Nursing Home DS0000019601.V332044.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 excellent. This judgement has been made using available evidence including a visit to this service. There is a stable and loyal staff team, which ensures consistency in the delivery of care, from which the residents benefit. The recruitment procedures are robust and ensure the ongoing protection of the residents. EVIDENCE: Staffing levels within the home were good, in-line with the dependency levels of the current residents. All residents’ dependency levels are assessed on admission and at regular intervals, then staffing needs are recalculated using a computer program to ensure that there is the right staffing levels and skill mix at all times. The home employs a wide variety of staff to cover all aspects of care including registered nurses and care assistants; activities staff; laundry and kitchen staff; housekeeping and maintenance staff; a staff of trainer and separate residential care staff. The manager and her deputy have separate responsibilities, but worked very well together. Staff spoken to were happy to speak to the manager if they needed to. Twenty-three staff have achieved National Vocational Qualification Level 2, or above, which corresponds to approximately 75 of the care staff team in the Verulam House Nursing Home DS0000019601.V332044.R01.S.doc Version 5.2 Page 21 home holding the qualification. The manager has the Registered Managers Award - Level 4 and the training director is a National Vocational Qualification assessor. The manager provided evidence of carers’ individual training and development files. These contained evidence regarding induction and mandatory training undertaken by carers prior to working with residents. Staff receive key training in the home that includes first aid, fire training, food hygiene and manual handling. Additional training includes: protection of vulnerable adults, medication training, managing aggressive behaviour, Health & Safety, first aid and dementia training. The home provides a thorough induction and foundation programme that meets the Skills for Care specification. The home has a training budget and has an appointed training manager who is in the home three days a week. Individual and group records are available and indicated the programme of training provided by the home. Staff commented that “….the training given by the home is good” and “I have had training that helps me to do my job better”. The staff spoken with and staff personnel records of the three newest member of staff employed by the home, confirmed that all pre-recruitment checks are completed prior to employment. The staff files contained references, application forms, Criminal Reference Bureau checks, personal identification, photograph and contract of terms & conditions for staff. The files of registered nurses contained an up to date Nursing & Midwifery Council registration Personal Identification Numbers. The file of the newest recruited employee confirmed that they had received a full induction programme, and had shadowed a senior care worker until they were assessed as fit to work alone. The manager is fully aware of all the checks that are necessary prior to the employment of staff and is currently achieving this. Verulam House Nursing Home DS0000019601.V332044.R01.S.doc Version 5.2 Page 22 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, 36 & 38 - Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home has systems in place that safeguard the residents’ finances, health & safety and continuing improvement of their care. EVIDENCE: There has been no change to the management of this home since the last inspection. Staff and residents were happy that the lines of accountability within the home were appropriate for their needs. The proprietors were readily available to staff, residents and visitors, if required. The deputy manager was supernumerary for approximately 50 of her weekly hours. All residents, staff and visitors, when questioned, said that they were very happy at the home Verulam House Nursing Home DS0000019601.V332044.R01.S.doc Version 5.2 Page 23 and felt that all the staff, management and proprietors “….make it as much like home as is possible.” There had been a recent residents’ questionnaire, which had been distributed previous to the site visit. The results showed a return rate of 63.8 , with a 90 response saying the home was ‘as expected or better that expected.’ The remaining 10 raised issues that the manager was going to address either individually with the residents, or at the next residents’ meeting. These questionnaires are sent out on a regular basis. Regular audits of care plans; wound care; catheter care; medication procedures; and other relevant areas of care are undertaken by the manager, her deputy or registered nurses. All results were available for review on request. The residents’ money is held in a bank account administered by one of the partners, who is an accountant. Each resident has their own customer account within the main account and separate statements can be raised on request. A cashbook is kept monthly and all monies received from the residents and expenses paid on their behalf, are recorded daily. The overall accounting is detailed, up to date and was shown to be correct when reviewed during the site visit. Where possible all cash paid out on the residents’ behalf is signed for by the resident themselves or their relatives if more appropriate. All staff receive regular supervision, which is undertaken by the manager, her deputy, registered nurses, or heads of department. Staff spoken to about supervision felt it was relevant to their work and especially helped during difficult situations. However staff also stated that there was an open door policy at all times for the manager, her deputy and the proprietors, which made them feel that they were able sort out problems in an ongoing process, rather that just at supervision. The administration confirmed verbally and in writing the following information. The home has systems in place that safeguard the resident’s finances. The home does not act as appointee for anyone currently living there. Relatives or representatives deal with most of the residents’ financial issues. The home has a non-interest account that holds residents’ monies. A small float of cash is kept secure in the home. Money received from and spent by the residents is recorded daily. Records are held by the home for all financial transactions and the home’s accountant reviews the accounts of each individual month. Verulam House Nursing Home DS0000019601.V332044.R01.S.doc Version 5.2 Page 24 Staff are aware of the H&S issues and are provided with appropriate training and procedures to decrease the risk to both themselves and residents. Health & Safety responsibility is held by one of the partners and there are three designated health & safety officers at the home. All certificates and servicing records seen at this inspection were up-to-date and appropriate for this home, ensuring the health and safety of the residents. Portable Appliance Testing was undertaken on an ongoing basis so that all appliances are tested at least once a year. During the site visit accident records for the home were reviewed and did not raise any issues regarding health & safety. The most recent checks for Legionella had been undertaken in January 2007. The same firm that undertakes the Legionella checks checked water temperatures regularly. At the time of the site visit there had been a recent Health & Safety Executive inspection regarding back care, which the home had been commended for. The last fire safety assessment of the premises had been undertaken in November 2006. Verulam House Nursing Home DS0000019601.V332044.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 4 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 4 STAFFING Standard No Score 27 4 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 3 3 X 3 Verulam House Nursing Home DS0000019601.V332044.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? N/A 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. 1 2 Refer to Standard OP1 OP9 Good Practice Recommendations The correct name of the regulatory commission should be in the statement of purpose for the home. Photographs on the medication administration records should be dated to ensure that they represent the most upto-date likeness of the resident. Verulam House Nursing Home DS0000019601.V332044.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Verulam House Nursing Home DS0000019601.V332044.R01.S.doc Version 5.2 Page 28 - 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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