Inspection on 20/04/05 for Vicarage Farm Nursing Home

This inspection was carried out on 20th April 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

Vicarage Farm Nursing Home 28/04/08

Vicarage Farm Nursing Home 21/08/07

Vicarage Farm Nursing Home 19/10/06

Vicarage Farm Nursing Home 22/05/06

Vicarage Farm Nursing Home 16/11/05

Vicarage Farm Nursing Home 16/12/04

Vicarage Farm Nursing Home 08/06/04

Vicarage Farm Nursing Home 17/02/04

Vicarage Farm Nursing Home 07/10/03

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

CARE HOMES FOR OLDER PEOPLE Vicarage Farm Nursing Home 139 Vicarage Farm Road Hounslow Middlesex TW5 0AA Lead Inspector Paula Eaton Announced 20 April 2005 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 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. Vicarage Farm Nursing Home Version 1.10 Page 3 SERVICE INFORMATION Name of service Vicarage Farm Nursing Home Address 139 Vicarage Farm Road, Hounslow, Middlesex TW5 0AA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8577 4000 020 8572 1221 Southern Cross Healthcare (Management) Limited Care Home 62 Category(ies) of Dementia (0), Mental Disorder, excluding registration, with number learning disability or dementia - over 65 years of of places age (0), Physical disability over 65 years of age (0) Vicarage Farm Nursing Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 7/03/05 Brief Description of the Service: The home is situated in a residential area of Hounslow. It is set back from the road and has good car parking faciliities. There are local shops within walking distance. There are accessible local bus routes and the home is within ten minutes walk of Hounslow West underground station. The home is set on two floors. THe ground floor provides accommodation for twenty-seven service users and the first floor provides accommodation for thirty-five service users. The home provides nursing care to older people with a wide range of needs including dementia, mental disorder and physical disability. There are fifty-four single rooms and four shared rooms in the home. There is a well-maintianed central courtyard area with furniture suitable for service users and their visitors. Vicarage Farm Nursing Home Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over six and a half hours as part of the annual inspection process. The manager, four staff and seven service users were spoken to and records, policies and procedures were examined. What the service does well: What has improved since the last inspection? What they could do better: Monitoring of the systems for administering medication could be improved and also the monitoring of the review of care plans. Staff should be more aware of and ensure that they use appropriate language when writing about service users. The home should ensure that appropriate fire safety equipment such as door guards are installed where this prevents inappropriate propping open of fire doors by service users and enables service users to maintain their independence. Please contact the provider for advice of actions taken in response to this Vicarage Farm Nursing Home Version 1.10 Page 6 inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Vicarage Farm Nursing Home Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Vicarage Farm Nursing Home Version 1.10 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 standard(s) 3 The home carries out satisfactory assessments of service users prior to admission to ensure the home is able to meet their needs. EVIDENCE: The home carries out a pre-admission assessment and a more detailed assessment once a service user is admitted to the home. The information contained in the assessment documentation inspected covered all areas of need for each service user. The home had also obtained any Care Management assessments that had been completed. The homes assessment and the Care Management assessments had been used to develop care plans for the service users. A qualified member of staff had carried out all assessments. Vicarage Farm Nursing Home Version 1.10 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 standard(s) 7, 8, 9 and 10 Assessed needs had been incorporated into individual plans of care. Health care needs had been assessed and were being met. The systems for the safe administration of medication could be improved. Service users were being treated respectfully EVIDENCE: Individual plans of care were available and were comprehensive. They were up to date at the time of the inspection but not all care plans had been regularly reviewed. It was evident that care plans were being updated as the needs of service users changed. For example, one service user had had a recent accident, following this accident the service users care plan and risk assessments had been updated. It was noted that some risk assessments were not being regularly reviewed. Daily records are maintained for each service user. In one care plan viewed inappropriate language was used when discussing a service user. Health care needs were outlined in the records examined and were incorporated into the care plans. Any health care appointments attended or treatment received had been recorded clearly. Appropriate assessments are Vicarage Farm Nursing Home Version 1.10 Page 10 carried out to ascertain a service users needs including assessments on nutrition, continence, moving and handling and risk of pressure sores. There are appropriate medication policies and procedures in the home. However, after lunch on the day of the inspection a member of staff was observed filling in the medication administration sheets all at the same time whilst sitting in one of the lounges. This is not acceptable practice. Medication must be signed for as soon as it is administered. It was also noted that some liquid medicines did not have the date of opening on them and the medication fridge temperature was too high as a result of some difficulties the home was facing with the air conditioning system in the medication room. Staff were observed treating the individuals living in the home respectfully. There had previously been issues with staff members unnecessarily putting extra incontinence pads on people but the manager said that she had addressed this matter with staff. Vicarage Farm Nursing Home Version 1.10 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 standard(s) 12, 13, 14 and 15 Social activities are provided for the people living in the home. Maintaining contact with family and friends is encouraged. The meals in the home are good offering both choice and variety; however, specific cultural needs of service users are not always met. EVIDENCE: The activity provision in the home has improved since the last inspection. An activity where animals were being brought into the home for service users had been introduced and creative activities using remote control cares etc. had been introduced. The manager said that plans were being made to further improve the activity provision including employing an extra activities coordinator. The manager also said that two members of staff had taken a driving test to enable them to drive a minibus and take service users out into the community. It was noted that preferences regarding daily routines were recorded in the records viewed and incorporated into care plans. One care plan included a list of Polish words and the English translation to aid with communication and to help the service user make choices. Visitors are welcomed in the home and Registered Manager, staff and service users spoken to said that visitors were welcome at any time. Vicarage Farm Nursing Home Version 1.10 Page 12 It was evident in service users rooms that people are encouraged to bring personal possessions into the home and that service users are enabled to make choices where possible. It is recommended that information regarding independent advocacy services be displayed in the home to ensure that service users and their families and friends have access to this information. The menus viewed were satisfactory and the meals provided varied and of good nutritional value. However, a comment card completed by a relative of a service user stated that their family member was not offered meals specific to their culture often enough. This was also confirmed by one of the service users spoken to. The manager said that this was being addressed with the catering staff. Vicarage Farm Nursing Home Version 1.10 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 standard(s) 16 and 18 The home has a satisfactory complaints system with information available to service users, staff and visitors to the home. The home has adequate systems in place for the protection of service users from abuse. EVIDENCE: The home has a satisfactory complaints procedure in place that provides all of the relevant information for someone wishing to make a complaint. The complaints record was satisfactory. One complaint had been made to the Commission for Social Care Inspection regarding the home that was partly investigated at the last visit to the home and the manager of the home had also been asked to investigate some aspects of the complaint. The home has satisfactory procedures in place for the protection of service users and clear guidelines for staff regarding the action they should take if they witness or suspect abuse is taking place or if an allegation is made. This information was readily available in the home and followed. One strategy meeting regarding an accident in the home had taken place since the last inspection and was being appropriately dealt with. Vicarage Farm Nursing Home Version 1.10 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 standard(s) 19, 21, 22, 24, 25 and 26. Some improvements to the décor had been made since the last inspection. Appropriate aids and equipment are available to meet service users needs. However, bathroom facilities need to be assessed. The home was generally clean, safe and comfortable for the people living there. EVIDENCE: There were no noted maintenance issues at the time of the inspection and the décor and furnishings were satisfactory. Individual service users rooms were comfortably furnished and had been personalised and some service users had a key to their room. However, some doors still do not have locks on them and this must be addressed. One of the shower facilities was not in working order at the last visit to the home. This had since been repaired. Although there are adequate numbers of bathroom facilities in the home, not all of these are assisted bathing facilities. The bathroom facilities need to be assessed by a suitably qualified individual to ensure that the current facilities are appropriate to meet the needs of all Vicarage Farm Nursing Home Version 1.10 Page 15 service users and ensure the safety of staff. Risk assessments regarding bathing had been put up in the bathrooms since the last inspection. The home was appropriately heated and ventilated on the day of the inspection. An issue raised at the previous visits regarding problems with the hot water had been resolved and an invoice for the work was seen. The home has appropriate laundry facilities and these were clean and tidy on the day of the inspection. The home was generally clean and tidy, however, some malodour was noted in one of the bedrooms viewed. Vicarage Farm Nursing Home Version 1.10 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 The numbers and skill mix of the staff team was adequate and the recruitment process was satisfactory. Staff training provided was adequate. EVIDENCE: The manager said that the home had no staff vacancies and that there were bank staff available to cover any staff absences to avoid the use of agency staff. The staffing rotas viewed showed satisfactory numbers of staff on duty and the numbers on duty during the inspection were satisfactory to meet the needs of service users. At the time of the inspection one of the qualified nurses had handed in their notice and the home was in the process of recruiting an extra activities co-ordinator. Staff records had improved since the last inspection and the records viewed contained all of the required information. The manager has been very proactive in arranging training for staff, regular mandatory training was taking place and records maintained to monitor the level of training in the home. An appropriate induction programme and NVQ level 2 and 3 are being completed by staff and a continence nurse from Hounslow Primary Care Trust has provided training to three of the homes qualified nurses to enable them to take the lead on continence issues in the home. Vicarage Farm Nursing Home Version 1.10 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33 and 38 The management approach of the home has improved and the home has appropriate systems in place to ensure the health, safety and welfare of service users and staff are promoted and protected. EVIDENCE: The manager said that she had completed the application forms to apply to be the Registered Manager of the home but that she had not submitted them yet. She also said that she had enquired about enrolling to complete her NVQ level 4 in management and that she was due to commence this shortly alongside the deputy manager of the home. Feedback had been received in relatives comment cards regarding the positive influence the new manager had had on the home. Comments included relatives observing an improvement in staff practice. The staff spoken to on the day of the inspection all also commented on the improvements in the home since the appointment of the new manager. Staff said that “she gets things done” and Vicarage Farm Nursing Home Version 1.10 Page 18 “you can talk to her”. One member of staff also said that the atmosphere in the home had improved. The home carries out regular audits within the home. Satisfaction surveys are available for service users and visitors to the home. Monthly inspections are carried out and reports sent to the home and the Commission for Social Care Inspection. The manager said that she had also organised a health and safety committee to monitor any particular issues in the home. Health and safety records were up to date and in order. All other equipment was being regularly serviced. Staff receive regular training on matters relating to health and safety and risk assessments had been carried out and reviewed to ensure safe working practices. It was noted that a service user who is a wheelchair user was using an aid for his leg to prop open his bedroom door to enable him to negotiate the doorway independently. This door is a fire door and should not be wedged open. Appropriate measures must be taken to ensure that fire doors are not propped open without the appropriate equipment such as door guards. Vicarage Farm Nursing Home Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 3 x 3 2 x 2 3 2 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x x x x 2 Vicarage Farm Nursing Home Version 1.10 Page 20 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. Standard 7 8 9 Regulation 15(2)(b) 15(2)(b) 13(2) Requirement Care plans must be regularly reviewed Risk assessments must be regularly reviewed Medication administration record sheets must be completed at the time the medication is administered. The date of opening must be written on all liquid medicines. (Timescale of 16/12/04 not complied with). Medication must be stored at an appropriate temperature. Inappropriate langusge must not be used when writing about service users. Meals provided must meet the individual cultural needs of service users. The bathroom facilities must be assessed by a suitably qualified individual to ensure these facilities meet the needs of all service users. (Timescale of 1/03/05) not met. All bedrooms must have appropriate locks fitted. (Timescale of 1/03/05 not met) Any malodour in the home must be addressed. Version 1.10 Timescale for action 1/06/05 1/06/05 20/04/05 4. 9 13(2) 20/04/05 5. 6. 7. 8. 9 10 15 22 13(2) 12(4)(a) 12(4)(b) 23(2)(j) 20/04/05 20/04/05 1/07/05 1/08/05 9. 10. 24 26 12(4)(a) 23(2)(c) 23(2)(d) 1/07/05 1/06/05 Vicarage Farm Nursing Home Page 21 11. 38 23(4)(a) Fire doors must not be propped open. (Timescale of 16/12/04 not complied with) 20/04/05 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 14 Good Practice Recommendations Information regarding independent advocacy services should be displayed in the home. Vicarage Farm Nursing Home Version 1.10 Page 22 Commission for Social Care Inspection Ground Floor 58 Uxbridge Road Ealing London W5 2ST 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 Vicarage Farm Nursing Home Version 1.10 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. 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