Inspection on 21/08/07 for Vicarage Farm Nursing Home

This inspection was carried out on 21st August 2007.

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 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 19/10/06

Vicarage Farm Nursing Home 22/05/06

Vicarage Farm Nursing Home 16/11/05

Vicarage Farm Nursing Home 20/04/05

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 Ms Jean Bovell Unannounced Inspection 21st August 2007 10:30 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 Vicarage Farm Nursing Home DS0000010962.V341148.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. Vicarage Farm Nursing Home DS0000010962.V341148.R01.S.doc Version 5.2 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 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) 020 8577 4000 020 8572 1221 vicaragefarm@schealthcare.co.uk Southern Cross Healthcare (Management) Limited Urvasee Shersing Care Home 62 Category(ies) of Dementia (35), Mental disorder, excluding registration, with number learning disability or dementia (5), Old age, not of places falling within any other category (27) Vicarage Farm Nursing Home DS0000010962.V341148.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP (maximum number of places: 27) Dementia - Code DE (maximum number of places: 35) Mental Disorder, excluding learning disability or dementia - Code MD (of the following age range: over the age of 50) (maximum number of places: 5) The maximum number of service users who can be accommodated is: 62 19th October 2006 2. Date of last inspection 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 facilities. 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 residents and the first floor provides accommodation for thirtyfive residents. The home provides nursing care to older people with a range of care needs to include dementia, mental disorder and physical disability. There are fifty-four single rooms and four shared rooms in the home. There is a well-maintained central courtyard area with furniture suitable for service users and their visitors. Vicarage Farm Nursing Home DS0000010962.V341148.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by two Inspectors between 10:45 am and 4:30 pm. During the inspection process the Inspectors met and spoke with a number of residents in the home and also met with the Registered Manager and Operations Manager from Southern Cross, a number of staff on duty and relatives who were visiting the home. The Inspectors also had a tour of the premises as well as examining documentation and records. What the service does well: What has improved since the last inspection? 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 Vicarage Farm Nursing Home DS0000010962.V341148.R01.S.doc Version 5.2 Page 6 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Vicarage Farm Nursing Home DS0000010962.V341148.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 Vicarage Farm Nursing Home DS0000010962.V341148.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have their needs assessed prior to admission so that both they and the home can be sure that those needs will be met. EVIDENCE: The Inspector viewed a number of service user plans that indicated full assessments had been undertaken by staff at the home, which included medical and social history and profiles. Care plans are then drawn up based on these assessments. The home does not provide an Intermediate Care unit, so this National Minimum Standard was not assessed. Vicarage Farm Nursing Home DS0000010962.V341148.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have detailed care plans that set out how individual needs are going to be met and are able to access health care professionals as required. The home has safe medication systems in place and residents were observed to being treated with dignity with their privacy being maintained, although some residents did not look as well groomed as they might have been. EVIDENCE: The Inspector viewed a number of care plans, which followed a nursing plan format based on the activities of daily living format. The care plans were very detailed and contained appropriate risk assessments that included moving and handling and risk of falls. All risk assessments seen had been reviewed and updated. A daily record is kept which includes a record of any activities undertaken. The care plans themselves contained a lot of historical information that did not appear relevant to the current needs of the residents and Vicarage Farm Nursing Home DS0000010962.V341148.R01.S.doc Version 5.2 Page 10 subsequently may not be as “user friendly” for staff as they might be. The Registered Manager informed the Inspector that there was currently one service user with a pressure sore and this was being managed with appropriate pressure relieving equipment and the community tissue viability nurse had been involved. The Inspector inspected the dementia care unit’s medication storage facilities and found all in order with appropriate medication storage facilities in place within an air conditioned locked storage room. A check on the medication administration sheets did not reveal any issues. Staff were observed to interact with residents in a polite and caring manner and were able to describe to the Inspector how they ensured personal care was given in a respectful way that maintained their privacy and dignity. Generally the majority of residents looked well groomed but it was noticeable that some female service users appeared as though full attention had not been given to their personal appearance e.g. their hair. A concern was mentioned to the Inspector about the extent to which resident’s clothes were satisfactorily ironed. Notices around the dementia care unit referred to it as being an “EMI Unit”. Such terminology is outdated and indicates a lack of awareness about service users with dementia. This was discussed with the Registered Manager and Operations Manager who informed the Inspectors that the home was in the process of re-naming its units and the issue of inappropriate terminology was being addressed as part of Southern Cross’s dementia care strategy. Vicarage Farm Nursing Home DS0000010962.V341148.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Not enough meaningful activities were being carried out in the home. The separate cultural and religious needs of people are being met at the home. Residents are able to maintain contact with relatives, advocates and/or friends and make choices regarding their daily living routines. Wholesome and nutritional meals are being provided. EVIDENCE: An Activities Programme was on display at the home and indicated that Roman Catholic residents received ‘one-to-one’ visits from a local Church Cleric and that there were sessions of ‘Asian’ music and dancing. Indoor activities including hand massages, art, sit down football and music and exercise, were also indicated. Vicarage Farm Nursing Home DS0000010962.V341148.R01.S.doc Version 5.2 Page 12 Activities within the community were not reflected on the Activities Programme. The Registered Manager reported that Residents received Holy Communion on a weekly basis and that families were involved in ensuring that prayers were said in relation to other religious faiths. Shared activities did not occur during the inspection but the Activities Coordinator participated in a board game with one resident and people were seen sitting quietly in the lounge, watching culturally preferred television programmes or resting in their separate bedrooms. There appeared to be a lack of planned activities taking place through out the home during the inspection. Discussions with relatives indicated that they thought more might be done to ensure that residents were able to out of the home with staff as escort. An open visiting policy was in place and the Inspector was informed by a Registered Nurse that at least six residents received daily visits from relatives. People were able to meet with visitors in the ‘quiet room’, separate bedrooms or in the main lounge. They were also able to make and receive personal telephone calls. One visitor was observed sitting in the lounge at the time of the inspection. The Registered Manager confirmed that people were allocated £10 in cash each week from individual allowances that were being safeguarded at the home and that care staff were requested to make personal purchases such as sweets, newspapers and magazines, on residents’ behalf. People were offered meal choices and chose whether to have meals in the dining room or delivered to their bedrooms. They made decisions regarding what they wore each day, when they got up in the morning and retired at night. Personal choices and interests were also reflected in individual bedrooms. Three Chefs and two kitchen assistants are employed at the home and varied and nutritional meals, including cultural options are being prepared. People who were spoken with reported being generally happy with the quality and quantity of food they received but expressed the desire for a cooked breakfast. Breakfast options listed on the menus included cereals, porridge and toast with butter and/or jam. One of the Inspectors sat with residents during lunch on the dementia care unit, which for the most part was an unhurried experience, with residents eating at their own pace and being given assistance by staff when needed. Vicarage Farm Nursing Home DS0000010962.V341148.R01.S.doc Version 5.2 Page 13 Residents appeared to enjoy their food and staff were able to find an alternative meal for a resident who had changed her mind as to what she had earlier ordered. Vicarage Farm Nursing Home DS0000010962.V341148.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure but there has been a recent allegation of physical abuse which although the home has dealt with in an appropriate way, when discovered, raises questions whether all of the staff group understand how to respond if they suspect abuse is taking place. EVIDENCE: The Registered Manager informed the Inspectors that she specifies one evening per week which she sets aside to meet with relatives. Alternative appointment times can also be made with her. In information received from the home as part of the inspection process it was indicated that the number of complaints to the home had decreased. The Inspector spoke to a number of staff one of whom had worked in the home for less than six months but had not had any POVA training yet but indicated that he/she would report any suspected abuse to senior staff. Another staff member told the Inspector that he/she had received POVA training. POVA training had been provided to staff in March and May this year. The home has the local authority’s safe guarding adult policy and procedure. The recent allegation which is being dealt with under Hounslow Safe Guarding Adult procedures was discussed with the Registered Manager and Operations Manager. The need for constant vigilance by senior staff in the home combined Vicarage Farm Nursing Home DS0000010962.V341148.R01.S.doc Version 5.2 Page 15 with creating the necessary culture in the home that encourages any grade of staff to feel confident to come forward to the Registered Manager with their concerns was discussed. POVA training that includes identifying different types of abuse and who to contact about concerns is not enough if staff do not feel confident to be able to implement what they were trained to do. The topic of Safeguarding Adults should be regular topics of team meetings and individual supervision sessions. Vicarage Farm Nursing Home DS0000010962.V341148.R01.S.doc Version 5.2 Page 16 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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was essentially well maintained but re-decoration was required in hallways on the ground floor and all bathrooms and shower rooms need refurbishment. The overall environment is calm and safe. EVIDENCE: A plan for refurbishment and/or redecoration was not in place but the Registered Manager confirmed that the home had budgeted for the replacement of carpets in communal areas. Vicarage Farm Nursing Home DS0000010962.V341148.R01.S.doc Version 5.2 Page 17 A tour of the building was undertaken and communal areas were found to be spacious, comfortably furnished and suitable for wheelchair users and shared and/or individual activity. However, redecoration of hallways on the ground floor and refurbishment of bathrooms and shower-rooms were required. The surrounding gardens were accessible to residents and adequately maintained. The home has satisfactory laundry facilities. The overall environment was clean and hygienic, safe and calm. Vicarage Farm Nursing Home DS0000010962.V341148.R01.S.doc Version 5.2 Page 18 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff are appropriate and care staff are suitably trained and qualified for meeting the needs of people who use the service, although more training is needed to meet the needs of residents with dementia. Staff recruitment records were examined but all required documents were not within each file viewed. EVIDENCE: The Inspector was informed by the Registered Manager that a Deputy Manager, fourteen Nurses and twenty-six Care Assistants were employed at the home. Ancillary staff consisted of three Chefs, two Kitchen Assistants and six Domestics including a Laundry Person. It was indicated on staff rotas, that on the Dementia Unit: two Registered Nurses with a mental health qualification and five Care Assistants covered duty on each shift during waking hours and one Registered Nurse with a mental health qualification and three Care Assistants covered waking duty at night. Vicarage Farm Nursing Home DS0000010962.V341148.R01.S.doc Version 5.2 Page 19 On the Frail Elderly Unit: Two Registered Nurses and four Care Assistants were on duty during the morning shift. One Registered Nurse and 4 Care Assistants were on duty in the afternoon and one Registered Nurse and two Care Assistants covered waking duty at night. Staffing levels at the time of the inspection were reflective of numbers on rotas. The Registered Manager reported that nineteen Care Assistants had achieved National Vocational Qualification in levels 2 and/or 3. A number of staff recruitment records were inspected at random. Copies of photo-identification were not seen within each file viewed and there were gaps on application forms in relation to employment histories. The records were indicative of recent staff training being delivered on Protection of Vulnerable Adults, Infection Control, Moving and Handling, Pain Management, Fire Safety and Food Hygiene. Care staff members were observed being respectful in their interactions with residents and competent in meeting their needs. Vicarage Farm Nursing Home DS0000010962.V341148.R01.S.doc Version 5.2 Page 20 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, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Manager is suitably experienced and qualified. Systems for effective quality assurance are in place and the process is ongoing. Placing authorities and relatives are responsible for financial interests of residents but personal allowances are being satisfactorily safeguarded at the home. Health and safety records were viewed and reflected that the welfare of residents were being protected. Vicarage Farm Nursing Home DS0000010962.V341148.R01.S.doc Version 5.2 Page 21 EVIDENCE: The Registered Manager has had a total of three years managerial experience. She has been in post for twelve months, has obtained the Registered Managers Award, and has also received mandatory training such as Health and Safety, Protection of Vulnerable Adults and Moving and Handling. Systems for carrying out effective quality assurance in 2007 were in place and it was evidenced on completed surveys that the process had been initiated and was ongoing. In response to recent allegation of physical abuse in the home the Registered Manager told the Inspectors that she was now undertaking spot checks during evenings and week-ends and toured the home at least two/three times when she was on duty in the home, which was usually from 8:30 am – 5:00 pm, Monday to Friday. The Inspector was informed by the Registered Manager that relatives or placing authorities held financial responsibility for residents but personal allowances were safeguarded at the home. All financial transactions were signed by two staff members and checked by the Regional Administrator on a monthly basis. Health and safety records were up to date and included gas maintenance, legionella testing, and water temperature, portable appliances and fire safety checks. Fire drills were regularly undertaken. Environmental risk assessments had been carried out. Accident and incident forms were appropriately completed. It was reflected on training certificates that staff training on Moving and Handling, Infection Control and Food Hygiene had been delivered. Vicarage Farm Nursing Home DS0000010962.V341148.R01.S.doc Version 5.2 Page 22 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 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Vicarage Farm Nursing Home DS0000010962.V341148.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP10 Regulation 16(2)(e) Requirement The Registered Person must ensure that all laundering tasks in relation to individual services users are carefully undertaken. (The previous time scale of 30/11/06 not met) The Registered Person must ensure that all resident’s personal care needs are fully met to include appropriate grooming. The Registered Person must ensure that sufficient and appropriate activities are undertaken in the home. The Registered Person must make arrangements, by training staff or by other measures, to prevent residents being placed at risk of abuse. The Registered Person must produce a maintenance plan that includes renovating bathrooms and replacing carpets in communal areas. The Registered Person must ensure that all staff records are complete. The Registered Person must DS0000010962.V341148.R01.S.doc Timescale for action 02/10/07 2. OP10 12(4)(a) 02/10/07 3. OP12 12(1)(a) 16/10/07 4. OP18 13(6) 02/10/07 5. OP19 23(2)(b) 30/10/07 6. 7. OP29 OP30 19(1) Schedule 2 18(1)(a) 30/10/07 30/10/07 Page 24 Vicarage Farm Nursing Home Version 5.2 ensure that all staff working on the dementia care unit receive appropriate training in that topic. 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 OP7 Good Practice Recommendations Care plans should organised so as not to contain information not relevant to current care needs. Out of date information should be archived. Vicarage Farm Nursing Home DS0000010962.V341148.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 Vicarage Farm Nursing Home DS0000010962.V341148.R01.S.doc Version 5.2 Page 26 - 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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