Inspection on 17/04/09 for Vicarage House Residential Home

This inspection was carried out on 17th April 2009.

CQC found this care home to be providing an Adequate service.

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

Vicarage House Residential Home 08/06/07

Vicarage House Residential Home 18/07/06

Vicarage House Residential Home 17/02/06

Vicarage House Residential Home 14/07/05

Vicarage House Residential Home 08/11/04

Vicarage House Residential Home 07/09/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 10/07/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Vicarage House Residential Home 1 Honicknowle Lane Pennycross Plymouth Devon PL2 3QR Lead Inspector Antonia Reynolds Key Unannounced Inspection 17th April 2009 09:30 DS0000003500.V375017.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Vicarage House Residential Home Address 1 Honicknowle Lane Pennycross Plymouth Devon PL2 3QR 01752 779050 01752 779050 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) Dr Pepper’s Care Corporation Limited Manager post vacant Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35), Physical disability over 65 years of age of places (35) Vicarage House Residential Home DS0000003500.V375017.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 only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Physical disability, aged 65 years or over on admission (Code PD(E)) The maximum number of service users who can be accommodated is 35 8th June 2007 2. Date of last inspection Brief Description of the Service: Vicarage House is a care home providing accommodation and personal care for a maximum of 35 people over the age of 65 who may also have physical disabilities. It is privately owned by Dr Pepper’s Care Corporation Ltd that also owns another care home in Devon. In April 2009 the fee levels started from £340 per week but varied depending on the individual needs of each person. Items not included in the fees include chiropody, hairdressing, newspapers, personal toiletries and public transport costs. The home is a detached, two storey property situated in the residential area of Pennycross. The home is within walking distance of local shops and close to bus services into central Plymouth and the railway station. There are 34 bedrooms in the home, 33 of which are single and one could be shared if people choose to do so. There are 24 bedrooms on the ground floor and 10 on the 1st floor, which can be accessed using a stair lift. The six bedrooms in the new extension all have en suite toilets. Communal rooms are on the ground floor and consist of two lounge rooms, linked by a sitting area containing a small library, and a dining room. The home has a large garden with patio and decking areas that people can easily get to. There is parking space at the front of the house and on street parking is available nearby. Information about the home, including copies of inspection reports, can be obtained from the manager of the home. Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection consisted of an unannounced visit to the home by one inspector, who was accompanied by an Expert by Experience, between 9.30am and 2.30pm on Friday, 17th April 2009; and a further unannounced visit by one inspector between 8.50am and 1.15pm on Thursday, 23rd April 2009. This inspection also takes into account the findings from the random inspections carried out on 12th February 2008 and the 20th October 2008. Throughout this report the term ‘we’ will be used as the report is written on behalf of the Care Quality Commission. An Annual Quality Assurance Assessment (AQAA) was completed by the home and received a few days after the inspection finished. The AQAA is a self-assessment that focuses on how well outcomes are met for the people who live in the home. A tour of the premises took place and records relating to care, staff and the home were inspected. Thirteen people living in the home and three visitors were spoken with during the visit. Seven postal surveys were received from people living in the home, although relatives had completed some of these. Three staff members were spoken with and five postal surveys were received from them. A healthcare professional was spoken with on the first day of inspection and a survey was received from a social care professional. The manager was available for consultation and discussion during the inspection process. What the service does well: A new manager has been appointed who is well liked and respected by the people living in the home, and their relatives, who were very complimentary about her. People liked living in the home and felt well cared for. Staff were described as respectful, polite, caring, friendly and helpful. The staff respect people’s privacy and dignity and this is actively promoted within the home. People said the laundry is done very well and efficiently. Relatives and friends can visit whenever they like and feel welcomed by staff when they come into the home. The garden has been landscaped and provides sitting areas for people that they are easily able to access. What has improved since the last inspection? Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 6 Care planning documentation contains more detailed information about each person’s needs and describes how the staff should meet those needs. People have been asked what their favourite meal is and these have been included in the menu planning. The times that people like to get up and go to bed are documented in their care plans so that all staff are aware of this and no one has to get up before they wish to. Staff are recording more detailed information about people on a daily basis so that there is a more accurate record of the care provided. The staffing rotas have been amended so that they accurately reflect which staff are on duty at all times of the day and night. Also there is a manager or deputy manager on duty every day including weekends. An independent trainer has been commissioned to provide essential training for staff. The dining room has been refurbished and redecorated, the patio doors have been replaced, some carpets have been replaced and bedrooms redecorated. Controls on radiators in people’s bedrooms have been altered so that they are all accessible to them so they can be turned up and down easily. The call bells in the lounge rooms have been clearly marked so that people can see them easily should they need to use them. The garden has been landscaped to provide sitting areas outside that people can get to easily. What they could do better: Before someone comes to live in a care home an assessment of all aspects of their health and social care needs must be carried out to ensure that the home is suitable, that any required equipment is available, and that the staff team are experienced, skilled and competent to meet the person’s needs. People need to be provided with information about the facilities and services in the home to help them make an informed choice about where to live. The information in this home, the Statement of Purpose and Resident Information Pack, need to be reviewed and updated to make sure that it contains all the information that will be helpful to people who are considering coming to live in the home or who already live there. Once a person moves into a care home, or before, a care and support plan needs to be developed with that person and/or relatives and representatives to agree on what care the person needs and how the staff team should support them. Whilst the care plans in the home have improved recently, they need to contain more information on people’s personal history and background, social interests, hobbies, religious and cultural needs, the management of their financial affairs and how their post should be dealt with. Staff should be alert to changes in people’s care and health needs and proactive in addressing those needs so that people receive the care, support and access to health services that they need. Whilst the home does have a stair lift to the 1st floor many people living in the home can only use it with staff assistance. Consideration should be given to repairing the shaft lift so that people will be able to go up and down to and from the 1st floor independently. Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 7 People living in care homes should have opportunities to go out of the home on a regular basis so that they can keep in touch with the local community and see any changes as they occur in the local area. Trips should be planned to suit people’s needs and preferences so that people have opportunities to enjoy and pursue their social, cultural, religious and recreational interests in the wider community. The views about meals expressed by people who live in the home were mixed in that some people said they enjoyed them and others did not. Therefore the menus and the quality of the food provided needs to be reviewed to ensure that people receive meals that are varied, appealing, wholesome and nutritious and are suited to individual requirements. When people are offered alternatives to the main menu, they should be offered a meal that they will enjoy. Where medicines are kept in the care home there should be a detailed written procedure for the receipt, recording, storage, handling, administration and disposal of medicines, including controlled drugs. The staff in this home had assumed that all eye and ear drops should be stored in a refrigerator but this is not always the case. Each medicine has different storage instructions and these must be followed at all times so that only medication that needs to be kept cold is kept in the refrigerator. When a bottle of eye drops is opened the staff need to write the name of the person to whom they belong on the bottle as well as the date of opening. This is to ensure that they are administered to the person who needs them and are not out of date. A proper register should be kept for the receipt, administration and disposal of controlled drugs. Controlled drugs must be stored in a cupboard specifically designed for the purpose and to comply with legislative requirements. Where people keep and take their own medication, the care plan should reflect the person’s wishes and their specific arrangements. This needs to be risk assessed to make sure that people are able to self-medicate safely. A record needs to be kept in the home of any medicines people keep in their own rooms. A robust recruitment procedure is necessary as the first step towards keeping the people who live in the home safe from harm and it has not been followed recently. Therefore, before appointing a new member of staff all the required checks and references must be received and a full employment history obtained. This is to ensure that recruitment procedures are robust enough to provide support and protection to the people who live in the home. All new members of staff should receive a formal programme of induction training and ongoing training needs to be provided so that staff are trained and competent to do their jobs. This training should include all issues relating to caring for older people who may also have physical disabilities and how to keep vulnerable people safe from the risk of abuse or neglect. The numbers of staff on duty need to be kept under review at all times due to the changing care needs of the people who live in the home and to cover shifts when staff are off sick or on holiday. This is ensure that there are enough staff on duty at all times to meet the physical, psychological, emotional and social needs of the people who live in the home. Whilst some staff had received occasional one to Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 8 one supervision sessions with the manager, these were not happening as regularly as they should and did not always include all aspects of practice, the philosophy of care in the home and career development needs. Health and safety practices need to be improved to ensure that any risks to people who live in the home are identified and, so far as possible, eliminated. Practices that need to be improved including making sure that all hoists are serviced regularly so that they are in proper working order and that other equipment, such as wheelchairs and bath lifts, are kept in a good state of repair. Fire safety equipment needs to be regularly checked to make sure it is in the correct location, that it is clean and that it has not been damaged so that it should work properly if needed. There should be a system in place to ensure that all staff receive fire safety training as frequently as the home’s fire risk assessment has identified as necessary for the safety of the people who live in the home. The electrical wiring system in the home should be checked by a competent person to make sure it is safe. Due to the vulnerability of people in the home the temperature of hot food should be taken and documented to show that it is properly cooked. The home has a designated smoking area in the lobby of the main front door and advice should be sought from the environmental health department as to whether this area complies with the law on smoking in public places. The home has a quality assurance system in place that asks for feedback from the people who live in the home and relatives or representatives. This system would be more comprehensive if it included an annual internal audit of the facilities and services in the home and, if a robust internal auditing system was in place, it would have identified the issues raised in this report. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 9 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 House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3 and 5 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home’s Statement of Purpose and Service User Guide do not provide people with all the information they need to make an informed decision about coming to live in the home. People have opportunities to visit the home before they move in but their needs are not always being clearly identified because pre-admission processes are not being followed. EVIDENCE: The home has a Statement of Purpose and a Service User Guide, called a Resident Information Pack, which describe the services provided at Vicarage House. Whilst these have been updated, and contain some very useful information, such as people’s rights and freedoms, an orientation map, meals and meal timings, the use of the call bell, and what to do in the event of a fire, they do not contain all the information that should be included or that would be Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 11 useful for people to know. We spoke to a person who had recently moved into the home and it was clear that she was not aware of some of the facilities in the home for example, the book shelves in the lounge room and the visiting library service. These services were not documented in the home’s Statement of Purpose or the Resident Information Pack. Also the Statement of Purpose says there are 29 bedrooms and we counted 34. The Statement of Purpose says there is a pay ‘phone but we were told this had been removed but there was a portable ‘phone in the home that people could use and they could also have telephone lines installed in their bedrooms. Neither did the Statement of Purpose contain a statement of terms and conditions of residency. The Resident Information Pack did not include information about the amount and method of payment of fees, the terms and conditions of residency, a standard form of contract for the provision of services and facilities, a copy of the most recent inspection report or information as to where a copy could be found, or any views about the home expressed by the people who live there. One person who had recently come to live at the home said that she and her relatives had been able to visit before deciding to move in. However she had not been given information about the services provided at the home and had not been involved in an assessment to identify her care needs. Discussion with the manager and examination of the person’s file held in the home confirmed that no assessment had taken place prior to admission to determine whether Vicarage House was a suitable home for this person and whether her needs could be met by the staff team. Neither had the home obtained a copy of any needs assessment or care plan from Social Services prior to admission. Examination of another person’s file showed that a pre-admission assessment had been carried out but did not contain enough detail about the person’s health and social care needs and how those were to be met by the staff team. Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are treated with respect and personal support is offered in a way that promotes people’s privacy and dignity. Health care needs are not always addressed as soon as they are identified and arrangements for the storage of some medication is not satisfactory. EVIDENCE: The files of three people who live in the home were inspected and these contained individual care plans, recently reviewed and updated, with information on care needs and how staff at the home would meet those needs. The care planning documentation has improved greatly and the manager is commended for the amount of work she has put into these. However they did not contain detailed information on personal histories and background, social interests, hobbies, religious and cultural needs and how people’s finances are managed and by whom. One person’s money was administered by the Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 13 Responsible Individual for the organisation, Dr Pepper, but the reasons for this and the details of how it works were not documented in the person’s care plan. Also there was personal post addressed to people living in the home kept in the office. The manager said this was because it was collected and dealt with by relatives, but this information was not recorded in people’s care plans. Where possible care plans were signed by people who live in the home and/or relatives/representatives to show that they have been involved in drawing up the plan and were aware of the content. People’s files contained the names and addresses of their relatives or representatives so that staff know whom to contact should they need to. Each file contained recently reviewed and updated risk assessments relating to falls, skin/pressure area care, moving and handling and, where required, the use of bed rails. Information about each person was recorded on a daily basis and any changes in needs were documented quickly so that staff coming on duty knew what had occurred. The people who lived in the home and their relatives said that they felt very well supported by the staff team and received the assistance they needed promptly. They said that the staff always answered the call bell immediately or within five to ten minutes and were satisfied with that response time. Comments from people who lived in the home included: “they do their best for me”; “they listen to what you have to say and nothing is too much trouble”; and “staff do what I ask”. One person commented in a survey: “Anything I have requested has been carried out without fail.” The District Nurse visits the home regularly to support the staff in meeting health care needs. Concerns were raised with Social Services towards the end of 2008 about the ability of the staff team to manage the health care needs of a person who had developed pressure sores whilst living in the home and there were subsequent concerns about the care of three other people in the home. Social and health care professionals who have also been providing advice and guidance to the staff at the home reviewed the care needs of these people. Following these concerns being raised the Responsible Individual, Dr Pepper, and the manager of the home responded positively and have introduced systems and staff training to ensure that no further incidents occur. We spoke to the District Nurse on the first day of inspection and she confirmed that communication with the care staff had improved and was now very good. The staff were proactive in contacting the district nursing service if they had concerns about someone although, during a weekend recently, they had waited to speak to the visiting District Nurse, rather than contacting a doctor, which meant there was a delay in a person receiving medical treatment. Discussion with the manager confirmed that the District Nurse reported this to her and the situation has already been resolved by ensuring a member of the management team is on duty at weekends. The people living in the home said they were satisfied with the health care received. Two visitors said that they were confident with the care given apart from an isolated incident some months ago where they were not informed by Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 14 the staff of an accident involving their relative. A visitor criticised a doctor for not attending his parent until the manager “put pressure on”. Apart from this one comment everyone else said they had experienced prompt and good attention from the District Nurses and doctors. Information in a survey from a social care professional said that staff at the home have not always recognised changes in care needs and relatives have had to point these out to the staff. In one instance this led to a person “becoming isolated with potential for emotional/psychological deterioration.” All the people spoken with said that they chose their own times for getting up and going to bed. People said that they tended to have a particular day allocated to them to have a bath and the same member of staff usually assisted them. One person said she particularly liked this because it meant she could look forward to her bath and had developed a trusting relationship with the staff member who supported her. Discussion with the manager confirmed that she has put this system in place to help preserve people’s privacy and dignity, rather than them being assisted to bathe by whoever happens to be on duty. Whilst some people were content with having a bath once a week, others said they would welcome the opportunity of a greater frequency. The manager advised that when staff time permits people are able to have additional baths. Discussions with people living in the home and information in surveys, as well as observation, showed that the staff treat people with respect and preserve their privacy and dignity at all times. Staff were observed knocking on bedroom doors before entering and people said that the staff always make sure bedroom, bathroom and toilet doors are closed when personal care is being given. Discussions with people living in the home, as well as the manager, confirmed that people could have their own telephone in their bedrooms, at their own expense, if they wished to. However the home had a telephone system with portable handsets and people could use this to make and receive private telephone calls. Medication was stored securely and most of it was administered from blister packs made up by the pharmacy. Records relating to the administration of medication were up-to-date and people were supported to manage their own medication wherever possible. However there were no risk assessments relating to those people who were self-medicating and there were no records of what medication those people had in their rooms. The home had a refrigerator specifically for storing medicines that needed to be kept cold however we found some ear drops in the refrigerator which stated that they must not be refrigerated. Also there was a bottle of eye drops that did not have anyone’s name on it and the date of opening had not been written on it. The staff confirmed that they knew who the eye drops had been prescribed for and they were administering them. Controlled drugs were kept in a locked cupboard in the office but this cupboard was not of the required standard to contain controlled drugs. The administration of the controlled drugs was not Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 15 being recorded in a proper register designed for the purpose and there was no record of what had been received in the home or what was currently being held in the home. Therefore there was no clear audit trail showing the receipt, administration and disposal of the controlled drugs, so it would be difficult to establish if any were missing. The home did not have a documented and detailed procedure for the administration of medication and controlled drugs for staff to follow. Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The routines in the home are relaxed, relatives and friends can be confident that they are welcomed, and social activities are arranged. The dietary needs of people who live in the home are catered for although the quality and choice of meals does not always meet individual preferences. EVIDENCE: The people who lived in the home said that they were free to come and go from the home as they wished. They were encouraged to maintain interests and friendships outside of the home and confirmed that friends and relatives are welcomed. Visitors in the home said that they were always made very welcome by the staff and felt that they could visit at any time. Activities are planned each weekday afternoon and the majority of people spoken with said they joined in, although some people told us that they chose not to participate. These activities included bingo, entertainers, singers, craft sessions making seasonal greetings cards and, because of the time of year, Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 17 Easter bonnets, painting and outside speakers such as a talk by a member of the Plymouth museum staff. The manager said that an Easter party had been held the day before we started the inspection. On the second day of inspection, staff from Plymouth museum were facilitating a reminiscence session and were observed talking about the use of the ‘cane’ at school creating great amusement as people recounted their experiences. People said they took advantage of the sheltered patio and decking within the centre of the home where the staff served drinks and ice cream when the weather was suitable. No one could recall any recent trips organised by the home although these had occurred in the past. One person said he was collected by a local charity and taken for a lunchtime meal twice a week. Three carers took a selected group of people out occasionally for a restaurant meal. One person in a survey said: “The person responsible for the entertainment schedule is very dedicated and has a lot of thought and patience.” A minister of religion visited the home regularly and people could participate in a communion service if they wished to. The staff knew which people usually attended and there was a list of those people kept in the office so staff knew whom to remind about the visit. The manager said that, if people wished to attend a place of religious worship outside the home, they would be supported to do so by staff from the home, relatives or volunteers from the church or other place of religious observance. The menu for the day was displayed on a white board outside the dining room. We sat with people having lunch on the first day of inspection and most people said they were satisfied with the food although responses were mixed. Comments included “food alright”; “food not bad at all”; “there is no choice but if I do not like what is on offer they will give me something else like cold meat and chips”; and “no complaints about the food – the variety is passable”. In a survey one person said that the meals they liked were good however if they did not like the main meal they were sometimes offered an alternative that they did not like either. One person said that sausages appeared too frequently. Another said that her favourite meal was egg and chips for Saturday teatime. On the first day of the inspection the lunch meal was fish, chips and peas. The rectangular shaped, coated fish portion appeared grey inside in colour, processed and did not look at all appetising. Some people said the food was too hard to eat and left quite a lot whilst other people ate everything. The dessert was fruit salad and whipped cream. The care staff checked that people had finished their meal before removing plates. One person needed assistance with eating and there was a staff member who sat beside the person and helped them until they had finished. No one could recall being asked what their favourite meal was although the manager said they had been asked. Some people said that much of the food was purchased at the minimum of cost without due regard to quality “but the cook does very well with what she has”. People could choose whether they ate meals in the dining room, the lounges or in their bedrooms. They also said they could ask for something to eat or drink at any time and fresh fruit was available in the Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 18 dining room. On the second day of inspection the lunchtime meal was roast beef and vegetables, which looked and smelt delicious, and people said they enjoyed it. Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home can be confident that any complaints or concerns will be listened to and acted upon by the staff and management team. EVIDENCE: The home has a written complaints procedure and this was included in the Resident Information Pack. Discussions with people living in the home and their relatives, as well as information contained in surveys, confirmed that the staff and manager were very approachable and they had confidence in bringing any concerns to them. One person said “I feel comfortable and safe here.” Some of the staff have received training related to the safeguarding of vulnerable adults and this is included in formal qualifications such as National Vocational Qualifications (NVQs). However staff have not attended the safeguarding training provided by the Local Authority therefore may not be aware of the local procedures to follow should an incident of abuse or neglect be suspected or alleged. Discussion with the manager confirmed that she was knowledgeable about the local processes in place to safeguard vulnerable people. Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 22, 23, 24, 25 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, comfortable and warm, providing people with a pleasant environment in which to live. EVIDENCE: We looked all round the home and it was found to be warm, comfortable, clean and free from offensive odours. There was a designated smoking area for people who lived in the home in the inside porch of the front door and smoke from this area could be smelt in the hallway. The manager said that the front door was rarely used because most people used the side entrance, however this place for smoking may not comply with the recent legislation regarding smoking in public places. The shared rooms consisted of two lounge rooms adjacent to each other - one contained a television whilst the other provided a Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 21 quieter environment. A sitting area containing a small library linked these rooms. The home had a separate dining room, which has recently been refurbished, and some carpets have been replaced. The manager confirmed that there are plans in place to replace the carpet in the hallways and on the stairs this year and there is an ongoing programme of redecoration and refurbishment. The bedrooms are located on the ground and 1st floors and there is a stair lift to the 1st floor. The home does have a shaft lift but this was not being used because it has been out of order since September 2007. The home has one bedroom that could be shared if people chose to do so and all the other bedrooms are for single occupancy. The six new bedrooms all have en suite toilets. All bedroom doors were fitted with locks to protect peoples’ privacy and the security of their belongings and people spoken with confirmed they had keys to their bedrooms. The bedrooms visited were well decorated, contained many personal possessions and people said they were comfortable in them. One person said that the room she was in had been redecorated before she came to live in the home. There was a call bell system throughout the home and these have been clearly marked in the lounge rooms so that people can see them easily should they need to use them. The laundry facilities were clean and spacious with sufficient equipment to meet the needs of the home. People spoken with said that the laundry was done efficiently and, on the odd occasion that any items of clothing go missing, the staff found them almost immediately. Appropriate arrangements for controlling the spread of infection were seen including gloves and aprons. Radiators were covered to prevent the risk of burns should a person come into contact with them when on. The manager confirmed that thermostatically controlled valves to prevent the risk of scalding controlled the hot water temperature to the baths. Toilets and bathrooms were clean and bath hoists were available to assist people with restricted mobility. Surveys from four staff members commented that the home would benefit if equipment was updated, such as wheelchairs and bath lifts, and if broken equipment was fixed quickly or replaced. The garden has been landscaped to provide patio and decking areas that were easily accessible to most people living in the home. The patio doors have been replaced as the old ones had a crack in them. People with restricted mobility said that the staff assisted them to go outside when the weather was nice. We spent some time talking to one of the people who lived in the home whilst she was sitting outside enjoying the sunshine. Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Caring staff, in sufficient numbers, support the people who live in the home. Recruitment practices are not robust enough to support and protect people. EVIDENCE: Information contained in staffing rotas, as well as discussion with the manager, showed that there are usually five care staff on duty in the mornings and four in the afternoons. They are supported by catering and domestic staff. At night there are two waking staff members. Surveys returned from five staff members said there are usually enough staff members on duty to meet the needs of the people who live in the home and they feel well supported by the manager. Most of the people who lived in the home were of the opinion that there were generally enough members of staff on duty. Although one person said “it is alright until someone is away sick and then there are problems”. One person did say that the home “was understaffed all the time”. Everyone said that the care staff were always very busy with little time for conversation. People said that the call-bell response time was usually within five to ten minutes and, whilst not actively complaining about this, ten minutes can feel like a long time when people are waiting for staff. Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 23 Discussions with people who lived in the home and information in surveys showed that the staff were respectful, polite and caring. One person, in a survey, said that the “staff are very friendly and helpful”. Other comments included: “the girls are very kind”; “all the staff are nice, gentle and friendly”; “the staff are very caring”; and “the staff are very good”. We observed that there are both women and men employed as care staff which gives people a choice as to whether they have their care provided by a woman or a man. The personnel files of four care staff, who have been recruited since November 2007, were examined. Three of these showed that the people had started work at the home before two written references and Criminal Records Bureau checks had been obtained. Two people had written references from other staff employed in the home that were dated after they had started work. It was clear from other information in the files that the staff members who had written the references had no prior knowledge of these people before they came to work in the home and had written references based on five to ten weeks of working with them. At the time of inspection two staff members were working in the home had not received a satisfactory Criminal Records Bureau check, despite being employed in the home since August 2008 and February 2009 respectively. The manager said they had been applied for. There was no evidence of a satisfactory check against the Protection of Vulnerable Adults list being received. Where people who were nationals of other countries were employed there were no employment histories, no references from previous social care employers (despite having CRB checks in their files from other care homes in England) and no evidence that police checks had been obtained from the country of origin. The manager confirmed that the home has a nationally recognised induction programme for new staff based on the standards expected by Skills for Care, the organisation responsible for setting the training standards for care staff. However the newly recruited staff, whose personnel files indicated that they had no previous experience of care, had only completed a basic induction programme rather than the more comprehensive induction. The manager said that staff were now receiving training from an independent trainer and this included courses in moving and handling, health and safety, first aid, infection control, food hygiene, safeguarding vulnerable adults, administration of medication as well as training related to caring for people, such as pressure area/skin care and diabetes. The AQAA said that thirteen of the twenty-two members of staff had obtained qualifications in caring for older people, namely National Vocational Qualifications (NVQs) at level 2 or above. However none of the staff had an individual training and development assessment and profile to show what training they had done, or were expected to do, to ensure they were trained and competent to do their jobs. Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home benefit from the open and positive approach of the manager. Health and safety practices are not robust enough to ensure that people’s health, safety and welfare are promoted and protected. EVIDENCE: The management of the home has changed since the last key inspection and the present manager has worked in the home since September 2007 and was appointed to the manager’s role in June 2008. She confirmed that she would be applying to register with the Care Quality Commission. The people living in the home and their relatives were very complimentary about the manager. Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 25 Comments included: “the manager is a kind and thoughtful person in every respect and nothing is too much trouble if she can help”; “the manager always listens”; “the manager is very friendly”; “the manager is a nice person” and “the manager is quite excellent”. Other comments about the running of the home included: “I am very happy with the Vicarage and very contented with my choice of a residential home”; “it was a good move coming here” and “I’ve been happy here for over ten years”. Information in a survey from a social care professional said “the service provides a friendly and ‘homely’ approach to residents.” The directors of the company that owns the home visit at least weekly to meet with the people living in the home, any relatives who may be visiting and the staff. Formal meetings are held regularly for both people living in the home and staff so that people have an opportunity to comment upon the quality of the services provided and be given information about the running of the home. Documentation showed that some staff have occasionally had one-to-one supervision meetings with the manager but there was no programme in place to ensure that all care staff received formal supervision at least six times a year. Discussion with the manager confirmed that the financial affairs of the people who lived in the home were usually managed by themselves, their families or representatives. However the Responsible Individual, Dr Pepper, administered the money of one person. The home did look after spending money on behalf of some people who lived in the home. The financial records for two people were checked and found to be correct. The fire safety equipment records showed that the fire alarm system was tested regularly and a local contractor serviced the fire alarm system and fire extinguishers at least annually. However staff were not checking, on a regular basis, other fire safety equipment, such as fire extinguishers, smoke detectors, fire blankets and emergency lighting. Discussion with the manager confirmed that fire drills were held regularly, newly appointed staff received training in fire safety procedures on the first day of employment and an external trainer visited annually to train staff. However the names of staff who had attended in-house fire safety training were not documented and the records did not show clearly that all staff had been trained in fire safety procedures. There was documentation in the home to show that the gas system and appliances had been checked and serviced in October 2008. There was an electrical wiring certificate dated 11th October 2003 recommending that the system should be checked again in five years but this had not taken place. All portable electrical appliances had been checked for safety in January 2009. Servicing records showed that the stair lift was serviced regularly. Information on a mobile hoist said the next service was due in July 2008 but this had not been done. The manager confirmed that all the windows above the ground floor had been restricted so that people could not fall out of them. All the Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 26 radiators were covered so that people could not be burned and the manager said that all the hot water taps had thermostatically controlled valves to reduce the temperature so that people could not be scalded. The environmental service of the Local Authority had carried out a food safety inspection in November 2008. The manager confirmed that the requirements and recommendations within that report had been met or were in the process of being addressed. However inspection of documentation kept by catering staff showed that the temperature of hot food was not being documented to show that it was properly cooked. The home had a quality assurance system in place based on consultation with the people who live in the home and the results of this survey are made available to people who live in the home and their relatives/representatives. However the quality assurance system did not include an annual internal audit of all the facilities and services in the home to ensure that the aims, objectives and statement of purpose of the home are being met. Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement Timescale for action 23/06/09 2. OP9 13 3. OP9 13 Before anyone is admitted to the home an assessment of the person’s needs must be carried out by a suitably qualified or trained person and a copy of that assessment obtained. This is to ensure that the home is suitable and that the staff team can meet the person’s needs. Controlled drugs must be stored 24/06/09 in a cupboard designed for the purpose. It must: • be a metal cupboard of specified gauge • have specified double locking mechanism • be fixed to a solid wall or a wall that has a steel plate mounted behind it • be fixed with either rawl or rag bolts. This is to ensure that controlled drugs are kept safely at all times. Storage instructions for 23/05/09 medication must be checked and followed at all times so that only medication that needs to be kept cold is kept in the refrigerator. DS0000003500.V375017.R01.S.doc Version 5.2 Vicarage House Residential Home Page 29 4. OP9 13 5. OP29 19 6. OP38 13 Eye drops must be properly labelled with the name of the person for whom they have been prescribed and the date of opening. This is to ensure that they are administered to the person who needs them and are not out of date. No person must be employed in the care home before all the required checks and references have been received and are satisfactory. These include two written references including one where the person has worked in a care capacity with adults or children where appropriate, a check against the Protection of Vulnerable Adults list, a Criminal Records Bureau check, a police check from the country of origin if the person is not a British national and a full employment history. If a person is employed in the home prior to receiving a satisfactory check from the Criminal Records Bureau, this person must be supervised by a designated staff member at all times, and must not escort people who live in the home away from the premises. This is to ensure that suitable people are employed and protect the people who live in the home from risk of harm. All hoists must be serviced regularly to make sure that they are in proper working order. This is so that people who live in the home are not put at risk of harm by the failure of lifting equipment due to lack of maintenance. 23/05/09 23/05/09 23/05/09 Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 30 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 OP1 Good Practice Recommendations The home’s Statement of Purpose should be updated and contain more information so that it includes the total number of bedrooms and all the facilities and services in the home such as telephone facilities and the visiting library service. This document should also contain the terms and conditions of residency. This is so that people considering coming to live in the home have the information they need to make an informed choice, and people already living in the home know what services are available to them. The home’s Service User Guide (Resident Information Pack) should include information on the amount and method of payment of fees, the terms and conditions of residency, a standard form of contract for the provision of services and facilities, a copy of the most recent inspection report or information as to where a copy can be found, and any views about the home expressed by the people who live there. Pre-admission assessments should contain detailed information about all aspects of the person’s health and social care needs to make sure that the home is suitable and that the staff team can meet those needs. The care planning documentation should include more information on people’s personal history and background, social interests, hobbies, religious and cultural needs and how people’s finances are managed, and by whom, particularly when the Responsible Individual for the organisation is involved in the administration of the person’s money. Care plans should also contain information about people’s post where that is collected and dealt with by relatives. This is so that staff have more detailed information about people’s diverse interests and lifestyles, which will help them provide more personcentred care. Staff should be proactive in monitoring changes in people’s care and health needs and addressing those needs in a timely way. This is so that people’s psychological and physical health is maintained and people receive the care, support and access to health services that they need to DS0000003500.V375017.R01.S.doc Version 5.2 Page 31 2. OP1 3. OP3 4. OP7 5. OP8 Vicarage House Residential Home 6. OP9 7. OP9 8. OP9 9. OP12 10. OP15 11. OP18 12. 13. 14. OP19 OP22 OP22 meet their changing needs. Where people are self-medicating, the care plan should reflect the person’s wishes and the specific arrangements for their medication. A risk assessment should be carried out to ensure that people are able to self-medicate safely. If any medicines are ordered by the home, these should be properly receipted and a record made when they are handed over to the person who self medicates. A record of medication that people have in their own rooms should be kept by the home so they know what the person has been prescribed should that information be needed. There should be a detailed written procedure for the receipt, recording, storage, handling, administration and disposal of medicines, including controlled drugs. This is so that staff know exactly what to do from when medication is received in the home and what process to follow to ensure that there is a proper audit trail of medication in and out of the home. A proper register should be kept for the receipt, administration and disposal of controlled drugs. This should be either a bound book, a register with numbered pages or a computerised record that is secure, cannot be altered at a later time, and is attributable to the person who created the record. Arrangements should be made for people to have trips outside the home on a regular basis, which suit their needs and preferences. This is so that people have opportunities to enjoy and pursue their social, cultural, religious and recreational interests in the wider community. When people are offered alternatives to the main menu, they should be offered a meal that they will enjoy. The menus and the quality of the food provided should be reviewed to ensure that people receive meals that are varied, appealing, wholesome and nutritious and are suited to individual requirements. All staff should receive training regarding the safeguarding of vulnerable people, including the training provided by the Local Authority. This is to ensure that staff are aware of the local procedures to be followed should an incident of abuse or neglect be suspected or alleged. Advice should be sought from the environmental health department as to whether the designated smoking area complies with the laws on smoking in public places. Consideration should be given to repairing the shaft lift so that people will be able to go up and down to and from the 1st floor independently. Equipment, such as wheelchairs and bath lifts, should be DS0000003500.V375017.R01.S.doc Version 5.2 Page 32 Vicarage House Residential Home 15. OP27 16. OP30 17. OP30 18. OP30 19. 20. OP31 OP33 21. OP36 22. OP38 23. OP38 24. 25. OP38 OP38 easily available if required and kept in a good state of repair. This is so that they can be used whenever they are needed. Staffing levels should be kept under review to make sure there are enough staff on duty to answer call bells promptly, to cover shifts when staff are off sick or on holiday, and to meet the physical, psychological, emotional and social needs of the people who live in the home. All members of staff should receive induction training to Skills for Care specifications within six weeks of appointment to their posts. This is so that staff are trained and competent to do their jobs. Staff should receive appropriate training particularly related to caring for older people and people with physical disabilities. This is to ensure that they have the skills to meet the assessed needs of people living in the home. All staff should receive a minimum of three paid days training per year (including in house training) and have an individual training and development assessment and profile. The manager should apply to be registered with the Care Quality Commission to ensure that she is qualified, competent and experienced to run the home. The quality assurance system should be developed to include an annual internal audit of the facilities and services in the home to ensure that the aims, objectives and statement of purpose of the home are being met. Care staff should receive formal supervision at least six times a year to include all aspects of practice, the philosophy of care in the home and career development needs. The names of all staff who have been trained in fire safety awareness should be documented. There should be a system in place to ensure that all staff receive fire safety training as frequently as the home’s fire risk assessment has identified as necessary for the safety of the people who live in the home. All fire safety equipment such as fire extinguishers, smoke detectors, fire blankets and emergency lighting should be checked regularly to make sure they are in the correct location and have not been tampered with or damaged. The electrical wiring system in the home should be checked by a competent person to make sure it is safe. The temperature of hot food should be documented to show that it is properly cooked. Vicarage House Residential Home DS0000003500.V375017.R01.S.doc Version 5.2 Page 33 Care Quality Commission South West Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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