CARE HOMES FOR OLDER PEOPLE
Vicarage House Residential Home 1 Honicknowle Lane Pennycross Plymouth Devon PL2 3QR Lead Inspector
Sheila Giblin Unannounced Inspection 17th February 2006 09.45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Vicarage House Residential Home DS0000003500.V284023.R01.S.doc Version 5.1 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 House Residential Home DS0000003500.V284023.R01.S.doc Version 5.1 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 Gaynor Braddon Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32), Physical disability over 65 years of age of places (32) Vicarage House Residential Home DS0000003500.V284023.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th July 2005The inspection was unannounced and took place over 3 hours on Friday 17th February 2006. The focus of the inspection was Brief Description of the Service: Vicarage House is a detached, two storey property situated in the residential area of Pennycross, Plymouth. The home is registered to Dr Peppers Care Corporation Ltd and the Directors are Dr and Mrs Pepper. The home is currently managed by Mrs Woodward together with the Registered Manager Ms Braddon. The home is registered to provide residential accommodation and personal care for a maximum of 32 older persons over the age of 65 who may also have a physical disability. The home has 26 rooms approved for single occupancy, 17 on the ground floor and 9 on the first floor. There are 3 rooms approved as doubles, two are on the ground floor and one the first floor. No bedrooms have en-suite toilet facilities. There is a chairlift which goes most of the way up the main staircase. There is a choice of communal areas on the ground floor and access to a garden area which is attractive and well used by Service users in the summer months. Smoking is permitted in designated areas only within this home. Vicarage House Residential Home DS0000003500.V284023.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over 3 hours on Friday 17th February 2006. The focus of the inspection was to monitor progress on the outstanding requirements imposed at the previous inspection and to consult with residents about the quality of life in the home as they experienced it. The Registered manager was on maternity leave and the general manager was on annual leave. The deputy manager was on duty and she and the staff team assisted with the inspection. There were 27 residents in the home plus another in hospital. Fifteen residents spoke to the inspector and four family visitors gave a view of the home and the care their relatives were receiving. The inspector toured the building, examined care records and other documents. What the service does well: What has improved since the last inspection?
Prospective residents are assessed prior to being admitted. The unpleasant odour in a bedroom has been removed by the use of sanitising cleaning agents and staff being vigilant. Staff files are being updated and records listed to show the contents of the files. Staff are maintaining the controlled drug book appropriately. Vicarage House Residential Home DS0000003500.V284023.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Vicarage House Residential Home DS0000003500.V284023.R01.S.doc Version 5.1 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 House Residential Home DS0000003500.V284023.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 Residents are given the information they require to make a choice about whether to be admitted to this home EVIDENCE: A number of pre-admission assessments undertaken by the Manager were available for inspection for newly admitted residents. The information was brief and in one case inadequate, the documents were undated and unsigned. The home does not provide intermediate care. Vicarage House Residential Home DS0000003500.V284023.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 10 Information to support particular health and care needs was not always fully recorded. EVIDENCE: Residents confirmed that they feel very well cared for and can ask at any time for assistance. A number of residents said that nothing was too much trouble for the staff. Assessments were recorded upon admission and included moving and handling, skin care and nutritional assessments to ensure that any additional support needs could be identified and other health care professionals involved if necessary. Significant events were not always recorded in detail in the daily record. There was no evidence that relatives are involved in the care of residents in the care plans or the reviews. Relatives had not participated in the care planning process. A request for a nursing care assessment had not been recorded on the care plan or daily record although a letter confirming an appointment was seen.
Vicarage House Residential Home DS0000003500.V284023.R01.S.doc Version 5.1 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Residents can be assured of a comfortable lifestyle that encourages them to be independent and make choices. EVIDENCE: Residents said that their visitors were free to visit at anytime. Evidence of this was seen during the inspection. Residents’ interests were recorded in their care plans and staff endeavoured to encourage these to continue. Independent residents said they were able to get up and go to bed at times that suited them. Residents described the food as “very good” or “excellent” and plenty of fresh fruit and vegetables were evident. The kitchen was very clean and tidy indicating that regular cleaning was taking place. The menu plan was well recorded and showed a variety of meals to suit all tastes. Alternatives to the main meal and teatime meal are offered and recorded on the plan. Vicarage House Residential Home DS0000003500.V284023.R01.S.doc Version 5.1 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Complaints and suggestions from residents, relatives or other visitors to the home, are treated seriously. Residents are listened to and issues resolved promptly EVIDENCE: Residents said that the Managers were approachable, the owner, Dr Pepper, visits regularly and meets with staff, residents and any visitors. Residents and relatives were confident that any issues of concern would be listened to and dealt with. No complaints had been received since the last inspection. A copy of the complaints procedure is available to residents and visitors. Staff who have completed NVQ training have received some information regarding the Protection of Vulnerable Adults. However, staff have not yet undertaken the specific training available that would ensure a clear understanding of protection from abuse. Vicarage House Residential Home DS0000003500.V284023.R01.S.doc Version 5.1 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23, 24, 25, 26 Residents live in a warm comfortable home, which is clean and hygienic. EVIDENCE: During the tour of inspection the inspector looked into most bedrooms, bathrooms and toilets. Residents were seen in the lounges and dining room. Residents said that they found the home warm and comfortable. Bedrooms and communal areas are pleasantly decorated and furnished. The home was very clean and tidy. The carpet upstairs on the landing is uneven and loose in places and may present a trip hazard. Locks had not been fitted to the bedroom doors of a number of residents to ensure their privacy. A broken pane of glass in the patio door has not been replaced. An extension and remodelling project is due to begin in March 2006 which will resolve this when the patio doors are replaced. The passenger lift was out of order and there were no plans to repair it. The inspector was informed that the stair lift was to be extended. Vicarage House Residential Home DS0000003500.V284023.R01.S.doc Version 5.1 Page 13 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 Residents cannot be confident that their best interests are protected because the recruitment and employment processes are not being followed. EVIDENCE: Residents described the staff as very kind and caring and confirmed they responded promptly to requests for assistance. Some comments were made by residents and visitors that the staff do not have time to provide the levels of care required to meet the needs of a resident. This was discussed with the deputy manager who said that staffing levels had been reviewed. Care staff are supported by catering and domestic staff. The staff rota was described and the hours staff work examined. A skill mix of staff were on duty during the morning of the inspection. Besides five employed paid staff –including the deputy manager - there was one on work experience and another who had been a volunteer for a year. Staff records were sampled and evidence seen of a lack of a robust recruitment process. One staff file inspected held all the records and documents required whilst others did not have references, records of CRB checks, proof of identity or application forms. The deputy manager informed the inspector that three applications for CRB checks had been submitted recently but there was no written record of this having been done. Vicarage House Residential Home DS0000003500.V284023.R01.S.doc Version 5.1 Page 14 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 37, Residents live in a home where the absence of members of the management team may be causing some shortfalls in the systems and processes that should be in place to protect and support residents and ensure their care needs are fully met. EVIDENCE: The registered Manager is on Maternity leave and was said to be returning in the near future. The general manager was on annual leave. The deputy manager is experienced and knowledgeable. However, during the inspection some terms and phrases used to describe residents’ behaviours and care were not professional or dignified and showed a lack of respect for the residents concerned. Residents’ and staff files sampled were not complete although there was evidence to show that efforts were being made to remedy this.
Vicarage House Residential Home DS0000003500.V284023.R01.S.doc Version 5.1 Page 15 The owner of the home visits monthly, holds residents and staff meetings and publishes a Newsletter. There is a requirement that visits are recorded and a copy of reports must be sent to the CSCI monthly under Regulation 26. Vicarage House Residential Home DS0000003500.V284023.R01.S.doc Version 5.1 Page 16 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 X X X X 2 X Vicarage House Residential Home DS0000003500.V284023.R01.S.doc Version 5.1 Page 17 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 OP3 Regulation 14 Requirement All service users must have a comprehensive pre-admission assessment on file that has been signed and dated. The cracked patio door must be repaired or replaced as stated in the letter supplied to the Commission. This requirement has been carried over from the previous inspection. Bedroom doors must be lockable to preserve the privacy of Service Users. This requirement is carried over from a previous inspection All staff employed in the home must undertake a CRB check and the list sent to the Commission. This requirement is carried over from the last inspection. All staff employed must have references on file. Care planning processes must involve close family members who are involved in the continuing care of the resident and recorded appropriately The Registered provider or representative must carry out
DS0000003500.V284023.R01.S.doc Timescale for action 01/04/06 2. OP20 23 01/06/06 3. OP24 16 01/04/06 4. OP29 19 01/04/06 5. 6. OP29 OP7 19 7 01/04/06 01/04/06 7. OP31 26 30/09/05 Vicarage House Residential Home Version 5.1 Page 18 8. OP18 14 Regulation 26 visits to the home and send them to the Commission. All staff should complete the Adult Protection course. 01/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP18 Good Practice Recommendations Any changes or updates to care plans should be signed by the person making those changes. Staff must be made aware of the importance of using appropriate respectful terminology when discussing residents’ behaviour and care. Vicarage House Residential Home DS0000003500.V284023.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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