Inspection on 21/11/07 for Victoria Care Home

This inspection was carried out on 21st November 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 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

Victoria Care Home 18/03/09

Victoria Care Home 28/11/06

Victoria Care Home 10/05/06

Victoria Care Home 25/11/05

Victoria Care Home 28/06/05

Victoria Care Home 02/02/05

Victoria Care Home 29/09/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Victoria Care Home Victoria Street Rainford St Helens Merseyside WA11 8DA Lead Inspector Ms Lorraine Farrar Key Unannounced Inspection 29th November 2007 10:00 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 Victoria Care Home DS0000005474.V353184.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. Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Victoria Care Home Address Victoria Street Rainford St Helens Merseyside WA11 8DA 01744 88 6225 01744 886193 victoria@fshc.co.uk None Four Seasons Healthcare (England) Limited (Wholly owned subsidiary of Four Seasons Health Care Ltd) ** Post Vacant *** Care Home 53 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) Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (30), Old age, not falling within any other of places category (23) Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 23 OP and up to 30 DE(E) Service users to include up to 3 DE (out of 30 DE(E) category) Date of last inspection 28th November 2006 Brief Description of the Service: Victoria Care Home is owned and managed by Four Seasons Health Care, a large organisation who provide care services across the country. The building is a purpose built care home, providing single bedrooms, shared lounges and bathrooms over two storeys. Outside there is an enclosed back garden with some parking to the front. Situated in a residential area of Rainford the home has good transport links. Two different services are provided within the home. Edward Unit is located on the top floor and provides care with nursing for people who have dementia. Alexandra Unit is located on the ground floor and provides care with nursing for older people. Both services provide staff, including registered nurses, 24 hours a day. It costs between £ 369 and £419 each week to live at Victoria Care Home. Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Information for this inspection was gathered in a number of different ways. This included an unannounced site visit where time was spent reading records and looking at the building. ‘Case tracking’ was used as part of the visit. This involves looking at the support a person gets from the home including their care plans, medication, money and bedroom, time is also spent meeting with residents, visitors and staff about how they meet the persons needs. The site visit took place over 7 hours and was carried out by 2 CSCI Inspectors, Lorraine Farrar and Mike Perry. Case tracking was used to look at life in the home for 4of the people living there. Discussions took place with 3 relatives, 10 staff, and 9 of the people living there. One of the inspectors carried out a two hour observation as part of the inspection on Edward Unit, which supports people who have dementia, using a specialist tool for dementia care which highlights levels of staff interaction, resident well being and engagement with surroundings of the residents observed. The findings are used in parts of the report. What the service does well: Everyone living at Victoria has an individual care plan, which is up to date and provides staff with clear guidance around how to meet the persons care needs. The people living at the home told us that they always get the help and support they need with their health and personal care. People are offered a choice of meals and told us they can ask for alternatives and can have a drink whenever they ask. Most people said that the quality of the meals was good and they enjoyed them. Visitors are encouraged at all reasonable times and told us they are always made to feel welcome. On Alexandra unit staff spend a lot of time with the people living there engaging them in activities and supporting them to join in and spend their time meaningfully. Staff spoken with displayed a good knowledge of their role and were enthusiastic about learning more so that they could enhance the support they provide to people. Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 6 Clear systems are in place for dealing with complaints about the service and the people living there told us that they are confident any concerns they have will be listened to and dealt with. The building is clean and well presented with aids and adaptations provided to meet the mobility needs of the people living there. Regular checks are carried out on the quality of the service and where areas for further improvement are identified plans are put into place to meet this. Checks are also regularly carried out on the safety of the building and equipment to ensure Victoria is a safe place for everyone living, working and visiting. What has improved since the last inspection? What they could do better: Further planning and delivery of training for staff around supporting people who have dementia, the protection of vulnerable adults and ensuring peoples are treated with dignity at all times should take place. This will help equip staff with the skills and knowledge to support people safely and well and ensure they are supported in a way which maintains their dignity at all times. The support provided to some people at mealtimes is not always respectful of their dignity. Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 7 The environment on Edward unit would benefit from further input in providing orientation aids such as menus, direction signs and memory boxes. The provision of these may help the people living there to understand more about their environment and the activities occurring around them. Discussions with the people living on Alexandra unit would help to establish their views of activities arranged by the home and plan to provide activities that they would enjoy. The practice of giving peoples medication in their meals, whilst well documented needs to be monitored to ensure it is only used where needed and does not occur more frequently than necessary. An audit of staff files should take place to ensure that all required checks are up to date and have been carried out. This will help to ensure that all staff are suitable to work with the people living at Victoria. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 8 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 Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 9 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&6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prior to anyone moving into Victoria detailed information is obtained about the person. This helps everyone to be confident that the service can meet the persons’ needs and choices. EVIDENCE: Four care files were inspected including two for people who had recently moved in. Assessments of the person’s needs and choices had been carried out for both people before they moved into the home. The quality of the assessment for the new admissions was comprehensive and completed to a high standard. The assessment covers a number of areas including, daily living, physical and mental health, professional support required and social needs. Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 10 The mental health assessment, for example, covers areas of good practice such as level of orientation, depression, psychosis, potential for abuse, sleep, medication and the capacity of the person to agree to care and treatment. These were completed and any areas of risk highlighted so that a care plan could then be drawn up. Once admitted there are further assessments carried out such as moving and handling, falls, level of support needed, continence and a tool for assessing the risk of pressure sores. There was also evidence that relatives and the person had been involved in the assessment process. For example one person had been assessed as needing bedrails to ensure safety at night and the records showed that the relative had been included in the decision. The in-depth information recorded in these assessments helps everyone to decide if the service can meet the persons needs and choices and is the right place for them to live. It also helps staff to plan for the providing the care and support the person needs. A senior member of staff is responsible for managing admissions to the home. He explained that this includes ensuring preparations for the admission are in place. That only two people a week are admitted to ensure staff have the time to get to know and support them and that extra staff are on duty on the day people move in to help them settle. Victoria Care Home does not provide an intermediate care service. Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living at Victoria Care Home are provided with a good level of support to meet their health and personal care needs. However they are not always supported in a way that ensures their right to dignity is respected. EVIDENCE: Up to date care plans are in place for everyone living at Victoria. These give clear information about the person’s health and personal care needs and how staff should meet them. Regular reviews of the plans take place and they are updated when required. The reviews, or evaluations are clear in that they commented on the progress made by the person so that the effectiveness of the care plan could be assessed. Discussions and involvement of relatives in the care planning was recorded. The people living on Edward unit are not always able to fully speak for Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 12 themselves, therefore the involvement of their families helps to ensure that both their needs and choices are being met, in a way that they prefer. A relative reported that this aspect of care had improved over the past year and gave examples of how staff are quick to report any changes in care. She explained, “My relative is always clean and tidy and looks well care for. Staff are very good, they tell me what’s happening and keep me informed. Staff work very hard and treat residents well”. People are referred for health reviews when needed, and regular visits by the GP and other health professionals are recorded. The people living at Victoria appeared well cared for and suitably dressed. Staff were observed over a two hour period in the main lounge on Edward Unit and the staff interactions with the people living there displayed a lot of understanding of the needs of people with dementia. One person who was periodically upset and agitated was supported by a number of staff who displayed very good skills in communicating and supporting them. People told us that they get the care and support they need from staff, with one person commenting “I’ve had more done here” than ever in the past. During the inspection the majority of staff were seen to speak respectfully to the people living there, knock and wait before entering their rooms and provide support when requested. However during an observation of the lunchtime meal of Alexandra Unit staff were seen to provide little support to people in wiping their faces following a meal. One person required support to eat her meal. No consistency of support was provided. Both staff members walked up to the person at various times during the meal and placed food in her mouth without talking to her or giving an explanation. They also walked away and chatted with each other without speaking or explaining their actions to her. One member of staff spoke with her only to describe her mealtime manners as “dirty”. This shows a lack of respect for the person and their right to be treated with dignity, it also demonstrates a lack of understanding of peoples support needs and how to provide a goof standard of care and support. Medicines were reviewed. Records were clear and medicines received into the home were recorded so that an audit trail could be followed. An exception was the recording of the application of creams. For example one person had ‘AD’ recorded on the record indicating ‘already dressed’. The nurse explained that ‘the night staff would have applied the cream’, but this was not clear, as the night staff signature was not recorded. Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 13 The Nurse at the time of the inspection was knowledgeable regarding peoples’ medication. None of the people living there are currently looking after their own medication although there are risk assessment forms to use if needed. Part of the medication round was observed and this was carried out safely and carefully. It was noted that quite a few of the people living on Edward Unit have been assessed as needing to have medication administered without their knowledge – in food or drink. The assessments were very good and covered areas of good practice such as relative and GP involvement. The ratio of people assessed for this does appear high however and managers need to be aware when carrying out audits that covert administration of medicines should only be carried out when all other means have failed and the risk to the person of not receiving the medicine is significant. Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living at Victoria receive a varied level of support to live a lifestyle of their choosing. EVIDENCE: Throughout the site visit a number of visitors were seen to come and go. All of those spoken with said that they are able to visit at all reasonable times and are always made to feel welcome As part of the site visit a two hour observational study was undertaken in the lounge on Edward unit so that care could be assessed in terms of the daily interactions of the people living there with their surroundings and how this effected their feelings of well being. The study indicated that residents are very well engaged with their surroundings and there are plenty of opportunities to interact with staff and others living there. Staff were observed to be very good at providing ongoing commentary and interacting with residents, which encouraged both orientation and general Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 15 feelings of wellbeing. For example one person had a newspaper and staff were observed to discuss items with him. Staff also engaged in general conversation and referred to items in the news. There was a strong staff presence with at least one staff always present in the lounge and staff interactions were noted to be supportive of resident’s feelings of well being. Staff were skilled at interacting appropriately and assisting people with activities at their own pace. The relative spoken with reported that there is a relaxed feeling and that care staff are always on hand. They commented that daily activities had improved, explaining. “I was concerned some time ago that there was not enough going on but now there are regular trips out for some of the residents and there is more going on generally. There is a staff member who does activities and she is very good”. The people living on Edward unit were seen to be engaged in activities in the morning including a physical activity session involving throwing a ball, which they seemed to enjoy. This was carried out appropriately with respect being paid to those who did not want to join in. The activity was well paced so that people felt involved. Later some music was also played and the staff member was careful to ask people their choice and involve them in the activity. No organised activities were taking place for the people living on Alexandra unit during the site visit. Four people spoken with said that there was a lack of activities for them to participate in, although one person explained they are asked to go on outings, which they enjoy. During the site visit the people living on Alexandra unit were spending their time with visitors, chatting to each other and watching TV. Two of the men spoken with said they enjoy watching sport and one explained that he would like the home to have extra sports channels for him to watch. The lunchtime meal was observed on Edward unit. The meal was nicely presented and appeared appetising and was appreciated by the people living there. Staff were on hand to provide assistance where necessary. The tables were not set prior to people going into the dining area. This is an activity that some people may be able to assist with if offered the opportunity. It also acts as an extra orientation prompt for people as they prepare to eat as well as improving the general mealtime experience. The presence of a menu board offering the choice of meal available would also benefit this resident group in particular. During the lunchtime meal on Alexandra unit serviettes had been provided. However staff put meals down on these, with the result that one man eating a custard dessert had no way of wiping his face following the meal. Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 16 Tables were not fully laid with no salt and pepper etc provided for people to use. During the meal visitors were seen to walk in and out of the dining room, this could prove to be distracting for others and could impact on their privacy and dignity. As detailed above in this report, staff did not support people in a way that promoted their dignity during the mealtime. The views of the people living at Victoria regarding meals varied. All said that they have a choice of meal and confirmed they can have a drink whenever they request this. Comments ranged from “the meals are great” to one person describing them as “unpalatable”. This person explained they like salads and was seen to return their lunch meal largely un-eaten, having a dessert only. Although the daily menu included healthy options such as homemade soups and vegetables with the main meal, if someone is regularly not eating their meal this could impact on their health and well being. Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 &1 8 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living at Victoria are confident that any concerns they have will be listened to and acted upon. However staff are not always equipped with a good knowledge of adult protection issues. EVIDENCE: The people living at Victoria said that they know how to raise any concerns they have and are confident these would be dealt with. One person explained that they would, “talk to staff, they would look after me”. Information about how to raise concerns or complaints is made readily available to the people living there and to their visitors via a notice on the foyer. Records in the home show that complaints are documented and investigated with information on the outcome given to the person raising the concern. The manager stated in her pre-inspection assessment that in the past 12 months there have been 6 complaints raised, all have which were investigated and two of which were upheld. In addition there has been one protection of vulnerable adults investigation in which the company cooperated with the local authority by providing information, attending meetings and carrying out an investigation when asked to do so. Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 18 Records show that staff do receive some training in adult protection issues. Some of this training is provided in-house with more in-depth training provided externally. During the site visit two carers were spoken with who had not received thorough training in this area. The company have identified that a lack of thorough training in this area can impact on the support staff provided and need to ensure this training is prioritised for all staff as soon as they commence work within the home to ensure they can support people well at all times. Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 19 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, 21, 24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Victoria provides a warm, comfortable and safe place for people to live that is adapted to meet their needs and choices. EVIDENCE: Since the last big inspection of Victoria many parts of the home have benefited from maintenance, decorating and refurbishment work. The quality of the décor and furnishings is very good and offers a warm and homely environment for the people living there. This was commented on by several of the people living there and their visitors, with one person expressing the view that, “its always clean, spotless” and another explaining, ”its nice and warm here”. Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 20 The home has level access to all areas, with a lift to Edward unit, and has a number of living and dining areas that are small and homely but are also accessible for people who may have mobility problems. Edward unit has some good design qualities with regard to supporting people who are confused and may be disorientated. Staff have made attempts to support people to recognise different areas by putting their names on doors and identifying some living areas but need to be more consistent with this, for example some bedrooms did not have names on the door. Currently there is some lack of direction signs and bedroom identification such as memory boxes and photos, which could help people, find their way around. The general environment has been upgraded over the past year and provides a bright and homely environment. There is a lack of orientation aids such as large clocks; boards with daily information or appropriate signs to indicate where toilets etc are situation and this could be worked on so that people’s orientation can be assisted. Bedrooms throughout are generally well appointed and those seen were very well personalised with people’s possessions, which reflected their past and present lives. There are also bathrooms and toilets, which provide good facilities for people with disabilities. A number of aids and adaptations are provided to support people, these include, hoists, adapted baths and shower facilities, grab rails and nurse call buzzers. All areas were clean and tidy and there were no offensive odours throughout the home. The home has a laundry room, which is clean and tidy with clear systems in place to help prevent risk of cross infection. Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living at Victoria are confident in the staff team who support them. Further training for staff would enhance their knowledge and skills in supporting people safely and well. EVIDENCE: Staff spoken to were of the opinion that staffing had improved over the past year overall in that there was a better consistency of staff. This view was repeated by most of the people spoken with who live there. They told us that there are sufficient staff to meet their needs. Their comments around staffing included, “Staff are very good, they help you” and “fabulous, helpful and kind”. During the site visit there were sufficient staff to meet peoples needs and ensure those people assessed as needing extra support received this. It was apparent that the nurse in charge of Edward unit was expected to complete a lot of paper work as well as monitor medication and the medicine round was reported to take over 2 hours. The amount of time spent on supervising direct care was therefore limited. The nurse reported that once there were over 25 people living there another care staff would be supplied. Management should consider whether the extra staff should be a qualified Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 22 nurse, particularly on the morning shift given the nurses workload as the residency figures increase to 30. Records showed that staff receive a variety of training in both basic care practices such as moving and handling people and fire as well as more specialist training in areas such as end of life care and the mental capacity act. This helps to ensure staff are up to date in how to support people safely and well. The company have supplied some training around dementia care and one staff was able to discuss an upcoming course he had been booked to attend. However staff still felt frustrated that more training around dementia care issues was needed. For example the designated staff that organises the activities on the unit has had little background training in this area and would obviously benefit from more diverse training material and courses. There is only one nurse on the unit who has any background in dementia care and further extended training for general nursing staff in this area would increase their knowledge of how to support people in line with current good practice. There was limited access for staff to journals and periodicals on dementia care, which would provide staff with up to date information on good practice in this area of care. New staff undergo induction training based on national standards, two staff explained this consists of workbooks which they complete and discuss with their line manager, they are also given a long standing member of care staff to act as a mentor and support them to learn more about their role. No specific plan was in place for newer staff identifying or planning their training needs and when this would be delivered. An individual plan would help to ensure people are supported to build on their existing knowledge and skills and provided with the information they need to support people safely and well. For example two newer staff spoken with had not had in-depth training on adult protection issues and no information was available on when this was planned for them. From the general observations made and the more specific observations using the two hour observational tool it is clear that most staff have good skills and provide individual care to the people living there. The exception to this was the support staff provided at lunchtime on Alexandra unit and their apparent lack of in-sight into how this should be provided to maintain peoples right to dignity. Staff files showed that checks are carried out on new and existing staff to ensure they are suitable to work with the people living at Victoria. All long standing staff had copies of a Criminal Records Bureau check on file and two written references had been obtained for all staff. However no records was available that a check had been made on the Protection of Vulnerable Adult register for one new member of staff. All Nurses are required to register each Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 23 year with the Nursing and Midwifery Council (NMC), this helps to ensure they are up to date and fit to practice. However no recent checks on their registration had been carried out with the NMC. These checks all help to ensure staff are safe and suitable to work within a care setting and should be retained in the home. Victoria Care Home DS0000005474.V353184.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clear management systems are in place at Victoria to ensure the safety and well being of the people who live there. EVIDENCE: Mrs Carol Baker s the appointed manager of Victoria. She has worked there for some time and is experienced in management within a care setting. Mrs Baker is not yet registered with the Commission for Social Care Inspection. This registration process helps to ensure the suitability of people to manage a care service and should take place as soon as possible after they are appointed to their role. Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 25 There are a number of systems in place within Victoria to assess the quality of the service they provide and plan future improvements. The manager carries out regular audits of care plans to ensure they are up to date and accurate. In addition an overall audit of the home is carried out by the company and the manager advised she is drawing up an action plan to meet any improvements recommended. Twice yearly surveys are carried out to obtain the views of the people living at Victoria and their relatives. The last survey in May 2007 expressed some dissatisfaction with meals and décor. These have been addressed since and the manager advised a new survey would shortly be sent out. Wherever possible the people living at Victoria or their representatives are encouraged to manage their own money and benefits. Where the company act as appointee for peoples benefits clear systems are in place for managing this safely. This includes ensuring the money is separate from the company’s money by storing it in a residents account with a national bank. A sample of money held for the people living at Victoria was checked during the site visit, this tallied with records and receipts. Records and certificates showed that regular health and safety checks are carried out on the environment and equipment to ensure they are safe for everyone to use. Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 26 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 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 X 3 X X 3 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 Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 27 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 OP10 Regulation 12(4) Requirement Training, discussion and observations of practice must be planned for all staff around treating people with dignity. This will help to ensure the people living at Victoria are supported at all times by staff who know how to maintain peoples right to dignity. 2. OP15 16(2)(i) People’s intake of food must be monitored and where they are unhappy with the food supplied alternative menus for them must be provided. This will help to ensure people have the nutrition they need and support their health. 3. OP29 19(1)(b) An audit of all staff files must be undertaken to ensure all required checks on staff have been carried out and are up to date. This will help ensure staff are suitable to working with the people living at Victoria. DS0000005474.V353184.R01.S.doc Timescale for action 29/02/08 15/02/08 29/02/08 Victoria Care Home Version 5.2 Page 28 4. OP30 13(6) - Where not already provided training for all staff including in the protection of vulnerable adults must be arranged. This will help to ensure staff have the skills to support people safely and well. 15/02/08 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 OP9 Good Practice Recommendations - Staff signatures should be recorded on the MAR sheet when creams are applied for residents. - The inspector’s comments around covert administration of medicines need to be considered by the manager when auditing the medication procedures. This will help to ensure medication is managed as safely as possible for the people living at Victoria. 2. OP12 - Discussions should take place with the people living on Alexandra unit around activities. - Once their opinions and choices are obtained a plan of action to meet these should be drawn up. This will help to ensure peoples personal choices are met as far as possible and enhance their experience of living in the home. 3. OP15 - Tables for meals should be fully set prior to residents going into the dining room. - The presence of a menu board offering the choice of meal available would also benefit this resident group in particular. - Senior staff should observe, record and act upon their observations of mealtimes, particular on Alexandra unit. Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 29 4. OP19 This will help to ensure people are supported as dignified and independently as possible with their mealtimes. Edward unit should be further developed with reference to good practice guidance around dementia care in providing additional orientation aids. Serious consideration should be given to supplying another trained nurse on Edward unit as the resident figures increase so that supervision of care and the quality of care can be maintained. There needs to be further ongoing training for all levels of staff in dementia care. Individual training plans for all staff, including new staff should be compiled. This will help to identify gaps in people’s knowledge and ensure they are met, thereby enhancing their knowledge in supporting the people who live at Victoria safely and well. 5. OP27 6. OP30 7. OP31 The manager should apply to register with the CSCI as soon as possible. This will meet current legislation and help ensure she is suitable for the role. Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Liverpool L22 0LG 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 Victoria Care Home DS0000005474.V353184.R01.S.doc Version 5.2 Page 31 - 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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