Inspection on 28/11/06 for Victoria Care Home

This inspection was carried out on 28th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 21/11/07

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 Lorraine Farrar Unannounced Inspection 11:00 28 November 2006 th 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.V315029.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.V315029.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 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) None Four Seasons Healthcare (England) Limited (Wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Sharon Ahern Care Home 53 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.V315029.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 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. Emily 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. Victoria Care Home DS0000005474.V315029.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 two days 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 three of the people living there. Discussions took place with 9 Residents, 4 Relatives, 2 professional visitors and 8 Staff including the Manager. Prior to the Inspection comment cards were sent to Residents seeking their views regarding the service, one of which was returned. The Manager was given the opportunity to provide information about the service by completing a pre inspection questionnaire, however this was not returned to the CSCI. For the past 12 months no new Residents have been admitted to the home as the local Social Services and Primary Care Trust (PCT) had concerns regarding the service provided. As a result of this the PCT have been providing a high level of input into the home to support care practices. The Manager advised that this input had slowly decreased and the situation was due to be reviewed at a meeting arranged for 13th December 2006. If further information regarding this is required, the person should contact the Manager or local Social Services Department. The weekly fees for living at the home are between £350 and £525. What the service does well: Staff provide a satisfactory level of personal and health care support to Residents. Until shortly before the inspection they were assisted in providing this care by the local Primary Care Trust and Social Services Department. The overall appearance of the home provides a clean and welcoming place for Residents to live in. Residents Relatives and friends are welcomed to the home and are able to visit at any time. Victoria Care Home DS0000005474.V315029.R01.S.doc Version 5.2 Page 6 Both Residents and Relatives spoken with were complimentary regarding the management of the home, with one Resident explaining he finds the Manager easy to talk to and that she will sort any issues out. There are clear polices in place for employing new Staff, these are followed and ensure that appropriate checks are carried out before employing new Staff to make sure they are suitable to work with Residents who are often vulnerable. What has improved since the last inspection? What they could do better: The home needs to obtain more specialists input around supporting people with dementia. This includes providing training for Staff and having an assessment of the environment carried out to establish the most effective way to support Residents. The evaluation of Staff support for people with dementia should be more specific in order to establish whether the support provided is having a positive effect. This will ensure that the home provides a service based on good practice and one that can meet Residents individual needs and choices. Although there are sufficient Staff working in the home, their working practices need to be reviewed so that Residents are not left alone in living areas for long periods of time. This will ensure that Residents are safe and protected within Victoria Care Home DS0000005474.V315029.R01.S.doc Version 5.2 Page 7 the home and that they have regular interaction with other people throughout the day. Some maintenance issues within the home have been identified and not addressed in a timely manner. For example there are bedrooms lights that do not work and several toilets with an offensive odour. These issues should be addressed as quickly as possible once identified and orders for parts etc should be followed up. There is an on going issue with the heating and water within the home. Some water outlets are providing very cool water in order to regulate the temperature. This would be uncomfortable for Residents to use. The heating system in the home has caused difficulties for some time and breaks down regularly. Although mended quickly, Residents advised that they are sometimes cold. A long term solution to this issue needs to be implemented. 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.V315029.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.V315029.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): 2&3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Appropriate procedures are in place for ensuring the needs of Residents are assessed before they move into the home. Existing Residents have most but not all of the information regarding the conditions of their stay in the home. EVIDENCE: Most but not all Residents had copies of their terms and conditions for living at the home, on file. Some of these had not been signed, however a letter sent to one Relative stated that the home assumed he agreed with the contract, as he had not returned a signed copy. One contract had been signed several months ago by a Resident who appears to have become more confused. The Manager should ensure all Residents have an up to date contract on file and that, if required they have external support before signing this. No new Residents have moved into the home for over 12 months. Therefore it was not possible to practically assess the level of information new Residents Victoria Care Home DS0000005474.V315029.R01.S.doc Version 5.2 Page 10 receive about the service or, whether Staff currently have the skills to obtain enough information about a new Resident to make sure their needs can be met by the home. Assessments carried out for 3 people who have lived at the home for some time, were looked at. These had not always been fully completed, which could lead to Residents support needs not being identified and met. However up to date assessments had been carried out in areas such as supporting people with their nutrition and mobility and these provided clear information on the persons support needs. The Manager showed Inspectors a new assessment form provided for future use. This was detailed and if fully completed, will help Staff and the person to make sure that they are able to identify and plan to meet the person’s needs and choices. She explained that she had used these forms to assess people moving into other homes within the organisation. This had helped her to become familiar with the information needed and she found it provided the necessary information. Victoria Care Home does not provide an intermediate care service. Victoria Care Home DS0000005474.V315029.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. Resident’s health and personal care needs are identified and met within the home. Further development of plans is needed to ensure that Staff support is always effective. EVIDENCE: Up to date care plans are in place for each Resident. 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. Each month the Manager audits plans and gives clear instructions for Staff to follow, if any areas require updating. For example one audit noted that the Residents agreement to the plan had not been obtained. A date for achieving this was recorded in the audit. On Emily unit it was not always clear whether the support provided was having a positive effect. For example one Resident who displays some aggressive bahavior had appropiate guidelines recorded for Staff to follow. However the evaluations of the effect Staff support had were very general. It was therefore Victoria Care Home DS0000005474.V315029.R01.S.doc Version 5.2 Page 12 not clear whether the incidence of agression was being reduced by following the guidelines in place. On Alexandra unit regular discussions and involvement of Relatives in the care planning was recorded. However on Emily unit there was no evidence that this takes place. The people living on Emily unit are not as able to speak for themselves, therefore the involvement of their families would help to ensure that both their needs and choices are being met, in a way that they prefer. Residents are referred for health reviews when needed, and regular visits by the GP and other health professionals are recorded. Two Residents who have pressure sores were being monitored effectively with support form the local Tissue Viability Nurse recorded. Visiting health and social professionals have acknowledged improvements in the care provided. However given that the home is supporting fewer than usual Residents, all of whom have lived there for some time and the input from other professionals, concerns have been expressed regarding the ability of Staff to maintain a long term, satisfactory standard of care. On one occasion a Resident, who was confused had to attend the local hospital and they were not accompanied by Staff. There are risks with this practice in that required information may not be passed on. There is also a lack of support for a Resident who is not able to speak for themselves and therefore may feel insecure. . Records of Residents who have fallen within the past 4 weeks were looked at. During that time 15 separate falls were recorded, 14 of which occurred at night. The Manager provided evidence that she is reviewing all falls within the home to establish if there are any patterns to these happening and how they can be reduced. During the site visit the majority of Residents appeared well cared for and suitably dressed. One Resident explained that a hairdresser visits weekly and this was observed during the visit. During the visit one lady was seen to have dirty fingernails and to be sitting in the lounge with her stockings around her knees. This was discussed with the Manager who was aware of it, and stated she had spoken to Staff about supporting the lady more effectively. A Resident explained that he is usually independent, but had recently needed help with personal care from Staff. He said this had always been provided and although he had to get up earlier, he was happy to do so. . Relatives reported that they are satisfied with the personal care provided. One commented that the, “care is very good – my sister is always clean and tidy”. Another said “there is a good lot of Staff at the moment and they are very caring.” Following the last key inspection of the home, the CSCI served a statutory requirement notice on the home. This required them to improve the way in Victoria Care Home DS0000005474.V315029.R01.S.doc Version 5.2 Page 13 which they managed medication. A further inspection evidenced that the notice had been complied with and medications were being managed safely. Medicines were reviewed on Alexandra Unit. Records were clear and medicines received into the home were recorded so that an audit trail could be followed. The Nurse at the time of the inspection was knowledgeable regarding the medicines for Residents. There are no Residents looking after their own medication, although it was reported that some Residents in the past had been supported to do so. Staff were seen to knock on Residents bedroom doors before entering and to speak appropriately and in a dignified manner to Residents. Victoria Care Home DS0000005474.V315029.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. Residents are supported to make choices in their daily lives. Further development of activities within the home would benefit Residents and ensure they have a meaningful way to spend their time. EVIDENCE: The general atmosphere during the visit was busy, with the hairdresser visiting and Christmas decorations being put up. There is an Activity Co-ordinator working in the home for 20 hours a week. Residents and Relatives were able to clearly identify her and spoke highly of the support she provides. In discussion she was enthusiastic about her role and about creating more activities for Residents to become involved in. However there is limited funding of 20 pence per Resident, per week for activities. Other money is obtained by fundraising, which is not always a reliable source. Staff commented that more activities such as art and crafts could take place if there were sufficient funds available. Advertised activities included, a Christmas party, sing-a-longs, exercises and occasional outings. A Resident explained that she particularly enjoys knitting and making up gardening baskets with the Activity Co-ordinator. Victoria Care Home DS0000005474.V315029.R01.S.doc Version 5.2 Page 15 There is little access to information or journals around appropriate activities for people with dementia and there has been no training for Staff in this area. This would enable Staff to provide activates for Residents, that meet their needs and choices. Despite the activities arranged by the Activity Coordinator there are limits to the time she can spend with each person. Several Residents said that they get bored, and during the site visit they were observed to spend long periods of time without any social interaction. In one lounge four Residents were sitting together. One Resident stated, “All you do is sit in a chair waiting for another person to come through”. Another Resident was observed shouting and telling the others off for no apparent reason. Although Staff entered the room to provide drinks they handed out the cups and left. One lady spilled her drink over herself and the other Resident continued to shout at everyone else. Later in the day members of Staff were observed sitting with Residents in this lounge, all appeared much calmer and were laughing and joking with each other. Visitors spoken with all said that they are able to visit at any time and good practice was noted in that Staff had contacted one Residents local church to arrange visitors for him. Residents comments around meals were positive, with one explaining, “‘I like the food here, its always lovely” and another, “The foods ok, they make something different if you ask”. Meals times were observed and these were social occasions with Residents receiving support where needed. There is a choice of food and the units are well equipped with comfortable dining areas. Relatives commented on the meals, with one explaining, “The foods much better, they get fresh fruit and veg now”. Staff have a good awareness of each Residents likes and dislikes and are able to explain these. Residents’ bedrooms have been personalised with photographs and ornaments, which reflect the person’s personality and history. Victoria Care Home DS0000005474.V315029.R01.S.doc Version 5.2 Page 16 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 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information about how to raise a complaint is available within the home, however not all Relatives have been made aware of this. Policies and procedures to protect Residents are in place, however these need to be reviewed to include Residents behaviours to each other. EVIDENCE: A copy of the homes complaints procedure is available in the service users guide. A note in the foyer states these are available on top of wardrobes, and these were observed in the bedrooms visited. However Relatives on Emily Unit said that they did not understand the homes complaints procedure and had not been made aware of this. A Resident on Alexandra unit said that he would speak with the Manager if he was not happy, or his Relative would contact the organisation. He explained that, the Manager is “ very good, she always has the time”. His Relative expanded on this, stating, “Ive now got confidence”, concerns and complaints would be acted upon. A record of complaints is held in the home, this records details of the complaint, the investigation and the outcome and provides a clear way for the Manager to audit the service being provided. Victoria Care Home DS0000005474.V315029.R01.S.doc Version 5.2 Page 17 Copies of the local authority adult protection procedures are available in the home and the Manager was able to explain the action she would take in the event that an allegation was made. Records and discussion with Staff evidenced that they have received training in this area. Staff reported difficulties in observing Residents in the lounges so that they can be safely monitored and protected from some of the more anti social behaviours apparent when elderly people become confused. This is particularly relevant in dementia care were observation is geared towards ensuring Residents dignity is upheld. For example it was observed that one Resident exposed herself in one of the lounges with both Residents and visitors present. In another lounge a Resident was observed shouting at others sitting in there, repeatedly telling them to “shut up”. No Staff were present during this exchange. Victoria Care Home DS0000005474.V315029.R01.S.doc Version 5.2 Page 18 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 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a pleasant environment for Residents to live in, however there are several maintenance issues that need to be addressed to ensure Residents safety and comfort at all times. EVIDENCE: Emily unit has some good design qualities with regard to Residents who are confused and may be disorientated. The unit has level access to all areas and has a number of living and dining areas that are small and homely but are also accessible to Residents who may have mobility problems. Staff have made attempts to support Residents to recognise different areas by putting their names on doors and identifying some living areas but need to be more consistent with this. Victoria Care Home DS0000005474.V315029.R01.S.doc Version 5.2 Page 19 A planned approach to developing the environment in line with current research around the environment and orientation for people with dementia, including use of different colours and signs, would help make sure the home can meet the diverse needs of the people living there. Bedrooms and are generally well appointed and those seen were very well personalised with Resident’s possessions, which reflected their past and present lives. All living areas were individually decorated to a good standard. There has been on going issues with the water and heating within the home. In June 06 the organisation informed the CSCI that quotes for work to be carried out had been obtained. However this work is still outstanding. The day before the visit the heating had not been working in some areas, an engineer had got it working again but advised that the system needs to be bled every two weeks to keep it working. One Resident, explained, “it went wrong, the heating, they fixed it and now its too hot”. The radiator in the downstairs lounge was not on, a Resident stated, “more often than not its off (radiator) I feel the cold, feel confused and fed up” and another said, “it is a bit cold in here”. The Handyman bled the radiator and explained it may automatically switch off when it reaches a certain temperature. As many of the people living in the home are elderly and immobile, it is important that the environment is at a temperature to suit their needs and ensure they are comfortable. Records showed that some water mixer valves had been replaced and a further 28 had been ordered. A member of Staff confirmed they had been ordered several weeks ago. These valves regulated the temperature of water Residents use to ensure it does not get too hot. They are usually set at around 43 degrees to ensure both safety and comfort. However one sink recorded a temperature of 23 degrees, and a bath a temperature of 31 degrees. These temperatures are very cool and would be uncomfortable to use. A member of Staff explained the bath takes around 10 – 15 minutes to get warmer, another member of Staff explained that temperatures had been turned down low, as valves were not working and there were concerns regarding the potential temperatures they could reach. A member of the organisations Estates Department contacted the CSCI following the site visit, and stated that the valves would be all replaced by 13th December 2006 and that two weekly checks of the heating have been implemented. Some minor maintenance issues were identified during the visit, these included overhead lights not working in bedrooms and cupboard doors needing repair in the clinical area. Some of the toilets on Emily unit had an offensive smell, which both Residents and Relatives commented on. Victoria Care Home DS0000005474.V315029.R01.S.doc Version 5.2 Page 20 It was observed that the hoists used for lifting Residents were in regular use. Staff identified difficulties in meeting care needs in a timely fashion as there is currently only one stand aid hoist for all of the Residents in the home and this is used on both units. This is a particularly useful aid as it can free up Staff to meet other care needs and provide support in a timely fashion. An assessment of the equipment and adaptations needed, by a professional experienced in this field of care, would benefit the people living in the home and ensure their needs are met. The home was clean and hygienically maintained throughout, Residents and Relatives confirmed that this standard is maintained with bedrooms and living rooms providing a pleasant environment. The laundry provides industrial washers and dryers and there is a good system in place for caring for Residents clothing and preventing the risk of cross infection. Victoria Care Home DS0000005474.V315029.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. Residents are supported by an experienced Staff team, further development of specialist training and working practices would benefit the people living in the home. EVIDENCE: The Staff rota showed that there is a Registered Nurse working on both units 24 hours a day. In addition there are 2 carers during the day on Alexandra Unit to support 19 Residents and 2 carers on Emily unit to support 9 Residents. One Resident has 12 hours 1-1 Staff support during the day, this was provided for her during the site visit. A Resident expressed the view that, “ The Staff are very nice, there’s enough of them, they take me about, very kind I can’t grumble” and another said that Staff are “okay” and confirmed there are enough Staff to meet his needs. The way, in which Staff work needs to be reviewed, to make sure lounge areas are covered and Residents protection ensured. Some Staff have obtained a care qualification (NVQ) and others are working towards this, however the percent of Staff with this qualification was not available in the home. Training records and discussions with Staff evidenced that they have attended a number of basic training courses in relevant areas. Victoria Care Home DS0000005474.V315029.R01.S.doc Version 5.2 Page 22 These included, Moving and Handling, Protection of Vulnerable Adults and Medication. More specialist training in supporting people with dementia has not been provided. Staff said that they would find this useful in supporting people to manage their behaviour. Training in this area will enable the home to develop a more specialised service that meets people’s individual needs, via an experienced and qualified Staff team. Staff files showed that the home carries out appropriate checks before appointing new Staff, this includes obtaining a completed application form, written references and Criminal Bureau Check (CRB). These checks help the Manager to ensure Staff are suited to working with this, often vulnerable, client group. Victoria Care Home DS0000005474.V315029.R01.S.doc Version 5.2 Page 23 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): 31,32, 33,35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is operated safely by an experienced Manager who has strategies in place for auditing and improving standards. EVIDENCE: Carol Baker has been the appointed Manager of the home for several months. She is an experienced Nurse with management experience within a hospital setting. Each unit has an identified Manager who specialises in the area of care provided. Discussions with Residents and Relatives evidenced a good level of support for both the unit Manager and overall Manager. One Relative expressed the view that, “Carol does a tremendous job, I just phone or meet Carol and she sorts it out”. Mrs Baker was able to explain the improvements she has made and plans to make, within the home and is motivated to improve the service offered. Victoria Care Home DS0000005474.V315029.R01.S.doc Version 5.2 Page 24 There are a variety of methods within the home for auditing the quality of the service provided. Once a year an external company carry out an audit of the home and provide a rating as to the quality of service provided. Each month a member of Staff from the organisation visits the home and provides a report of their findings. In addition the Manager carries out monthly audits. These cover a variety of areas and provide an action plan for any areas of improvement needed. It was clear from reading audits that action plans are followed up and improvements made within the service. A safe is provided within the home for Residents who wish to store small amounts of money. Records of all monies held for Residents are on computer. These evidenced that wherever possible the organisation encourages Relatives to act as appointee for the Resident, rather than the organisation. The majority of money held for Residents is in a bank account, specifically for Residents of Victoria. A small cash float is available for anyone who wants access to some of their money. Records and receipts checked were in order. Health and safety records and certificates were satisfactory and up to date for the environment, gas and electric supplies, fire, aids and adaptation and appliances. The exception to this is the on going issues with water and heating within the home. Victoria Care Home DS0000005474.V315029.R01.S.doc Version 5.2 Page 25 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 2 2 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 3 3 X X 2 Victoria Care Home DS0000005474.V315029.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP19 Regulation 23 (2) (a)(f)(h) Requirement The Registered Person must arrange for an assessment of the environment, by a suitably qualified person with specialist knowledge of the client group [particularly dementia care]. Particularly with respect to disability equipment and environmental adaptations in the home. The Registered Person must address maintenance issues identified within this report. The Registered Person must review working practices regarding arrangements for Staff observing Residents in living areas and ensuring their protection. Timescale for action 28/03/07 2 OP19 23(2)(b) 28/02/07 3 OP18 13(6) 15/01/07 Victoria Care Home DS0000005474.V315029.R01.S.doc Version 5.2 Page 27 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 OP2 Good Practice Recommendations The Responsible Person should ensure all Residents have an up to date contract on file and that, if required they have external support before signing this. The Registered Person should ensure evaluations of support provided to people with their challenging behaviour are be backed up by reference to more measured observations such as behaviour observation charts and monitoring tools. The Registered Person should ensure care plans on Emily unit must be drawn up and evaluated periodically with the input from Relatives or advocates. 2 OP8 The Registered Person should review the policy on the escort of Residents to hospital to ensure their safety and wellbeing. . The Registered Person should provide current literature on developing the environment for dementia care and introduce orientation aids in line with good practice. The Registered Person should provide training for Staff Manager around dementia care and management of challenging behaviour. 1 OP7 3 OP19 8 OP30 Victoria Care Home DS0000005474.V315029.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Knowsley Local 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.V315029.R01.S.doc Version 5.2 Page 29 - 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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