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Inspection on 14/08/08 for Victoria House Care Home

Also see our care home review for Victoria House Care Home for more information

This inspection was carried out on 14th August 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There is a Statement of Purpose and Service Users Guide that gives prospective residents the information required to enable them to make an informed choice about where they live. One resident confirmed that they were visited by a member of staff prior to admission to the home and another stated they had been invited to visit the home to see if they liked it enough to live there. The menus evidence a well thought out balanced diet with a varied choice of food in line with resident`s preferences.Comments received included ` food is always good` `good honest food` Quality assurance systems are in place, which are enabling the service to monitor and meet the expectations of the people who live there. There is an open-house policy, which welcomes visitors at all reasonable times. Satisfactory arrangements are in place to safeguard residents` finances. Robust recruitment practices are being followed. The atmosphere of the home is pleasant with a good level of interaction seen between residents and staff. The Comments received from residents and families regarding the care received included: ` Staff are kind and have a good sense of humour` ` there has to be a bit of give and take on both sides` ` I have no complaints, they look after us very well` Victoria House is clean with no offensive odours and residents are encouraged to bring in their own possessions and furniture. Comments regarding the home were generally positive and included:

What has improved since the last inspection?

At the last inspection there were thirteen requirements made and again progress has been made in certain areas. The managers` hours are totally supernummery so as to concentrate on the running of the home and fulfilling the management duties. Staff training is now being provided to ensure staff have the required care skills and empathy to provide appropriate support and care for residents living in the home. There were no doors being inappropriately wedged open and the home have purchased electronic door closures. Care planning and the accompanying risk assessments are continuing to improve and be developed.

What the care home could do better:

The home needs to confirm in writing to the prospective resident or their representative that with regard to the needs assessment completed the home can meet the needs of the prospective resident. This ensures that decisions around admission to the home are informed.The care documentation including individualised care plans and risk assessments still need to be improved in some areas to ensure residents receive appropriate and person centred care that meets their assessed needs and to minimise any risks. Staffing levels need to be assessed against the specific needs of the residents living in the home and continually reviewed to ensure the safety of the people who live in the home. The environment has not been attended to as previously stated by the registered provider, and the home needs a rolling plan of maintenance and renewal to ensure it meets the Statement of Purpose and the expectations of the people who use the service. In particular the kitchen and communal bathrooms are a health and safety risk and infection control concern. In addition a number of health and safety issues were identified including the need for accurate record keeping, appropriate up to date policies and procedures and robust individual and environmental and lone working risk assessments.

CARE HOMES FOR OLDER PEOPLE Victoria House 71-73 Victoria Road Polegate East Sussex BN26 6BX Lead Inspector Debbie Calveley Unannounced Inspection 08:00a 14 August 2008 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 House DS0000021277.V369365.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 House DS0000021277.V369365.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Victoria House Address 71-73 Victoria Road Polegate East Sussex BN26 6BX 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) 01323 487178 01323 487178 ered4867@aol.com Supreme Care UK Limited Mrs Esther Redmond Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Victoria House DS0000021277.V369365.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated is twenty (20). That service users must be older people aged sixty-five (65) years or over on admission. 15th August 2007 Date of last inspection Brief Description of the Service: Victoria House is registered to provide care and accommodation for up to twenty older people. The home is a three-storey detached property situated in a residential area of Polegate. It is located in close proximity to local amenities including bus and rail links. Service users accommodation consists of twenty single rooms, eleven of which have en-suite facilities. All bedrooms have at least a wash hand basin. The home has a range of communal areas including a large lounge and dining area. There are two communal bathrooms, both of which are assisted, and four communal toilets. There are toilet riser seats and handrails fitted as required. The external grounds offer an attractive garden and patio area. Car parking is available at the front of the property. The home has a passenger lift and a series of ramps that enable service users to access all parts of the home; however there are some internal steps so service users on the upper floors need to be mobile. The service provides prospective service users and their families with a copy of the Statement of Purpose and Service Users Guide when the pre-admission assessment takes place. Copies of inspections reports are made available on request. Fees charged as from 1 April 2008 range from £450 to £540. Additional charges are made for hairdressing, chiropody and newspapers. Intermediate care is not provided. Victoria House DS0000021277.V369365.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Victoria House will be referred to as ‘residents’. This was a key inspection that included an unannounced visit to the home and follow up contact with resident’s representatives and visiting health and social care professionals. This unannounced inspection was carried out over 6.5 hours on the 14 August 2008. There were fourteen residents living in the home on the day, of which five were case tracked and spoken with. During the tour of the premises three other residents both male and female were also spoken with. The purpose of the inspection was to check that the requirements of previous inspections had been met and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. Two members of care staff and the cook were spoken with in addition to discussion with the Manager and maintenance person. Telephone contact was made with visiting professionals following the visit. The information received verbally has been incorporated into this report. An Annual Quality Assurance Assessment was received from the previous registered Manager completed only in part prior to this key inspection. What the service does well: There is a Statement of Purpose and Service Users Guide that gives prospective residents the information required to enable them to make an informed choice about where they live. One resident confirmed that they were visited by a member of staff prior to admission to the home and another stated they had been invited to visit the home to see if they liked it enough to live there. The menus evidence a well thought out balanced diet with a varied choice of food in line with resident’s preferences. Victoria House DS0000021277.V369365.R01.S.doc Version 5.2 Page 6 Comments received included ‘ food is always good’ ‘good honest food’ Quality assurance systems are in place, which are enabling the service to monitor and meet the expectations of the people who live there. There is an open-house policy, which welcomes visitors at all reasonable times. Satisfactory arrangements are in place to safeguard residents’ finances. Robust recruitment practices are being followed. The atmosphere of the home is pleasant with a good level of interaction seen between residents and staff. The Comments received from residents and families regarding the care received included: ‘ Staff are kind and have a good sense of humour’ ‘ there has to be a bit of give and take on both sides’ ‘ I have no complaints, they look after us very well’ Victoria House is clean with no offensive odours and residents are encouraged to bring in their own possessions and furniture. Comments regarding the home were generally positive and included: What has improved since the last inspection? What they could do better: The home needs to confirm in writing to the prospective resident or their representative that with regard to the needs assessment completed the home can meet the needs of the prospective resident. This ensures that decisions around admission to the home are informed. Victoria House DS0000021277.V369365.R01.S.doc Version 5.2 Page 7 The care documentation including individualised care plans and risk assessments still need to be improved in some areas to ensure residents receive appropriate and person centred care that meets their assessed needs and to minimise any risks. Staffing levels need to be assessed against the specific needs of the residents living in the home and continually reviewed to ensure the safety of the people who live in the home. The environment has not been attended to as previously stated by the registered provider, and the home needs a rolling plan of maintenance and renewal to ensure it meets the Statement of Purpose and the expectations of the people who use the service. In particular the kitchen and communal bathrooms are a health and safety risk and infection control concern. In addition a number of health and safety issues were identified including the need for accurate record keeping, appropriate up to date policies and procedures and robust individual and environmental and lone working risk assessments. 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 House DS0000021277.V369365.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 House DS0000021277.V369365.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): 1, 2, 3, 4 and 5. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides prospective residents and relatives with a good level of information about the home, its facilities, services and the costs involved. The admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission. EVIDENCE: A copy of the combined Statement of Purpose and Service Users Guide is kept on a shelf under the visitor’s book in the foyer of the home. Again it would be beneficial to visitors and residents if it were more predominately displayed. It was last reviewed in January 2008 and provides prospective residents with enough information to make an informed decision whether the home is suitable. Victoria House DS0000021277.V369365.R01.S.doc Version 5.2 Page 10 It was not apparent if all residents had a copy of their own, two residents did not know of the service users guide, but a new resident said she had a copy. It was confirmed whilst talking to residents that the contract arrangements were clear and understood. There is a copy of the terms and conditions of residency included in the Service Users Guide, a copy of the contract seen did not include the room agreed to be accommodated and this needs to be included. The registration certificate is clearly displayed and was found to be accurate at the time. The new manager has made some changes to the format of the pre – admission document. The last three admissions to the home were identified and the records relating to the admission procedures followed were reviewed. This confirmed that pre admission assessments are completed and provide a clear assessment of prospective residents care needs. These are completed by the manager and discussion with the manager confirmed that these are used to ensure new admissions to the home are appropriate and that the home have the staff, equipment and environment to meet their care needs. It was however noted that the home does not confirm having regard to the assessment that the home can meet the assessed needs of the prospective resident. This was discussed with the manager who was advised that this should be completed in writing in accordance with the required documentation. The prospective residents’ are seen either in their home or hospital before admission and the staff confirmed that wherever possible the family or representatives are involved. The staff spoken with knowledgeable regarding the registration category of the home and of the level of support they can offer. Trial visits to the home can be arranged. It was confirmed that all residents are invited to a trial period to ensure suitability of the home; this is clearly stated in the Statement of Purpose and in the statement of terms and conditions. Residents spoken with said that ‘ the home was one of three I was told about, and I liked the location’, ‘ it was chosen for me’. Victoria House DS0000021277.V369365.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 and 10. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although care documentation provides a framework for the delivery of care it needs to be developed to provide clear guidance to care staff on all the care needs of the residents, along with robust systems for risk assessment to ensure individual person centred care is delivered. Residents are treated with respect and have their privacy and dignity maintained. EVIDENCE: The care documentation pertaining to four residents were reviewed as part of the inspection process. The review identified that work has been commenced and care plans have improved. Care plans were found to include plans of care, personal histories and risk assessments. Overall the care documentation demonstrated that the care was reviewed and evaluated, however it was noted that not all the plans of care highlighted all the specific needs of residents, for instance catheter care and mobility Victoria House DS0000021277.V369365.R01.S.doc Version 5.2 Page 12 changes. It was also found that social histories and social care plans were not completed in full on all residents. This is important to this home as the residents are very able and still value their independence. Staff do enter daily entries in to the care plan, but as identified at the previous inspection, the comments remain very limited and the majority state ‘Resident fine no problems’. There was however little evidence that the plans of care are written in consultation with residents or their representatives. Risk assessments for dependency levels have been introduced and are used as a guideline for staffing levels. Nutritional assessments are also in place but as discussed they are incomplete and have no guidance for staff. The monthly weights evidenced that staff are identifying weight loss or weight gain, but they are not following through with a plan of action or developing a care plan that addresses this issue and provide guidance for staff to follow. From direct observation staff were experiencing problems in assisting residents up from chairs despite a moving and handling assessment being in place, the assessments were not accurate and staff confirmed that they did not have the correct equipment. This inspection highlights that though improvements have been made staff still need to improve their documentation in certain areas and this was discussed in full with the manager following the site visit, who was to review and address the identified shortfalls. Staff were observed when administering medicines and were seen to be working safely. A visiting community pharmacist visited the home during this inspection and left some recommendations of good practice from her audit and the manager confirmed that these would be actioned. There are policies and procedures in place for staff to refer to regarding the safe administration, storage, disposal and recording of medication. The systems for recording and checking controlled drugs were found to be thorough, however the storage of controlled drugs was identified as not being suitable. There is a small clinical fridge, which is kept in the staff office, topical creams are being unnecessarily stored due to the lack of appropriate storage. Medication Administration Charts were found on the whole to be competently completed. Staff were seen to be respectful and considerate to all residents and visitors, whilst attending to their needs Staff were seen to be kind and pleasant to residents and a good rapport was noted between them. Each of the residents were addressed by their preferred term and dressed appropriately in well-laundered clothing. Victoria House DS0000021277.V369365.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The lifestyle experience by residents at this time does not always match their expectations, choice or preferences. Meals remain good in respect of both quality and variety that meets the majority of residents’ tastes and choice. EVIDENCE: The care plans viewed evidenced some residents past histories and social preferences, but they are not linked constructively to a formal activity programme. On the day of the site visit a crossword had been enlarged and distributed to residents in the lounge, but little interaction was observed due to the reduced staffing levels. There is an activity programme on the lounge door for residents to view, but it did not demonstrate a wide selection of activities for residents to participate in. Victoria House DS0000021277.V369365.R01.S.doc Version 5.2 Page 14 The manager has brought in jigsaws and games and plans to develop the activities in the home following consultation with the residents. Staff confirmed that the residents are encouraged to go out and about; these include shopping trips and one residents walks to her own home. However the residents spoken with were not enthusiastic about the range of activities at this time, but talked of the plans to find a pianist to come in to the home. The documentation regarding the social activities needs to be developed Activities should be an important part of life to the residents of Victoria House, as there are very able and independent people living there and therefore it is identified as an area that requires development to meet all the residents’ social needs. It was discussed in full with the manager following the inspection. Residents are facilitated to maintain their independence for as long as they are able. There are no restrictions on visiting times as long as consideration is shown to all the residents. Many of the residents have individualised their bedroom with items from home and residents and relatives spoken with confirmed that they are encouraged to make it homely. It was observed during the inspection that the routines at the home are flexible, residents spoken with confirmed that they were consulted about all aspects of their lives. The home has an advocacy policy in place and the information regarding this is available to all residents. The home has a lounge and dining area, but as identified at the last inspection from residents they don’t have much choice of where to spend their time during the day. The planned extension and refurbishment has not been commenced and the provision of a quiet room where residents can choose to go is still not available. The dining area is well furnished and comfortable with natural lighting and residents can choose where they wish to sit. Breakfast and the mid-day meal were observed. The residents have a choice daily of the main meal; a vegetarian option or a salad of their choice, there is also a choice of pudding. The catering manager visits every resident daily to ask them their choice; the residents remain complimentary regarding the choice and quality of their food. There is evidence that residents’ dietary requirements regarding their diet were taken into consideration and catered for. The menu was viewed and demonstrated a varied and nutritious diet. The catering manager confirmed Victoria House DS0000021277.V369365.R01.S.doc Version 5.2 Page 15 that the resident’s likes and dislikes are recorded and taken into consideration when planning the meals. Food diaries for residents have not been introduced as recommended at the last inspection and it was discussed again the benefit of monitoring the residents appetite on a continuous basis. Victoria House DS0000021277.V369365.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 and 18. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a formal complaints system with evidence that residents feel that their views are listened to and acted upon. Staff receive training to protect residents from abuse EVIDENCE: The complaint policy and procedure is clear and uncomplicated and a copy of this is readily available in the home and the Service Users Guide. A system of recording complaints was demonstrated to the inspector during her visit to the home and was seen to have been improved. All the complaints received evidenced the outcome and action taken by the home. Relatives and residents spoken with confirmed that they were confident that any complaints or concerns that they had would be listened to and responded to effectively. The home has relevant guidelines on the protection of vulnerable adults and the manager confirmed that staff have now all received appropriate training. The training records also confirmed this. The manager has a clear understanding of adult protection guidelines and is aware of how to initiate an investigation if required. Victoria House DS0000021277.V369365.R01.S.doc Version 5.2 Page 17 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): People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst Victoria House provides a comfortable, clean and generally safe environment for those living in the home and visiting, there is a need for a plan of renewal and redecoration throughout. Residents are enabled and encouraged to personalise their room, and rooms are homely and reflect the resident’s personalities and interests. EVIDENCE: At the last inspection the provider shared the plans for improving the homes facilities and refurbishment programme. The tour of the home identified that whilst the home is safe and clean, it is in need of decorating and refurbishment in many areas. The décor and furniture are of a good standard in the communal lounge and dining area, but as previously identified there is little alternative communal areas for residents to use if they wish. The home is looking ‘Tired and dismal’. Victoria House DS0000021277.V369365.R01.S.doc Version 5.2 Page 18 The maintenance of the interior of the property was seen to be adequate. There is a maintenance book, which evidenced that staff are vigilant in identifying maintenance issues that may affect the safety of the residents. All issues are then actioned and dated by the maintenance person. It was identified that the maintenance position is soon to be dissolved and this is a concern due to the condition of the home. The home is in need of redecoration and refurbishment to ensure it meets the homes Statement of Purpose. The garden is fairly large and has a summerhouse, which residents can use as a smoking area. The gardens have been attended to and are safe to use. Residents who expressed an opinion spoke positively about the home, many have decorated their rooms with their own possessions, pictures and ornaments. Comments from residents included, ‘ its comfortable’ ‘ I like the home, it is easy for me to walk home’. There are adequate communal bathrooms in the home with specialist equipment, which enables frailer residents and those with a physical disability to enjoy the facilities available. However the bathrooms are not attractive and inviting and one in particular is very small and for that reason not used. This remains unchanged since the last inspection. The resident toilets situated in the home do not have a washbasin and there is no staff toilet in the home. Specialised equipment to encourage independence is provided e.g. handrails in bathrooms and a large shaft lift to all areas of the home. Residents said that they are not to use the lift without a staff member and so once downstairs they generally stay downstairs. The hoist is still kept on the top floor and is used only when required. The hoist is an old model and difficult to manoeuvre, as discussed it needs to be kept in a place that ensures staff can access it easily. Call bells are provided in all areas, and from direct observation are more easily assessable in the lounge and bedroom areas. The call bell the facility was not seen in dining room, but staff were seen entering and observing residents whilst eating. The kitchen was found to be below the expected standard, the cupboard doors are missing, worktops are damaged and not impermeable, the floor is in need of replacing or refinishing to ensure it is also impermeable, this are both a possible source of cross contamination. The equipment is of a mixed standard some new and some in need of replacing, the dishwasher has been replaced recently. From discussion with staff the kitchen was to have been re located to ensure that it is not used as a walkway for staff. At present the staff have no choice but to walk through it to reach the staff office, clinical fridge and medication cupboard, the laundry and the managers office. This is a source of cross infection and is a health and safety risk. The planned extension and refurbishment has not been commenced as expected. The staff are disappointed and aware of the shortfalls, the manager is to seek advice from the Environmental Health Agency regarding the discussed shortfalls. Victoria House DS0000021277.V369365.R01.S.doc Version 5.2 Page 19 The lighting in the home is of domestic quality and there are above bed lights as well as the main ceiling lights. Water temperatures are monitored monthly and a record kept, these need to be regularly monitored to ensure they are of a safe temperature for residents. Some bedrooms outlets tested were cold and one was not working at all, this was relayed to the manager. Polices and procedures for infection control are in place, but need to be updated regularly. The home was clean and free from offensive odours on the day of the inspection. Good practice by staff was observed during the day and there were gloves and aprons freely available in the home. However commode pots were found soaking in the communal bathroom again, which is not considered good practice. The facilities for laundry are small and the ironing and folding of resident clothes take place in a food storage and office area, once again this is due to lack of space. Victoria House DS0000021277.V369365.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Robust recruitment procedures are in place to protect residents and the staff training enables staff to provide the support and care the resident’s need. However the staffing levels need to be kept under close review to ensure the residents safety at all times. EVIDENCE: The staffing rota was viewed and evidenced that there are two care staff on duty during the day to give support to all the residents, serve meals, teas and coffees, administer medication, provide activities/interact with the residents, make beds and attend to the laundry. The manager is supernummery to the numbers, but says she does do the activities with the residents. The rota also identified that there is only one waking carer on at night. This is identified as a concern as there is no supporting lone worker policy and procedure in place to guide staff if there should be an emergency. The fire policy also needs to reflect that there is only one staff member on duty. Resident bedrooms are situated on three floors and in some areas of the home the bedrooms are behind a fire door and also near very steep stairs and therefore the management team need to be confident that the staffing ratio is sufficient to meet their statement of purpose and ensure the residents safety. Victoria House DS0000021277.V369365.R01.S.doc Version 5.2 Page 21 It is therefore necessary for the home to review the staffing levels on a regular basis taking in to account the changing needs of the residents and to ensure that the staffing provision is sufficient to ensure the safety and health of its residents. The manager is also to audit the accidents and incidents occurring in the early mornings or evenings. In addition to care staff, staff are employed for cooking and cleaning and the maintenance work, however the maintenance person has recently been made redundant and will be leaving at the end of August. A selection of staff recruitment files were viewed and demonstrate that a robust recruitment process has been maintained to protect residents and contained all the relevant information required. The files are much more orderly and easier to track. There was evidence of health questionnaires, Criminal Record Bureau checks, two references, a resume of previous employment and work permits where necessary. All the paperwork is kept within a locked room. These robust recruitment systems ensure the protection of service users. From conversation with the manager and staff and from viewing the training records it was confirmed that they receive regular Fire Training, Moving and Handling, COSHH, Health and Safety and First Aid. There was evidence of training being accessed for staff in Safe Guarding Adults, infection control, food hygiene and health related illnesses that affect the elderly, such as promoting continence, confusion and the onset of dementia. It is acknowledged that not all training was in place but was planned for. This will be verified at the next key inspection. Staff are encouraged to undertake the National Vocational Qualifications (NVQ) and at present have 2 staff with NVQ 2/3. The staffing section of the Annual Quality Assurance Assessment received was not completed. The home has induction and foundation training programmes that meet the Care Skills Sector specifications. The induction records for two new staff were available for viewing at this time, one was being completed and one had been completed. Victoria House DS0000021277.V369365.R01.S.doc Version 5.2 Page 22 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, 36, 37 and 38. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is managed in an open and friendly manner with suitable quality monitoring systems. Resident’s financial interests are safeguarded. The systems in place to promote and protect the service users need to be more robust. EVIDENCE: The registered manager has retired since the last key inspection 15/08/07, the recently appointed manager has been in post for three months and has many years experience in the care industry and has a management and care qualification. Victoria House DS0000021277.V369365.R01.S.doc Version 5.2 Page 23 She is committed to improving the outcomes for the residents living in the home, and from information received from the residents, the staff and visiting professionals she is approachable and knowledgeable. The manager’s hours are not included in the caring rota as she is supernummery to the numbers. The quality assurance systems in the home include questionnaires sent out to residents and relatives following admission to the home. The introduction of this formal quality assurance and quality monitoring systems has enabled the management to objectively evaluate the service and ensure it is run in the residents best interests. Service users financial interests are safe guarded by satisfactory policies, any items that are handed over to staff for safe keeping are documented. Staff spoken with confirmed that they receive supervision and a plan of the year’s supervision sessions was seen. Copies of supervision sessions and yearly appraisals are kept secure in the recruitment files. There is a set of policies and procedures in the home, the AQAA states these were reviewed 20/10/07. The policies are generic and not service generated. Accident records were seen and as previously identified at the last inspection a monitoring system for recurrent falls needs to be implemented as a preventative measure for certain residents-the incidence of falls occurring in early morning and evening also monitored. There are trained first aiders in the home in sufficient numbers, however there is only one first aid box kept in the staff office. Further first aid boxes would be beneficial on each floor. This is brought forward from the previous report. There are systems in place for monitoring safety issues such as fire checks, fire drills, PAT testing, electrical tests and gas and boiler checks and all the rooms are routinely checked for safety and maintenance issues. The records in the home confirmed they were up to date. Queries regarding bedroom water temperatures were discussed and it said that there was an on going problem with water Some Health and Safety issues were raised and these included: Moving and handling techniques used on the residents on helping them out of chairs and the practice of soaking commodes in communal bathrooms. Victoria House DS0000021277.V369365.R01.S.doc Version 5.2 Page 24 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 3 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 2 2 2 3 3 2 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 X 3 X 3 3 1 2 Victoria House DS0000021277.V369365.R01.S.doc Version 5.2 Page 25 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 (1) (a) Requirement That the registered person confirms in writing that having regard to the assessment made on any prospective service user that the home can meet those needs. That the registered person ensures that the care plans accurately reflect the changing needs of the service users in respect of their health and social needs. (Timescale of 01/10/07 not met in full.) That service users and/or their representatives are consulted regarding the formation of the care plans. That the registered person ensures that suitable risk assessments are completed in respect of continence, risk of choking and risk of falls to promote resident safety. That nutritional assessments to be completed in full with an appropriate plan of action for staff to follow for all service users and linked to the care Victoria House DS0000021277.V369365.R01.S.doc Version 5.2 Page 26 Timescale for action 15/11/08 2 OP7 15(1)(2) 12 15/11/08 3 OP8 13(4bc) 15/11/08 4 OP9 13 plan. That staff ensure that when a residents needs change in respect of their ability in moving safely that the appropriate equipment is obtained. That the registered person ensures that the storage of controlled medications is safe and is in keeping with pharmacist guidelines. 15/11/08 5 OP12 16 (2) (m) (n) 6 OP19 23 (1)13 (4) (c) 7 OP19 OP21 23 (2) (b)(c) That the staff follow the good practice guidelines set by the pharmacist from the Primary Care Trust. That the registered person 15/11/08 ensures that all service users are supported in pursuing their social interests and enable them to engage in local and community activities. That the registered person 15/11/08 ensures that there is a robust redecoration and refurbishment plan in place to meet the Statement of Purpose. That the registered person 15/11/08 ensures that expert advice is sought from an appropriate agency regarding the kitchen, toilets and communal bathrooms and act on the advice given. That the hot water outlets are in working order and are checked regularly. That the registered manager ensures that staff follow the correct procedures in the cleaning and storage of commodes and the prevention of cross infection. that expert advice is sought from an appropriate agency regarding infection control measures in the kitchen, toilets and communal 8. OP26 16 (2) 15/11/08 Victoria House DS0000021277.V369365.R01.S.doc Version 5.2 Page 27 9. OP27 18 (1) 9. OP37 13 bathrooms and act on the advice given. That the registered person 15/11/08 ensures that the service users welfare and safety is protected by appropriate staffing levels and that systems are in place to monitor and review the staffing levels and service users needs and adjust the staffing levels accordingly. That the registered person 15/11/08 ensures that there are up to date and service specific policies and procedures in the home to protect the service users. In respect of: Lone working and catheter care and continence management. That the registered person ensures that generic risk assessments are used to ensure resident’s safety. These should include risks presented by the kitchen and lone working. That full accurate policies and procedures that underpin practice in the home are readily available and adhered to ensure staff and residents safety. 15/11/08 10. OP38 13 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations That the Service Users Guide is in an appropriate format for its intended users and that all service users are familiar with it’s purpose. Victoria House DS0000021277.V369365.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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