Inspection on 15/08/07 for Victoria House Care Home

This inspection was carried out on 15th August 2007.

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

Other inspections for this house

Victoria House Care Home 14/08/08

Victoria House Care Home 06/06/06

Victoria House Care Home 25/01/06

Victoria House Care Home 01/07/05

Victoria House Care Home 17/02/05

Victoria House Care Home 28/04/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Victoria House 71-73 Victoria Road Polegate East Sussex BN26 6BX Lead Inspector Debbie Calveley Key Unannounced Inspection 15 August 2007 08:15 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.V345602.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.V345602.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.V345602.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. 6th June 2006 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 2006 range from £367 to £510. Additional charges are made for hairdressing, chiropody and newspapers. Intermediate care is not provided. Victoria House DS0000021277.V345602.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 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 15 August 2007. There were eighteen residents living in the home on the day, of which six were case tracked and spoken with. During the tour of the premises eight 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. Four members of care staff and the cook were spoken with in addition to discussion with the Registered Provider. A subsequent one hour visit and telephone call was made to access information that was unavailable on the initial site visit due to the Registered Manager being away from work following an accident. Telephone contact was made with visiting professionals following the visit and one relative were spoken with during the inspection visit. The information received verbally and from 8 surveys has been incorporated into this report. An Annual Quality Assurance Assessment had not been received from the Manager prior to this key inspection. The inspector would like to thank the staff and residents for their hospitality and time throughout the inspection visit. 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. Two residents confirmed that they were visited by a member of staff prior to admission to the home and two stated they had been invited to visit the home to see if they liked it enough to live there. Victoria House DS0000021277.V345602.R01.S.doc Version 5.2 Page 6 The menus evidence a well thought out balanced diet with a varied choice of food in line with resident’s preferences. Comments received included ‘ very good food’ ‘ excellent selection and well served’ ‘ meals are continued pleasure, the way they are served and the standard are a credit to all concerned’ Quality assurance systems are in place, which enables the service to monitor and improve their service. 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 good interaction seen between residents and staff. The Comments received from residents and families regarding the care received included: ‘ Staff nice and polite ’ ‘ there has to be a bit of give and take on both sides’ ‘ I receives excellent care and care workers are kind, considerate and supportive of her every need’ Victoria House provides a clean and comfortable, which is appreciated by the residents and their relatives. Comments regarding the home were generally positive and included: ‘I have been here for a long time and like it’ ‘ I haven’t been here long, but its quiet and peaceful, I am comfortable’’ I am only here for a little while, but its really okay, but I am not ready to live here full time. What has improved since the last inspection? What they could do better: From information gathered from previous reports the homes documentation continues to improve, but there are still areas of person centred care planning and appropriate risk assessments that need to be expanded and improved. Victoria House DS0000021277.V345602.R01.S.doc Version 5.2 Page 7 Although there is an activity programme, which demonstrates that activities are scheduled on a daily basis, it was confirmed by residents that this does not always happen and the residents are bored and would like a more robust and stimulating programme. One resident said ‘ I can go out on my own, but I do think that the other residents need more, they just sit there’ another said ‘ are there activities, I didn’t know that’. Therefore an appropriate programme of activities needs to be created that is realistic and based on the residents preferences to ensure that their social and leisure needs are met on an individual basis. Staffing levels need to be assessed against the specific needs of the residents living in the home. Staff training needs to be provided to ensure staff have the required care skills and empathy to provide appropriate support and care for residents living in the home. This includes training in Safe Guarding Adults, Dementia, epilepsy, stoma care and catheter care. In addition there were some health and safety issues identified, which included pieces of furniture being used to prop open residents doors, advice from the fire Service needs to be sought regarding this practice. The ground floor windows were found unrestricted and due to the location is a security risk. 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.V345602.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.V345602.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. Not all pre-admission assessments provided the level of information needed to ensure the home could meet the needs of prospective residents. EVIDENCE: A copy of the Statement of Purpose is kept on a shelf under the visitor’s book in the foyer of the home. It would be beneficial to visitors and residents if it were more predominately displayed. It was last reviewed in June 2006 and whilst it contains the necessary information there are areas that need to be updated. The Service Users Guide was provided on request and staff confirmed Victoria House DS0000021277.V345602.R01.S.doc Version 5.2 Page 10 that all residents receive a copy on admission to the home. Not all the residents spoken with were aware that they had a copy, and what it was. Eight residents spoken with said that they were not aware of this document. One resident who is in the home for respite care confirmed she had a copy. The format of the Service Users Guide is quite formal. It was discussed that the format could be reviewed to make it more user friendly and include photographs of the home and residents trips. 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. The pre-admission assessment is the first 10 pages of the care plan format used by the home. It is not apparent however when viewing the care plans that this is the pre-admission assessment. A second visit to the home was needed to re-review the document. There needs to be clear documentation which includes the date it was performed, whom it was undertaken by, who was present and where it took place. The format of the pre-admission document was seen to be thorough and relevant. However not all the six assessments seen were completed in full and did not contain all the information required to ensure that new admissions to the home were suitable and that the home have the staff and environment to meet the care needs identified. 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 self-funding 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 recommended to them by a friend’, another said they’ lived just down the road and visited before making the decision to move in’ ‘ I know friends who live here now and so it was the sensible choice to come here’. Victoria House DS0000021277.V345602.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 six residents were reviewed as part of the inspection process. These were found to include plans of care, personal histories and risk assessments. On the whole the care documentation demonstrated that the care was reviewed and evaluated with the individual residents, however it was noted that not all the plans of care highlighted all the specific needs of residents, for instance catheter care, stoma care, tissue damage and epilepsy and not all were up to date with their review. It was also found that social histories and social care plans are not completed on all residents. This is important to this home as the residents are very able and Victoria House DS0000021277.V345602.R01.S.doc Version 5.2 Page 12 still value their independence. Staff enter daily entries in to the care plan, but it is very limited and the majority state ‘Resident fine no problems’. Risk assessments were not all accurately completed and some were in need of review. Nutritional assessments need to be undertaken on admission to provide a base line to monitor resident’s nutritional needs. 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. It was also discussed that a system be developed in the way residents are weighed to ensure continuity. e.g. time of day and clothing. This inspection highlights that 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. There are policies and procedures in place for staff to refer to regarding the safe administration, storage, disposal and recording of medication. These are in need of review and updating. The systems for recording and checking controlled drugs were found to be thorough. Medication Administration Charts were found to be competently completed, however all verbal orders received need to be signed and dated by the staff member receiving the directive. One resident at present is self -medicating and whilst there was a care plan that mentioned self-medication, there was not an appropriate risk assessment performed. Staff were seen to be kind and pleasant to residents and a good rapport was noted between them, staff are kind and respectful in their manner, and resident’s said ‘Staff are good to me’ ‘ all of them are nice, they are busy but still very kind’ ‘ its very nice here’. Each of the residents were addressed by their preferred term and dressed appropriately in well-laundered clothing. Victoria House DS0000021277.V345602.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 good 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: Care plans evidence some residents past histories and social preferences, but they are not linked constructively to a formal activity programme. From direct observation, the morning shift did not evidence any activities and when asked staff stated that a musical movement class was scheduled to take place at 4pm. There is an activity programme on the lounge door for residents to view, but it did not demonstrate a wide selection of activities. It was confirmed by staff that the residents are encouraged to go out and about; these include shopping trips and two residents walk to their own home. However the residents responses were quite negative in this area, and it was Victoria House DS0000021277.V345602.R01.S.doc Version 5.2 Page 14 not clear from documentation how often these take place and how staff support the residents to exercise their independence. One resident said that ‘the activities were disappointing, and the residents are bored’, other comments included ‘ I do not go to the activities, because they don’t appeal to me, but I think there should be more for the other residents’ ‘ I get very bored and it can be lonely’. ‘ Due to my poor hearing, I don’t like to join in’,‘ I think the staff try very hard and I enjoy some of the activities’. Relative feedback included ‘ more mental stimulation is required’ 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 from talking to residents they don’t have much choice of where to spend their time during the day. It is either their bedroom or the lounge. The staff said that the intended extension and refurbishment will address this with the provision of a quiet room where residents can choose to go. The dining area is well furnished and comfortable with natural lighting and residents choose where they wish to sit. The mid-day meal was 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 were very complimentary regarding the choice and quality of their food. Two residents said that their special 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 that the resident’s likes and dislikes are recorded and taken into consideration when planning the meals. Food diaries for residents are not in place and as the monthly weights Victoria House DS0000021277.V345602.R01.S.doc Version 5.2 Page 15 evidence variable weight gains and weight losses, it was discussed the benefit of monitoring the residents appetite on a continuous basis. A recent Environmental Health inspection 06/08/07 made no requirements and was pleased with the standard seen. Victoria House DS0000021277.V345602.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 adequate quality outcomes in this area. Policies and procedures are in place to investigate complaints. Training in adult protection needs to be provided for staff to protect residents from abuse. EVIDENCE: The complaint in the home was viewed, complaints are recorded, but the system needs to be improved with documented outcomes and action taken with timescales in place. The residents spoken with were not aware of the complaint system but said they would start at the top and work down. Another said they would talk to the senior person on duty. One resident said that she had raised some little issues with staff, but as the manager was away at present they had not been dealt with. It was identified from viewing the training records and from talking to staff that staff have not received appropriate Safe Guarding Adults training. There are policies in place in regard to Adult Protection Procedures, but they need to be updated and reviewed in line with new legislation and protocols. From conversation with the manager following the inspection, she states has received ‘Train the Trainer’ training in Safeguarding Adults and will be training staff in the future. Victoria House DS0000021277.V345602.R01.S.doc Version 5.2 Page 17 Victoria House DS0000021277.V345602.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): 19,20, 21, 22, 23, 24, 25 & 26. 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. Victoria House provides a comfortable, clean and generally safe environment for those living in the home and visiting. Residents are enabled and encouraged to personalise their room, and rooms are homely and reflect the resident’s personalities and interests. EVIDENCE: The home was seen to be clean, fresh smelling and tidy on the inspection visit. The décor and furniture of the home is of a good standard in the communal lounge and dining area, however some parts of the home are faded (tired) and in need of decorating and refurbishing. The maintenance of the interior of the property was seen to be satisfactory. There is a maintenance book, which evidenced that staff are vigilant in identifying maintenance issues that may affect the safety of the residents. All Victoria House DS0000021277.V345602.R01.S.doc Version 5.2 Page 19 issues are then actioned and dated by the maintenance person. The staff are aware that not all areas of the home are ideal regarding size and location, but it was confirmed through talks with the staff and Registered Provider that extensive refurbishment with an extension is planned to commence in the near future. The garden is fairly large and has a summerhouse, which residents can use as a smoking area. The garden could be used more effectively and benefit the residents if paths were cleared of slippery moss and the tarmac mended. Residents said that they don’t generally use the garden as they feel it is unsafe for them. They are frightened of slipping/tripping. 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, ‘ it’s a nice place to live’, ‘ I do my own dusting in my room it keeps me active’ ‘ I have been asked if I would like to change the colour of my room, but I like it as it is’. 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, again this will be attended to with the planned work. 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. One resident said she brings everything down with her in the morning, as she knows the staff don’t have the time to keep going up and down in the lift. The hoist is kept on the top floor and is used only when required. Call bells are provided in all areas, however they are not easily accessible in the lounge or dining area. This was mentioned by the residents in the lounge. 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. 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, 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. The cupboard used for sheets, towels and other communal linen was disorganised and unsuitable for its intended use. It is recommended that this be reviewed. Victoria House DS0000021277.V345602.R01.S.doc Version 5.2 Page 20 Victoria House DS0000021277.V345602.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 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. A review of staffing levels based on residents’ dependency levels needs to be implemented to ensure there are sufficient skilled staff to meet residents needs. Thorough recruitment procedures are in place to protect residents. EVIDENCE: The staffing rota was viewed, and evidenced that there are three care staff on duty in the morning to give support to all residents, serve meals, teas and coffees, administer medication, provide activities/interact with the residents, make beds and attend to the laundry. This staffing ratio is not considered sufficient to meet the residents’ needs and expectations. From direct observation on the day of the inspection, residents were still being assisted to get washed and dressed at 11.30 am and staff spoken with said that they that they would benefit from more staff at key times. The afternoon shift is again three care staff, with a member of staff coming in from 6pm until 10pm to help residents to bed. It was noted that on weekends the staff ratio in the afternoon is only two care staff. From surveys received and from verbal feedback this does affect the outcomes for residents in respect of meal service and assistance given at weekends. A concern had been raised from an anonymous source that the one night care on duty sleeps and thus do not Victoria House DS0000021277.V345602.R01.S.doc Version 5.2 Page 22 meet residents needs. This has been fully investigated by the Provider and it was proven by the call bell records that the night staff were prompt in answering the call bells. However 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 one staff member is insufficient to monitor for falls and illness during the night. It is 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 recruitment processes were seen to be thorough, however the files were muddled and difficult to assess. A more ordered filing system need to be implemented so as to enable the management team to update records as required. All staff have provided employment histories, two references, proof of qualifications, identification and Protection of Vulnerable Adult and Criminal Records Bureau checks had been carried out. These robust recruitment systems ensure the protection of service users. However it was noted that some references have been accepted in an alternative language to English and this practice needs to be reviewed. The training records were difficult to track and the training matrix on the board in the office was from the previous year. The staff spoken with confirmed that they receive regular Fire Training, Moving and Handling, COSHH, Health and Safety and First Aid. There was no evidence of training 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 was a requirement at the last key inspection in July 2006 that staff receive training in dementia care, this was not evidenced as being met and remains outstanding. Staff are encouraged to undertake the National Vocational Qualifications (NVQ) and at present have 2 staff with NVQ 2/3. The home has induction and foundation training programmes that meet the Care Skills Sector specifications. The induction records for two new staff were not available for viewing at this time. Victoria House DS0000021277.V345602.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, 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. Not all aspects of service users health, safety and welfare are safeguarded. EVIDENCE: The manager has many years experience in the care industry and has a management and care qualification. It was not possible to meet her at this inspection visit, but both staff and residents respect her open management style and they could approach her at any time about anything, however small. Victoria House DS0000021277.V345602.R01.S.doc Version 5.2 Page 24 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 has done considerable work to improve the service. It is apparent from viewing the records and documentation in the home that the manager would benefit from receiving administration support and more defined management hours. Following an accident the manager is unable to work at this time, the Registered Provider is visiting the home regularly and the Catering Manager has been put in day to day charge of the home with the senior carers support. The Registered Providers need to ensure that support systems are in place during this time and that CSCI are informed of changes in the management structure as they occur. 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, but they are in need of urgent review and updating as many were dated 2003, and do not reflect the changes in certain legislation. Accident records were seen and a monitoring system for recurrent falls needs to be implemented as a preventative measure for certain residents. 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. 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. Some Health and Safety issues were raised and these included: Risk assessments for the home environment need to be introduced for stairs and banisters. A window of a ground floor bedroom with road access was without suitable restrictors. As mentioned previously under standard 19, the garden areas need to be safe and accessible to residents. As found on previous inspections, residents bedroom doors were found kept open by various pieces of furniture in one case a table, which would put Victoria House DS0000021277.V345602.R01.S.doc Version 5.2 Page 25 residents and staff at risk if a fire broke out. Advise needs to be sought from the fire service. Victoria House DS0000021277.V345602.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 3 3 2 3 3 X 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 2 17 X 18 2 2 2 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 2 2 Victoria House DS0000021277.V345602.R01.S.doc Version 5.2 Page 27 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 pre-admission assessment clearly states its purpose and includes the date performed, the venue, who was involved and who undertook the assessment. That the care plans accurately reflect the needs of the service users in respect of their health, social and behavioural needs and that they are reviewed regularly. Risk assessments must be expanded in relation to service users individual disabilities. (Timescale of 08/09/06 not met) Nutritional assessments to be completed for all service users and linked to the care plan. That suitable risk assessments are completed in all areas of risk including walking frames and risk of falls to promote service user safety. That moving and handling risk assessments are completed correctly and updated regularly Victoria House DS0000021277.V345602.R01.S.doc Version 5.2 Page 28 Timescale for action 01/10/07 2 OP7 15(1)(2) 12 01/10/07 3 OP8 13(4bc) 01/10/07 and when a service users needs change. 4 OP9 13 That all verbal changes to 20/08/07 medication are signed and dated. That resident’s who self – medicate are appropriately risk assessed. That ‘as required medication’ (PRN) is reviewed regularly with the G.P. 5 OP12 16 (2) (m) (n) That the activities programme be 01/10/07 increased to meet the individual preferences of service users and satisfies their social, cultural, religious, and recreational interests. (Previous timescale of 08/09/06 not met.) That the registered person ensures that a full complaints procedure is used and that complaints are dealt with effectively and appropriately and that records are maintained to demonstrate a thorough and robust investigation with a documented outcome and action taken. (Previous timescale of 08/09/06 not met.) That all staff working in the home undertake Safeguarding Adult training. That all areas of the home and garden are safe and well maintained. Staffing levels need to be increased to ensure service users needs are met. (Previous timescales of 1/10/05, 09/02/06 and 08/09/06 not met) That staff receive training appropriate to the work they are DS0000021277.V345602.R01.S.doc 6 OP16 22 (8) 01/10/07 7 8 9 OP18 OP19 OP27 13 (6) 23 (1)13 (4) (c) 18 (1) 01/10/07 01/10/07 01/10/07 10 OP28 18 (1) 01/10/07 Page 29 Victoria House Version 5.2 11 OP30 18 (1c) (i) (ii) to perform and are supported to enrol on a NVQ training qualification. That staff receive training 01/10/07 specific to meet the needs of services users admitted to the home. (Stoma care, epilepsy and trips and falls.) That staff are trained to meet the needs of those service users who have become confused. (Previous timescale of 08/09/06 not met.) 12 OP31 9(1)(2bi) 12(1b) That the Managers’ management hours be increased to enable her to fulfil her management duties and that support with the administrational duties provided. (Previous timescales of 1/10/05 and 31/03/06 and 08/09/06 not met). 01/10/07 13 OP38 23 (4ac) (i)(v) That the use of wedging open 16/08/07 doors with furniture ceases and appropriate door closing devices provided. (Previous timescales of 1/07/05, 28/02/06 and 06/06/06 not met) That call bells are easily accessible to all residents in the communal areas. That ground floor windows have appropriate restrictors. Risk assessments for those residents who are at risk from recurrent falls need to be implemented. The stairs and banister rails need to be appropriately risk assessed. Victoria House DS0000021277.V345602.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP1 OP26 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. That the current space used for communal laundry is reviewed. That the practice of storing commode pots in the communal bathroom is reviewed. Victoria House DS0000021277.V345602.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Local 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. Extracts may not be used or reproduced without the express permission of CSCI Victoria House DS0000021277.V345602.R01.S.doc Version 5.2 Page 32 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!