Inspection on 07/08/08 for Victoria House

This inspection was carried out on 7th August 2008.

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 08/08/07

Victoria House 15/06/06

Victoria House 13/12/05

Victoria House 14/06/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/11/2008.

CARE HOMES FOR OLDER PEOPLE Victoria House 25 Victoria Avenue Brierfield Nelson Lancashire BB9 5RH Lead Inspector Mrs Pat White Unannounced Inspection 7th August 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Victoria House DS0000063398.V370427.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 DS0000063398.V370427.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Victoria House Address 25 Victoria Avenue Brierfield Nelson Lancashire BB9 5RH 01282 697535 01282 697535 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) Delta Care Limited Mrs Dianne Elizabeth Clarke Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Victoria House DS0000063398.V370427.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 15 Date of last inspection 8th August 2007 Brief Description of the Service: Victoria House is an older type detached two-storey property, in a residential area on the outskirts of Brierfield. Delta Care Ltd owns the home and Mr Baki of the company was the Responsible Individual. The home is registered to provide accommodation and care for 15 older people over the age of 65 yrs of age. Accommodation consists of single and double bedrooms on the first floor, two lounges and a separate dining room on the ground floor. Access between the two floors is by two stair lifts. Various aids and adaptations were available to assist people with restricted mobility. There were two bathrooms providing assisted bathing facilities, including a shower. There were no en suite facilities, but commodes were provided in each bedroom and there were sufficient communal toilets. There were pleasant gardens and views for residents to enjoy. Current fees for accommodation at the home are £350 to £390 per week, with additional charges for hairdressing, toiletries, magazines and papers. The home had a Statement of Purpose and a Service User Guide providing information about the care provided, the qualifications and experience of the owner and staff and the services residents can expect if they choose to live at the home. Victoria House DS0000063398.V370427.R01.S.doc Version 5.2 Page 5 Victoria House DS0000063398.V370427.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 Star. This means that people who use the service experience adequate outcomes. This inspection site visit was carried out on the 7th August 2008. The site visit was part of an inspection to determine an overall assessment on the quality of the services provided by the home. This included checking important areas of life in the home that should be checked against the National Minimum Standards for Older People, and checking the progress made on the matters that needed improving from the previous key inspection. The inspection included: talking to residents, touring the premises, observation of life in the home, looking at residents’ care records and other documents and discussion with the registered manager. In addition the home provided the Commission with written information, prior to the inspection, about the residents, staff and services provided, and some of this is also included in the report. Seven residents spoke about their views on the home. Survey questionnaires from the Commission were sent to the home for residents, relatives and staff to complete. Five residents, 5 relatives and 5 residents returned these questionnaires. Some of the views of these people are included in the report. What the service does well: The manager made sure that she met people in their own home or hospital before they moved into the home so that she could find out about their needs and whether or not Victoria House was a suitable place for them to live. These details were written down so that care staff had a record to refer to and from which a care plan could be developed. Residents and staff felt there was a good atmosphere in the home and residents and staff appeared to have a good rapport. Some relatives made positive comments in the questionnaires, such as, “They care about people in the home and try and help them as much as possible”, “Small family feel to it where people are catered for individually” and “Very friendly to visitors and residents. Victoria House DS0000063398.V370427.R01.S.doc Version 5.2 Page 7 The home provides pleasant, homely and comfortable accommodation with a high standard of décor and furnishings, which suits the residents’ tastes and needs. Residents complimented the environment, and comments such as “it is pleasant and comfortable” were made. The home was clean and fresh for the residents’ comfort and one relative said, “Cleanliness is impressive”. The home had ways to find out the views of residents and relatives about the service. Residents and relatives meetings were held every few months and there was evidence that residents felt able to air their views. There was an experienced and well qualified manager who had nearly completed further relevant qualifications for the post of “registered manager”. What has improved since the last inspection? The medication procedures and practices had further improved and the way residents’ received their medication was safer. The written information about people’s needs, how the needs were to be met and how the care was to be provided had been improved and most of the written care plans looked at had been updated. This meant that staff had more accurate information to help guide them give the most appropriate care. There was also useful information about peoples past lives that enabled staff to understand more about them and what their interests were. The assessments of the risks associated with residents every day life and the care needed had improved. Staff had clearer information about the risks and how to minimise them and care for people safely. Staff had also undertaken up dated moving and handling training and this helped them transfer people safely. The Induction programme that new staff undertook had improved. It was more detailed and covered more matters in depth and according to Government guidance. Some staff had also undertaken relevant training to help them understand and look after people with dementia. The way residents’ finances were managed was safer than at the previous inspection and money was no longer borrowed from one resident for another resident. Victoria House DS0000063398.V370427.R01.S.doc Version 5.2 Page 8 What they could do better: The written information about the care people needed and how that should be provided could be further improved. On the records looked at there should be more details about continence, the personal care required, teeth and oral care and mental health, to help staff understand these care needs. The procedures and practices for the management and administration of medication could be further improved, so that for example, staff have written instructions about ordering medication and how to assess whether or not people are capable of administering their own medication. The management should ensure that there are enough staff on duty to organise stimulating and fulfilling activities for the residents. Staff should undertake training in the “Protection of Vulnerable Adults”, in order to help ensure that residents are protected. The way that staff are recruited to work in the home could be improved. References from employers of care services where people have worked must always be sought. This will ensure useful and relevant information is received about applicants. Also a full employment history must be recorded and any gaps should be explained. This will help ensure that that there is enough background information on people to help make a decision about whether or not they are suitable to work in the home. Some aspects of the home’s management could be improved so that the manager has sufficient resources and equipment at work to manage the administrative duties efficiently. Some safety aspects of the home must be improved for the benefit of the residents and the staff. The work that needs to be done on the electrical installations must be carried out without delay and the advice of the fire service about not pegging open fire doors must be followed. Please contact the provider for advice of actions taken in response to this Victoria House DS0000063398.V370427.R01.S.doc Version 5.2 Page 9 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 DS0000063398.V370427.R01.S.doc Version 5.2 Page 10 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 DS0000063398.V370427.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 & 5. Standard 6 not applicable Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s admission procedures helped to determine whether or not the home could meet people’s needs and helped staff understand them. Residents and relatives had sufficient written information about the home. EVIDENCE: The viewing of residents’ records showed that people’s needs were assessed before they were admitted to the home and that these needs were written down. Social work assessments had also been obtained for those residents admitted through care management arrangements. This enabled a decision to be made about whether or not the home could meet people’s needs and provided useful information to staff. The assessment continued on admission and the quality of the information recorded had improved since the last inspection. For example this now included useful information about how to try Victoria House DS0000063398.V370427.R01.S.doc Version 5.2 Page 12 and reduce the risk of people falling. However on some of the assessments looked at there was no information about what people could do for themselves so staff were not clear how to help people keep their independence. The inspection methods, including discussion with residents, showed that residents and relatives were able to visit the home prior to admission and that the person carrying out the assessment visited people in their home environment to carry out the pre admission assessment. This assisted people to make a choice about whether or not they wanted to live at Victoria House. All the residents and relatives who completed the questionnaires stated that they had enough information to help them make a decision about moving into Victoria House. Evidence at this inspection including talking to residents and the questionnaires returned showed that people felt the residents were well cared and some relatives were positive about the care the residents received and one said, “They care about people in the home and try to help them as much as possible” and “Small family feel to the home where people are catered for individually”. However some negative comments were also made, for example, that staff were not always available when needed and that the residents’ “social” and individual needs were not always met (see later sections). Victoria House DS0000063398.V370427.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents had care plans that helped staff to provide personal care for residents, though not all had sufficient details on all aspects of health, personal and social care. Residents’ health care needs were monitored and medication practices were safe and helped to promote residents’ health. Residents felt staff treated them properly and with respect. EVIDENCE: All the residents had care plans prepared from an assessment and some aspects of the care plans had been improved. All the ones looked at had been reviewed an updated and the assessment of the risks associated with every day life had improved. This should help staff safely deliver the right care. There was also improved information on nutrition and personal and social history. There was also evidence of regular reviews of the care needed. However the care given was not supported by detailed written information in all matters relating to health, personal and social care. One care plan viewed Victoria House DS0000063398.V370427.R01.S.doc Version 5.2 Page 14 did not contain sufficient information about the personal care required, capabilities, oral care or how to manage aggressive behaviour. Although the care plan of a resident who was having all care in bed had been recently reviewed because of changing care needs, this still had not been sufficiently updated with accurate information about how staff should be carrying out some personal care tasks. There was also insufficient information about how to prevent pressure areas when people had been identified as being at risk. As stated above the risk assessments on most matters had improved to help keep people safe, and there were up to date risk assessments for falls, nutrition, the use of bed rails and pressure area prevention. The inspection methods used showed that in general residents’ physical and psychological health was promoted and maintained, and that residents had access to all necessary health care professionals (see below). The intervention and advice of the district nurses were sought for pressure area care and continence promotion. There was good written information about diet and food preferences. However not all residents could be weighed as they could not use the scales so their weights could not be monitored. Also the medical records of one resident did not indicate the action that had been taken regarding an “urgent referral to the dietician” or the outcome of such a referral and intervention. Therefore it was not clear whether or not this person was having the correct diet according to specialist advice. In the residents questionnaires most said that they usually had the care and support they needed and that staff were “usually” available when needed but not always. A number of medication procedures and practices had been improved since the previous inspection and two legal requirements had been met. This included medication being administered as prescribed, and more written instructions to guide staff on when to give “when required” medication. The medication was stored safely, and the home was checking the prescriptions for errors prior to dispensing. All staff who administered medication had appropriate training. However some written procedures that were outstanding at the last inspection were still not in the home, and these were - ordering medication, drug errors, verbal changes and a procedure for self – medication. Also there were no risk assessments to demonstrate that people were not capable of administering their own medication. The Medication Administration Records (MARS) viewed and the medicines checked showed the following. Records kept of medication received into the home and returned to the pharmacist were accurate and in general the information on the MARs and the quality of recording on them had been improved since the previous inspection. There was evidence that medicines were being given as prescribed, but that the records and written instructions to staff could be further improved. Although useful information about when to Victoria House DS0000063398.V370427.R01.S.doc Version 5.2 Page 15 give “when required” (PRN) medication had been written on the MARs of some residents, there was still a lack of clarity about whether or not some medicines were correctly being given as “when required” as this was not stated on the instructions. Also on some MARs viewed there was insufficient information/instructions about administering medication “as directed” and what this meant. On one MAR viewed a night time medication had not been signed as given for a number of weeks but from the stock of medication checked it appeared that this had been given. There were no formal regular audits being undertaken that would have identified this error. Residents’ rights to dignity, respect and privacy were understood by staff, and upheld. Residents spoken with confirmed this and said that care was carried out appropriately and that staff treated them properly. Relatives in the questionnaires commented on the good relationships between residents and staff. Members of staff were observed treating residents with kindness and respect. Victoria House DS0000063398.V370427.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were insufficient leisure activities to suit the needs and preferences of the majority of residents. Residents had sufficient choices in their everyday lives and were enabled to maintain contact with their relatives and the community. The food served was wholesome and varied and suited the needs and the preferences of most of the residents. EVIDENCE: Whilst there were examples of occasional trips out for a few residents in the home’s minibus, and examples of games such as cards, some residents spoken with felt there were insufficient activities to keep them occupied and some said they would like to go out more. All those who completed questionnaires said that there were only “sometimes” suitable activities. Some comments made by relatives supported this view, such as that there did not appear to be enough staff on duty to meet residents’ social needs (see “Staffing” section) and that the garden should be developed for the residents to enjoy. However at the time of the site staff supported residents to sit outside, and the front Victoria House DS0000063398.V370427.R01.S.doc Version 5.2 Page 17 gardens were in the process of being tidied and developed to give further opportunities to residents. Visitors were made welcome at any reasonable time and visiting arrangements are explained in the Statement of Purpose. Two relatives who completed the questionnaires commented that the home was a small friendly home and most felt that the communication between them and the home was sufficient and that they were kept up to date with important matters. Some residents were able to say that they felt they had sufficient choice in such matters as rising and retiring times and whether or not they could stay in their rooms for privacy. Most residents had small items of furniture to personalise their rooms. The food served appeared nutritious and varied and was praised by some of the residents who were spoken with at lunch time. One resident said “I always enjoy my food”. However discussion with other residents and the questionnaires suggested that the meals did not suit all tastes and preferences. This was discussed with the manager who felt that this was a result of changes in cooks following the retirement of a long serving cook last year. This had been addressed in residents’ meetings and it was felt that there had been some improvement. There was not a choice of main cooked meal, served at mid - day, but alternatives were given to residents who request it. Special diets were catered for and there was good organisation and written information about this. Staff gave assistence with meals to those who needed it and on the day of the inspection the midday meal appeared relaxed and unhurried. Drinks and biscuits were served at times throughout the day and fruit was offerred in mid morning. However two resident said more drinks should be offered in between meals rather than them having to ask when staff were busy. Victoria House DS0000063398.V370427.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaints procedure was accessible to residents and visitors but some residents were not sure what to do if they were not happy with something. There were satisfactory policies and procedures to help protect the residents from abuse but staff had not had training in this matter. EVIDENCE: The home had a simple complaints procedure, a copy of which was on the home’s notice board and was therefore available for residents and visitors. Some residents spoken with said they would speak to a member of staff if they were unhappy about any aspect of their care. However those who completed the questionnaires indicated that they were not always sure who to speak to. Also one person said, “I would never complain, I don’t want to cause any trouble”. Most relatives said they knew how to make a complaint, or how to find out if need be, and indicated that they were satisfied with the response from the management if they had expressed concerns. However one person spoken with for the inspection felt that their concerns about a safety aspect of the home had not been dealt with promptly enough. Information provided by the home to the Commission indicated there had been 2 complaints since the previous inspection. The records of these kept in the Victoria House DS0000063398.V370427.R01.S.doc Version 5.2 Page 19 home were looked at and were found to incomplete. There was no record in the home of the action taken to investigate one complaint (made by a relative) to support the explanation given in the letter to the complainant explaining how the matter had been investigated and the action taken. The home had policies and procedures to follow in the event of an allegation or suspicion of abuse and the information supplied to the Commission prior to the site visit stated that there was now a policy and guidance on staff dealing with aggression from residents. There had been no incidents or allegations of abuse since the last inspection and the manager knew what procedures to follow in such an event. However staff had not yet undertaken any training in “Safeguarding adults” and which would help them protect residents. Victoria House DS0000063398.V370427.R01.S.doc Version 5.2 Page 20 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, 22, 23, 24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well maintained and furnished and provided residents with pleasant, clean and comfortable accommodation. EVIDENCE: The home was well maintained and furnished, and was bright and well decorated throughout. Since the previous inspection some refurbishment had taken place. The tour of the premises and the information supplied by the home prior to the site visit confirmed that some refurbishments and improvements had been carried out since the previous inspection. Some bedroom carpets had been replaced by none slip vinyl floors and the lounge carpets had been replaced. Victoria House DS0000063398.V370427.R01.S.doc Version 5.2 Page 21 However some fire doors were still being pegged open and the fire service had not been consulted about this (see “Management and Administration”). This could put residents and staff at risk in the event of a fire. Also some bedrooms did not have cords attached to the call bells and it was not clear whether or not the occupant could use the system without. Residents’ bedrooms were well furnished and personalised and appeared to suit their needs. The communal areas, consisting of two lounges and a dining room, were also pleasantly furnished and attractively furnished, and as said above the lounge carpets had been replaced. One side of the outside of the home was safe and accessible for residents, including those in wheelchairs. The grounds at the front of the home were being tidied, and the disabled access improved, though this work was not completed at the time of the site visit. At the time of the site visit all areas of the home viewed were clean and fresh and five residents who completed questionnaires confirmed that this was the case. One relative felt that the “cleanliness was impressive”. Victoria House DS0000063398.V370427.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers and skills of the staff were adequate for meeting the physical care needs of the residents but not the recreational needs. Staff recruitment procedures were not in accordance with the Regulations in all cases but were sufficiently thorough to help ensure that unsuitable staff didn’t work in the home. EVIDENCE: At the time of the site visit, the home was staffed according to the levels set by the registered provider, and the registered manager was working in the home on caring duties. There were 3 members of staff on duty from 8:00am till 1:00pm but for the rest of the day and night there were only 2 and some residents and relatives felt that this was not enough to meet all the needs of the residents particularly their social and recreational needs. As last year there had been recent difficulties with staff leaving, staff sickness and filling vacant shifts, including the cook’ shifts. Residents spoken with stated that staff were not always available when needed. Overall relatives felt that staff gave good care but there were several comments suggesting that there were not enough staff in the afternoon. Victoria House DS0000063398.V370427.R01.S.doc Version 5.2 Page 23 Information supplied at the time of the site visit stated that 6/14 staff were qualified to at least NVQ level 2 and that 6 others were studying for these qualifications. Therefore the home had still not achieved the target of 50 of care staff having these qualifications, though would be expected to achieve this is the near future. However other aspects of the home’s training programme had improved. The Induction programme for new staff had improved and this was now comprehensive, in accordance with Government guidance, and was properly recorded and signed. There was now a rolling programme of moving and handling training and some staff had completed dementia training. Other training was planned in fire safety, first aid, food hygiene and infection control. In the survey questionnaires staff were satisfied with the Induction training that they undertook and with the ongoing training they received though not all felt there were enough staff on duty all of the time. One member of staff whose records were viewed showed that this person had been recruited in accordance with the care home’s Regulations, but for another person these procedures had not been fully followed. Though this person had not commenced work until the Criminal Records Bureau and Protection of Vulnerable Adults checks had been received, the references were not the most appropriate and a long gap in the employment history had not been explored. None of the references were from previous employers even though two of these were in a care service. This means that valuable information about his person’s work experience and performance has not been obtained. Victoria House DS0000063398.V370427.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was managed by an experienced manager. Quality assurance policies and procedures were implemented which took into account some of the views of residents and relatives. There were some aspects of the home which did not promote the health and safety of the residents and staff. EVIDENCE: The manager at Victoria House had been in post for about 9 months and was registered with the Commission. She has a nursing qualification, was experienced in managing a care home, and studying for the relevant NVQ management course. However it was not clear that she had sufficient time Victoria House DS0000063398.V370427.R01.S.doc Version 5.2 Page 25 allocated for management duties, and this combined with the lack of computer/internet facilities in the home made it difficult to fulfil all the management duties as efficiently as possible. Also the previous manager was only in post just over a year so the management of the home had gone through an unstable period and which had an impact on some of the residents. In addition the responsible individual was not making unannounced visits to the home under the Care Home’s Regulations to monitor the services and care in the home so the Commission could not be confident that any concerns or problems were being dealt with promptly. However staff meetings and residents meetings were held to assist their respective involvement in the running of the home. Staff stated in the questionnaires that they felt that communication worked well in the home and that the manager met with them regularly for support. The home had a quality monitoring system involving residents’ and relatives’ questionnaire surveys. However these had not been undertaken since the last key inspection. Residents meetings were held every 3 or 4 months with relatives being invited, and their views were given about such matters as trips out and the food served. However not all residents who completed the survey questionnaires felt that their views were always acted upon The management of resident’s spending money had improved and there was no borrowing of some residents’ money to pay the small bills of other residents. Appropriate records were kept of the cash given to the home by relatives for residents’ spending money, and the spending of this money. A random check of the cash kept in the home for 3 residents showed that this balanced with the amount stated in the records. Some aspects of the home’s health and safety procedures needed improving. Some fire doors were routinely pegged open, potentially putting residents and staff at risk. Also staff had not undertaken fire safety training. This was outstanding from the previous inspection. The manager subsequently contacted the fire service and informed the Commission of the action that had to be taken following a visit by the Fire Safety Officer. The electrical installations in the home had only just been tested in spite of a previous requirement at the last inspection which stated this should have been undertaken by September last year. The certificate issued said the wiring in the home was “unsatisfactory” and listed 11 faults. At the time of writing this report there was no assurance that this was being rectified and that the electrical systems were safe. Victoria House DS0000063398.V370427.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 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 2 17 x 18 2 3 3 x 2 3 3 x 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 2 Victoria House DS0000063398.V370427.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 OP7 Regulation 15 & 17(1)(a). 3 (k)(m) Requirement All details of medical and specialist health care intervention, including that of the dietician, and the recommended action, must be recorded. The Medication Administration Record must always be signed when medication has been given. After consultation with residents there must be suitable facilities and resources including staffing, for recreation and leisure activities. Staff recruitment procedures must always be in accordance with the Care Home Regulations and references from previous employers must always be obtained and particularly from employers of a care service wherever this is possible. Gaps in employment history must always be explored. The responsible individual must make monthly unannounced quality monitoring visits to the home DS0000063398.V370427.R01.S.doc Timescale for action 31/08/08 2. OP9 13 (2) & 17(1)(a). 3(i) 16 (2)(n) 31/08/08 3. OP12 30/09/08 4. OP29 19 (amended sch 2) 31/08/08 5. OP31 26 30/09/08 Victoria House Version 5.2 Page 28 6. OP38 13(4) (a)(c) 7. OP38 23(4)(c)v, & (e) The registered person must ensure that the electrical installations in the home are made safe according to the test report The recommendations of the fire service must be complied with including not pegging open fire doors. 30/09/08 31/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations The homes assessment should include all relevant written information about health, personal and social care, including what people can do for themselves, to assist staff understand the care needed and how to help keep people as independent as possible. The care plans must contain sufficient information on all matters related to health, personal and social care, including continence, oral and foot care, managing aggression and pressure area prevention. Suitable weighing scales for those residents unable to weight bear should be purchased. Whether or not residents are capable of administering their own medication should be underpinned by risk assessments. There should be clear information, confirmed by the prescriber if necessary, about whether or not some medications are to be given as “when required” medication. There should be accurate instructions about how and when “as directed” medication should be given, including skin preparations. Procedures covering all aspects of the ordering, handling and administration should be in the home so that they are at hand for staff to use. Regular audits of all aspects of medication management should be undertaken and a recorded to help prevent errors. DS0000063398.V370427.R01.S.doc Version 5.2 Page 29 2. OP7 3. 4. 5. OP8 OP9 OP9 6. 7. OP9 OP9 Victoria House 8. OP16 9. 10. 11 12. OP18 OP22 OP28 OP38 Records of all complaints investigations should be fully recorded and residents should be reassured that they can make complaints and express their views without worry of the consequences. Staff should undertake training in the Protection of Vulnerable Adults to help ensure that residents are safe. Call bell leads should be attached in every bed room to ensure that residents have access to the emergency call system and if they are not at risk from them. 50 of care staff should be qualified to at least NVQ level 2 as soon as possible. Staff should undertake training in fire safety and infection control. Victoria House DS0000063398.V370427.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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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