Inspection on 19/12/07 for Victoria House Care Home

This inspection was carried out on 19th December 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Victoria House Care Home 21/06/06

Victoria House Care Home 20/12/05

Victoria House Care Home 19/05/05

Victoria House Care Home 06/05/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOMES FOR OLDER PEOPLE Victoria House Care Home 59 Victoria Street Newark Nottinghamshire NG24 4UG Lead Inspector Mary O`Loughlin Unannounced Inspection 19th December 2007 09:30 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 Care Home DS0000060427.V356647.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 Care Home DS0000060427.V356647.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Victoria House Care Home Address 59 Victoria Street Newark Nottinghamshire NG24 4UG 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) 01636 708007 Mrs Dareen Marjorie Morgan Vera Allen Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Victoria House Care Home DS0000060427.V356647.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st June 2006 Brief Description of the Service: Victoria House is a large detached property close to Newark town centre. The home caters for 3 adults with a learning disability. There is a large garden to the rear and parking to the front of the property. The home is within walking distance of all local amenities. There are 2 bedrooms on the first floor and 1 on the ground floor. There is a shower room and toilet on the ground floor and a bathroom with toilet and a separate toilet on the first floor. The home is furnished and decorated to a high standard. The fees are from £ 2,297.00 to £3,353.00 per calendar month. Victoria House Care Home DS0000060427.V356647.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. One inspector conducted the unannounced visit along with an expert by experience. An expert by experience is a person who, because of their shared experience of using services, visits the service with an inspector to help them get a picture of what it is like to live in or use the service. The main method of inspection used was called ‘case tracking’ which involved selecting two residents and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. The care manager and members of staff were spoken with as part of this visit. Documents were read as part of this visit and medication management was inspected to form an opinion about the health and safety of residents at the home. A partial tour of the building was undertaken which included a sample of resident’s bedrooms, to make sure that the environment is safe and homely. A review of all the information we have received about the home since the last inspection was considered in planning this visit and this helped decide what areas were looked at. A range of additional information was used to determine the outcome of this visit, including information provided by the registered provider within an Annual Quality Assurance Assessment (AQAA). What the service does well: Visitors are welcome to come to the home at anytime. This enables residents to keep in contact with family and friends. The home is suitably decorated and furnished and kept in a good state of repair as a result residents live in a safe and well-maintained environment. Victoria House Care Home DS0000060427.V356647.R01.S.doc Version 5.2 Page 6 Residents are involved in meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. A skilled and trained staff team is offering support to residents. Staff have access to training in health care matters to enable them to meet the changing needs of the residents. Residents can access and enjoy the opportunities available in their local community. What has improved since the last inspection? What they could do better: The residents should be consulted about care plan reviews to ensure that their individual needs and aspirations are taken into account. The care plans should be produced in a style that the service users can understand and should be regularly sorted out to remove out of date information. They should reflect how staff are to meet the identified needs of each resident. The medicine policies should be reviewed using the available up to date guidance from The Royal Pharmaceutical Society and available on the Commission for Social Care Inspection’s website. www.csci.gov.uk Medicines should be recorded into the home and tube feeds administration should be recorded to provide a suitable audit trail. Residents should be given opportunities to express their views through regular meetings. The statement of purpose should be reviewed to accurately reflect the services provided at the home. Policies and procedures for the safeguarding of adults and infection control should be regularly reviewed using up to date good practice guidance to ensure the home is providing appropriate support and protection to the residents and that staff training is up to date. Victoria House Care Home DS0000060427.V356647.R01.S.doc Version 5.2 Page 7 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 Care Home DS0000060427.V356647.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 Care Home DS0000060427.V356647.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3-6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The present residents and their representatives had the information needed to choose a home, which would meet their needs. They had their needs assessed and a contract which told them about the service they would receive. Intermediate care is not provided at the home. EVIDENCE: 3 Responses from the Commission for Social Care Inspection survey’s state that 100 of the residents were happy with the information provided to them about the home. The three residents at the home have been accommodated for a considerable time and the process of their admissions has been previously assessed as appropriate with suitable pre-admission assessments of their needs. Victoria House Care Home DS0000060427.V356647.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7-8-9-10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The plan in most cases includes the basic information necessary to plan the resident’s care and includes a risk assessment element. When developing the plan the home has complied where possible with relevant social care guidelines and recognises the specialist nature of the care required for some residents. Better document management and archiving old records could improve care plans. Medicine policies and procedures could be improved to ensure the safety of the residents. EVIDENCE: Two care plans were examined; these were unwieldy files with old out of date care plans along with more recent ones. Victoria House Care Home DS0000060427.V356647.R01.S.doc Version 5.2 Page 11 The files were so large that they were not easy to follow or locate the most up to date issues affecting the residents. That said there was good information once you had found it. The plans were reviewed monthly, there were daily records held and the original plans showed the involvement of the resident. The reviews did not show who had been involved but the manager said she discusses with the resident any changes. The expert by experience reported that residents said they were aware of the care plan but had not seen it or participated in drawing it up. The care plans showed that all specialist information was used alongside the home’s care plan however the details were not fully comprehensive for staff to be able to read them and know all the care that the person needed. One resident was being cared for on a pressure relieving mattress and seat cushion and although there was a care plan for pressure sore prevention the equipment in use was not recorded in the plan. A key worker system was in place that enables staff to establish special relationships and work on a one to one basis with the resident. The records of a recent Pharmacist inspection was examined along with the medicine administration records of two residents. There were shortfalls identified in the recording of medicines into the home and the administration of prescribed feeds via a percutaneous gastric Peg (tube). A requirement has been set to rectify this matter. Staff files demonstrated that those staff administering medicines were trained to do so. The results of the Commissions survey’s showed that 100 of the residents said that staff always treat them well and always listen and act on what they say. Victoria House Care Home DS0000060427.V356647.R01.S.doc Version 5.2 Page 12 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 good. This judgement has been made using available evidence including a visit to this service. Improvements could be made to ensure residents are fully consulted about their social and recreational aspirations to ensure they have been fully involved in the planning of their lifestyle and quality of life. The food in the home is of good quality, well presented and meets the dietary needs of people who use the service. Staff are trained to help those individuals who need help when eating EVIDENCE: 100 of the service user survey responses said that the staff assist them to go out and that they usually make the decisions about what they do each day. 100 said they choose what they wanted to do during the day, evening and at weekends. Victoria House Care Home DS0000060427.V356647.R01.S.doc Version 5.2 Page 13 The expert by experience reported that residents commented on insufficient staff provision that did not allow them to do certain activities such as visiting the pub. Residents did confirm that they were supported to go out shopping, walking, taking holidays and that they could have visitors whenever they wished. From observation the residents were involved in meaningful daytime activities of their own choice and according to their individual interests and capability. There was key worker on this day and she works specifically with one resident who was out and about with her doing shopping. One resident also attends a day centre twice each week. All three residents confirmed that they are happy with the meals, said the staff were good cooks and could they have a choice of what to eat. They had a hearty soup for lunch on this cold December day and the tea/dinner meal was traditional stew and dumplings, which the residents said they were looking forward to. The care records contained evidence of annual holidays; one recent one was in Blackpool at a specialist hotel that could cater for people with complex needs. Residents have the opportunity to develop and maintain important personal and family relationships, one resident was celebrating his birthday and was visited by a family member, and there was also a planned party at the home. Care staff spoken with demonstrated they were sensitive to the needs of those residents who find it difficult to eat and give assistance with feeding. They are aware of the importance of feeding. Victoria House Care Home DS0000060427.V356647.R01.S.doc Version 5.2 Page 14 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 policies and procedures regarding protection of people who use the service are satisfactory but need to be reviewed and updated in line with regulations and other external guidance. People who use the service state that they feel safe and supported. EVIDENCE: 100 of the resident’s responses received from the Commission for Social Care Inspection survey’s said they knew who to speak to if they were unhappy and they knew how to make a complaint. The expert by experience reported that all residents said they felt safe in the home, and knew how to complain if they needed to. The manager had a record book but no complaints have been made since the last inspection. The Commission have received no complaints or safeguarding referrals. The manager did not have the most recent policies or guidance on Safeguarding Adults referrals. Victoria House Care Home DS0000060427.V356647.R01.S.doc Version 5.2 Page 15 The staff file looked at did not show evidence of up to date training in safeguarding adults. We recommend that this is addressed by ensuring staff are suitably trained in the procedures for safeguarding adults. Victoria House Care Home DS0000060427.V356647.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the residents who live there. The well-maintained environment provides specialist aids and equipment to meet the needs of the residents. Infection control policies and procedures could be improved by obtaining the up to date guidance from external specialists and ensuring through risk assessment that the home are adequately protecting residents from infection. EVIDENCE: The home provides a physical environment that is appropriate to the specific needs of the residents who live there. The well-maintained environment provides specialist aids and equipment to meet the needs of the residents. Victoria House Care Home DS0000060427.V356647.R01.S.doc Version 5.2 Page 17 The expert by experience reported that residents had said the home was like “paradise” The resident case tracked with physical disabilities is accommodated in a ground floor single room with all the required aids and equipment. There is a shower room adjacent to the kitchen that is lockable, provides very good wheelchair access and is suitable for the person’s needs. There are no records within this person’s file to suggest if he has been asked about having a bath or what the home could do to enable this. The staff demonstrated good knowledge of infection control procedures that they undertake within their daily work. There are suitable arrangements for clinical waste collection. Victoria House Care Home DS0000060427.V356647.R01.S.doc Version 5.2 Page 18 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 good. This judgement has been made using available evidence including a visit to this service. Residents are in safe hands with a staff team that are trained to meet their needs. EVIDENCE: The staff team at the home has remained unchanged since the last inspection. The previous inspection identified appropriate and safe recruitment procedures were undertaken that safeguard the residents from anyone that may be unsuitable to work with them. The manager reported that up to date induction training guidance has been accessed and that all staff are being given the opportunity to undertake this to ensure the care practice is up to date and that residents are in safe hands. It was identified that as the residents conditions have changed the staff have been able to access the training required to ensure they are competent with new techniques such as Percutaneous feeding and catheter care. Victoria House Care Home DS0000060427.V356647.R01.S.doc Version 5.2 Page 19 Records of staff duties were examined but these did not fully record the staff hours of work. The home was well maintained, staff unrushed and service user’s physical needs were being met. One staff member was providing individual care to a resident. There was three staff on duty during this inspection. Victoria House Care Home DS0000060427.V356647.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31-33-35-38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This is a well-managed small home that could benefit from a review of policies to ensure that all arrangements are in line with current good practice and the Department of Health guidance. Regular recorded meetings with residents could ensure that the manager is aware of any areas for improvement EVIDENCE: The home has a good record of meeting relevant health and safety requirements and legislation. Records are of a good standard and are routinely completed. Victoria House Care Home DS0000060427.V356647.R01.S.doc Version 5.2 Page 21 The records of fire precautions were examined and show strict adherence to the policies by regular checks, drills and maintenance. The manager has the necessary experience to run the Home; she demonstrated that she is aware of and works to the basic processes set out in the National Minimum Standards. The manager develops staff through training and supervision to ensure they that are competent and knowledgeable to care for younger adults and the present resident group that are now over 65yrs. The service is planned to be user focused, and generally works in partnership with families of residents and professionals as demonstrated by the collaboration with external professionals involved in the health care support that residents require. Although the manager has signed and dated the reviews of the home’s policies she has not accessed or used up to date guidance in line with current thinking and good practice. More work needs to be done to ensure that records such as the statement of purpose sets out the current care provision at the home. Examination of one residents finances showed that there are good safeguards in place to protect them from abuse. They have control over their own finances and are supported to access the bank. They have their own lockable cupboard to keep money and valuables. All expenditure is recorded to provide an appropriate audit trail of their personal monies. Residents reported to the expert by experience that they no longer had opportunities for meetings. Victoria House Care Home DS0000060427.V356647.R01.S.doc Version 5.2 Page 22 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Victoria House Care Home DS0000060427.V356647.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Each residents care plan should be developed and reviewed with the resident and in a style that is easily understood by them. The plans should be holistic and describe how identified needs are to be met. You must ensure that medicines are recorded into the home and that records of Percutaneous feeds are held. You must update your policies and procedures in line with current good practice guidance available for; 1. Safeguarding Adults 2. Infection Control 3. Medicines in Care Homes 4. Statement of Purpose Timescale for action 31/03/08 2 OP9 13 01/02/08 3 OP33 12 31/03/08 Victoria House Care Home DS0000060427.V356647.R01.S.doc Version 5.2 Page 24 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 OP7 Good Practice Recommendations You should review the present care plan records to ensure that out of date care plans and documents are removed and archived. Ensure that residents are involved in all care plan reviews You should ensure that residents are fully consulted on their social and recreational activities. You should obtain the up to date guidance on Safeguarding Adults and ensure that staff are trained in its application. You should ensure that the care plans reflect the wishes regarding bathing for individuals that are unable to access the first floor bathroom. You should obtain the current guidance on Infection Control Procedures in Care Homes from the Department of Health. You should ensure that the duty records clearly reflect the numbers of staff on duty at any time. You should develop opportunities to seek the views of the residents, such as residents meetings. 2 3 4 5 6 7 OP12 OP18 OP19 OP26 OP27 OP33 Victoria House Care Home DS0000060427.V356647.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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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