CARE HOMES FOR OLDER PEOPLE
Vine House Vanell Road Easebourne Midhurst West Sussex, GU29 9AZ Lead Inspector
Annie Taggart Unannounced Tuesday 17 May 2005, 9:30am
th 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 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. Vine House H60-H11 S14819 Vine House V226760 170505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Vine House Address Vanzell Road, Easebourne, Midhurst, West Sussex, GU29 9AZ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01730 815441 Mr Alan David Michael Hill Mr Alan David Michael Hill Care Home 17 Category(ies) of PC Care Home Only 17 registration, with number of places Vine House H60-H11 S14819 Vine House V226760 170505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Care Home only (PC) Date of last inspection 23/10/04 Brief Description of the Service: Vine House is a care establishment providing personal care and accommodation for seventeen older people (over the age of sixty five years). Vine House is a large detached house situated in the village of Easebourne, approximately one mile from the town centre of Midhurst with its shops and other ameneties. Accomodation is provided in nine single rooms each with ensuite facilities and four double rooms each with en-suite facilities located on the ground and first floor. There is a car park to the front of the home and a garden to the rear. The double rooms are let as singles unless two people request to share. On the ground floor is a lounge and a dining room.The floor is accessible by lift. Vine House H60-H11 S14819 Vine House V226760 170505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out over a 6.5 hour period which covered the early and late shifts at the home. During the course of the inspection 18 residents and 4 staff were spoken to by the inspector who also held conversations with two visitors and a district nurse who was attending a resident in the home. The inspector also held a telephone conversation with Mr. Hill the owner and registered manager for the home at the end of the visit to give him feedback and to gain clarification regarding concerns raised at the inspection. Prior to the inspection the last two reports for the service were read by the inspector as were issues detailed in a Letter of Serious Concern sent to Mr. Hill by the Commission and also a letter of Enforcement Notice sent by the fire department. Requirements detailed in these letters were discussed with the acting manager who was working on shift and helped with the inspection. What the service does well: What has improved since the last inspection?
Care plans have been improved to ensure that the staff on duty have sufficient information regarding the needs of the people they support. All of the radiators in the home have now been covered to ensure residents are safe from accidents. The acting manager of the home has applied for registration to be considered as the registered manager. The number of recreational activities available for residents has increased therefore offering more choice for residents. Regulators have been installed on all taps in the building to decrease the risk of scalding in the home. Risk assessments are being compiled by the acting manager to identify and individual risks to residents and also risks in regard to the environment.
Vine House H60-H11 S14819 Vine House V226760 170505 Stage 4.doc Version 1.30 Page 6 What they could do better:
The Statement of Purpose and Service User Guide should be reviewed and updated to provide sufficient information for prospective residents to make an informed choice. Staffing levels should be increased to ensure that there are always sufficient staff available on duty to meet the assessed needs of residents. Medication policies and procedures should be reviewed and suitable training made available for staff to ensure the safety of residents. The complaints procedure should be reviewed and updated to inform people of the address for the Commission for Social Care Inspection and timescales for responding to complaints. All staff should receive adult protection training to ensure they provide a safe environment for the people they support. Locks should be provided to the bedroom doors of all residents in the building unless there is evidence documented that this would be against their wishes. Risk assessments should be carried out and magnetic closures fitted to the bedroom doors of residents who wedge open their doors to ensure they are protected should a fire occur. Staff should be provided with training to ensure they have sufficient knowledge to carry out the duties they perform. 50 of staff should have completed NVQ level 2 in care and this has not been achieved. Recruitment files should be reviewed to ensure that they contain all of the necessary documentation to ensure the safety of residents. The registered provider should ensure that a business and financial plan is sent to the Commission to enable the financial viability of the home to be confirmed. The registered provider of the home should ensure that a copy of the current insurance policy for the home is sent to the Commission within seven days and that a copy is displayed in the home. The registered provider should ensure that adequate facilities are made available to ensure the safety of the staff when carrying out sleep in duties. Adequate staffing arrangements should be made to ensure that the acting manager receives the time and support required to ensure she can manage the home.
Vine House H60-H11 S14819 Vine House V226760 170505 Stage 4.doc Version 1.30 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. Vine House H60-H11 S14819 Vine House V226760 170505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Vine House H60-H11 S14819 Vine House V226760 170505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 3 4 5 6 The Statement of Purpose and Service User Guide need to be reviewed and updated to ensure prospective residents have sufficient information about the home. The assessment process for the home has improved to ensure that the information needed to provide support for residents is available prior to them moving into the home. EVIDENCE: The Statement of Purpose and Service User Guide do not contain all of the information required for prospective residents to make an informed choice. There is no schedule of room sizes and the complaints procedure is out of date. Assessments were seen for two new residents to the home and the documents contained basic information regarding the needs of each person. The acting manager said that she visited prospective residents in their own homes or in hospital to carry out the assessments. Residents and family members confirmed that they were able to make visits to the home prior to moving in. Vine House does not provide intermediate care.
Vine House H60-H11 S14819 Vine House V226760 170505 Stage 4.doc Version 1.30 Page 10 Vine House H60-H11 S14819 Vine House V226760 170505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Vine House Although healthcare needs are recorded and the healthcare needs of residents is met to a good standard there is concern that because of a shortage of staff these standards could not be sustained in an emergency situation or if the needs of residents were to increase. Medication procedures are in place but there are risks to residents by staff members not being trained and procedures not always being followed. EVIDENCE: Staff at the home are very dedicated and care for the health of residents well but the numbers of staff on shift are not sufficient to ensure that there would be enough people available if the healthcare needs of residents were to increase or an emergency were to occur. Visits from doctors and other healthcare professionals are recorded and a district nurse visiting the home said that she considered the standard of care to be very high. The specific needs of one resident who is cared for in bed was discussed with the acting manager and the district nurse who both confirmed that the doctors felt that her needs are currently being well met.
Vine House H60-H11 S14819 Vine House V226760 170505 Stage 4.doc Version 1.30 Page 12 There are policies and procedures in place regarding medication but gaps were found in the recording on the MAR sheets and this was brought to the attention of the acting manager. Staff at the home have still not received suitable training in the administration of medication. Medication for a resident admitted to the home for respite care had not been counted and recorded therefore causing a risk of ensuring that adequate medications were available for his stay in the home. In response to a requirement made at the last inspection, the acting manager has worked hard at producing care plans for all of the residents at the home and although still basic they provide information to inform staff about the care needs of each person. Care plans had been signed by the resident or their representative. Vine House H60-H11 S14819 Vine House V226760 170505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 13 14 15 The home meets the preferred lifestyle of the current resident group and there are some organised activities available. Contact with family and friends is encouraged and visitors are made welcome to the home. Meals are attractive and freshly cooked and residents are given a choice of where they eat. EVIDENCE: All of the residents spoken to said that they were very happy in the home and confirmed that their choice of lifestyle was respected. One person said that she liked the home because “ I can please myself completely if I stay in my room or not”. Another said “ I was so well looked after during a respite period here I decided to stay”. Two visitors to the home confirmed that they could call in at any time suitable to the residents and said that they were always made very welcome by the staff. Two residents said that they go out for a walk together on a regular basis and others talked about outings to activities run by a local church. There are no regular activities undertaken at the home but a poster in each persons room showed that monthly activities take place including a bring and buy sale and a strawberry tea to which families are invited.
Vine House H60-H11 S14819 Vine House V226760 170505 Stage 4.doc Version 1.30 Page 14 One person who is in the home receiving respite care said “I went to another home where staff were not so helpful, It’s a wonderful atmosphere here, if you need anything staff will drop whatever they are doing and help you”. All of the residents spoken to complimented the cook at the home for the variety and quality of food provided and confirmed that they were consulted on their likes and dislikes and special requirements. Vine House H60-H11 S14819 Vine House V226760 170505 Stage 4.doc Version 1.30 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 18 Although residents said they would feel comfortable making a complaint there are risks in the home in respect of the complaints procedure being out of date and staff at the home having received no training in the protection of vulnerable adults. EVIDENCE: Residents said that if they had a complaint they would speak to the manager or a member of staff but the complaints procedure available to them does not contain the details of the Commission for Social Care Inspection. No complaints have been recorded since the last inspection. A requirement for staff to receive adult protection training has not been met but the acting manager showed the inspector details of a course she is booked to attend in June 2005 which is designed to teach her the skills to cascade the adult protection training down to the rest of the staff team. Vine House H60-H11 S14819 Vine House V226760 170505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 20 22 23 24 25 26 The home provides a homely, clean, well-decorated and attractive environment for residents to live in. A pleasant garden is available which is well maintained. Residents private rooms are comfortable and contain their own furniture and belongings and aids and adaptations are available where required. Some residents are at risk from the practice of wedging open their bedroom doors. EVIDENCE: All radiators in the home have now been covered to ensure safety from injury to residents. All of the residents spoken to said that they liked their rooms and had brought furniture and belongings from their former homes. In response to a requirement at the last inspection locks have been fitted to four bedroom doors and the acting manager is speaking to other residents to ask if they would also like locks fitted. Vine House H60-H11 S14819 Vine House V226760 170505 Stage 4.doc Version 1.30 Page 17 Although residents confirmed that they are encouraged by staff to keep their bedroom doors closed several people are still wedging doors open putting themselves and other residents at risk should a fire occur. A requirement has been made for a risk assessment to be carried out in respect of the need for magnetic closures to be fitted to these rooms. Hoists, grab rails and other aids and adaptations are available for the use of residents and the home was found to be very clean and fresh. Vine House H60-H11 S14819 Vine House V226760 170505 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 28 29 30 Although staff at the home are very dedicated and work very hard there are risks to residents in respect of the numbers of staff on duty and the levels of training available for staff to undertake. EVIDENCE: Rotas show that the acting manager is working on the shift on a daily basis usually with only one other carer. This is not sufficient staff to ensure that the needs of residents can be maintained if an emergency occurs or if the needs of residents change. There is also a concern regarding how the levels of care would be sustained if the acting manager were to fall sick or go on holiday. A staff member confirmed that staffing levels are very stretched and that there is not enough time available to spend with residents. The recruitment files of six staff were seen. All files contained evidence of current CRB checks having been undertaken but all files did not contain two references or completed application forms. Apart from the acting manager there are no staff members holding an NVQ in care and apart from in-house training there is no training available to enable staff to become competent in the job they are undertaking. Vine House H60-H11 S14819 Vine House V226760 170505 Stage 4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 32 33 34 36 37 38 The home is currently being managed on a day- to- day basis by a committed and hard working acting manager. There are risks to residents and staff by a lack of sufficient staff on duty and insufficient support and supervision is available to the acting manager to allow her to manage the home in a safe and competent manner. EVIDENCE: The insurance policy for the home had expired in February 2005, the registered manager was telephoned by the inspector, he confirmed that a current policy was available and would be sent to the Commission within seven days. The current owner / registered manager currently lives in Cumbria and therefore cannot provide daily support to the acting manager therefore causing a risk to the home if the acting manager was unavailable to work through sickness or holiday. There was no documentation available to prove that the
Vine House H60-H11 S14819 Vine House V226760 170505 Stage 4.doc Version 1.30 Page 20 acting manager received regular supervision and support from the registered manager. Staff and residents in the home spoke very highly of commitment and hard work regarding the acting manager but a lack of staff and suitable staff training prevents her from carrying out the duties required to manage the home rather that be a carer on shift on a daily basis. There is evidence from speaking to residents and visitors to the home that the current staff team work very hard and are committed to running the home in the best interests of the people living there. Despite being a requirement in previous inspection reports the registered manager still has not provided the Commission with a business and financial plan for the home. Records were seen showing that staff supervision is now in place and staff spoken to confirmed that they were supervised on a regular basis. Health and safety records were in place and records of fire drills kept. The acting manager confirmed that actions required from an Enforcement Notice received from the fire department have now all been met. Records were seen for the maintenance of equipment and during the inspection the lift was being serviced. As detailed in other parts of this report all records were not in place to ensure the safety of residents and staff are maintained. Sleep in staff are still having to sleep on a mattress on the floor of a room attached to the residents lounge putting them at risk from fire as the room has an open archway. Vine House H60-H11 S14819 Vine House V226760 170505 Stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 x 3 3 2 2 3 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x 1 2 3 3 1 1 3 1 1 Vine House H60-H11 S14819 Vine House V226760 170505 Stage 4.doc Version 1.30 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP 1 OP9 Schedule 1 17 Regulation Requirement The Statement of Purpose and Service user Guide should be ammended and updated Policies and procedures for the administration and recordingof medication should be reviewed and staff should receive suitable training The homes complaints procedure should be updated to contain timescales for response and details of the CSCI. All staff should receive training in protecting vulnerable adults from abuse. Outstanding from last inspection. Risk assessments should be carried out and magnetic closures fitted to the rooms of residents who wedge open their doors. There must be sufficient staff on duty at all times to ensure the safety of residents and to meet their assessed needs. All staff files should contain information regarding the interview process and two written references. That all staff receive sufficient training including NVQ to allow Timescale for action 31st July 2005 31st July 2005 3. OP 16 12 31st July 2005 31st August 2005 31st August 2005 4. OP 18 13 5. OP 24 and 25 23 6. OP 27 and 28 OP 29 18 31st July 2005 31st July 2005 31st September
Page 23 7. 19 8. OP30 18 Vine House H60-H11 S14819 Vine House V226760 170505 Stage 4.doc Version 1.30 9. 31 9 10. 31 9 11. 34 25 12. 37 17 13. 14. 38 38 18 23 them to become competent and safe in their job roles. The acting manager will require a job description which will enable them to take responsibility for the running of the home Outstanding from the last report There needs to be documented clear lines of accountability between the acting manager and registered provider Outstanding from the last report The registered provider should provide information regarding the financial resources of the home (business / financial plan) Outstanding from the last 4 reports The registered provider should ensure that a current insurance policy is displayed in the home and that a copy is sent to the CSCI. The registered provider should ensure the health and safety of residents and staff at all times The registered person shall provide for staff suitable sleeping in accommodation where the provision of such facilities is needed in connection with their work at the care home Outstanding from the last inspection. 2005 31st June 2005 31st June 2005 31st June 2005 24th May 2005 31st June 2005 31st June 2005 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 OP25 Good Practice Recommendations Risk assessments should be carried out and documented with regards to the wishes of residents who do not want to have locks on their bedroom doors.
H60-H11 S14819 Vine House V226760 170505 Stage 4.doc Version 1.30 Page 24 Vine House 2. OP31 3. OP7 Documented evidence should be kept of supervision and support sessions between the registered provider and the acting manager of the home to ensure that sufficient time and resources are made available to allow her to fulfill the management role Work should continue in the development of care plans to offer further detailed information regarding the support needs of the people living in the home. Vine House H60-H11 S14819 Vine House V226760 170505 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection 2nd Floor, Ridgeworth House Liverpool Gardens West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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