Care Home: Lady Of The Vale

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What the care home does well People were given information about the home to help them make a choice about where to live and their needs were fully assessed before they were offered a place and moved in to Lady of The Vale. This meant that people knew their needs could be met. People spoken to who use the service during this visit including relatives were satisfied with the standard of care provided at the home. The seven people Lady Of The Vale DS0000006715.V377794.R01.S.doc Version 5.2 who filled in surveys said they always received the care and support they needed and the staff always listened and acted on what they said. One person added, "The staff here are excellent at caring, the staff are very willing and they create a good atmosphere." People were positive in their remarks about the staff generally and stated that the staff respected their need for privacy. People said they liked their bedrooms and commented during the visit that that the home was always kept clean and was well looked after. One person said, "The home is always kept in a clean and homely way that I feel very comfortable here." The home has open and flexible visiting arrangements and relatives stated they were always made to feel welcome. The management encourage people to stay in touch with relatives and friends. A choice of food is available at each meal and the people spoken to were happy about the choice, quality and quantity of food provided. The home do have a procedure to follow to raise any concerns or complaints. The people accommodated at Lady of The Vale, staff and relatives benefit from the commitment of the management team. What has improved since the last inspection? Since the last inspection improvements had been made to the record keeping in relation to risk assessments, including those for pressure monitoring and bed rails. Since the last inspection the policy and procedures regarding medicines had been reviewed and revised. Improvements had been made to the arrangements for the management of medication and some checks were being made and recorded to make sure people are given their medicines as prescribed. Some improvements have been made to auditing various aspects of care practices, for example, medication systems, care plans, staff files, accident/incident monitoring since the last inspection. There was some improvement in the recreational activities provided and the record keeping for these activities. Some improvements had been made to the procedure in place for the recruitment and supervision of staff employed. Lady Of The Vale DS0000006715.V377794.R01.S.doc Version 5.2 The manager needs to gain the views of people who use the service so they can be assured the service is run in their best interests by developing the quality assurance system. What the care home could do better: Further improvements were needed to risk assessments to make sure these are identified and completed for all areas of risk for people living at the home. In particular this must include nutrition and moving and handling. Although there were some improvements in the care plans and risk assessments, these still need to be more person centred and central to the needs of the individual. If records are not kept up to date, people may be at risk of not having their needs met in full. A recommendation was made for staff to receive some guidance/training in relation to carrying out supervisions for other staff. A recommendation was made for water temperature checks to be carried out at regular intervals even though the thermostats are in place to minimise the risk of any shortfalls in water temperatures. A recommendation was made for the home to purchase a sluicing disinfector/macerator to minimise the risk of cross infection. Key inspection report CARE HOMES FOR OLDER PEOPLE Lady Of The Vale Grange Road Bowdon Altrincham Cheshire WA14 3HA Lead Inspector Elizabeth Holt Key Unannounced Inspection 9th July 2009 10:00 DS0000006715.V377794.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Lady Of The Vale DS0000006715.V377794.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Lady Of The Vale DS0000006715.V377794.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lady Of The Vale Address Grange Road Bowdon Altrincham Cheshire WA14 3HA 0161 928 2567 0161 941 7305 matron@ladyofthevale.co.uk 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) Sisters of St Joseph Joanna Catherine Pimlett Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38) of places Lady Of The Vale DS0000006715.V377794.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 with nursing - Code N. 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: 38. 3rd September 2008 Date of last inspection Brief Description of the Service: Lady of the Vale is a large detached care home providing nursing care and accommodation for up to 38 older people. The home is a large detached house providing 34 single bedrooms and 2 double bedrooms over 3 floors. The home is owned by the Sisters of St Joseph of the Apparition. There are 4 lounge/dining areas for residents/relatives and a chapel where Mass is said on a daily basis. The home is surrounded by mature, well-maintained gardens and residents can access these. Ample car parking is provided at the front and side of the building. The weekly fees for care and accommodation at the home range from £665 to £705 pounds per week. Additional charges are made for hairdressing, chiropody and newspapers. Lady Of The Vale DS0000006715.V377794.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This visit was undertaken as part of a key inspection, which includes an analysis of any information received by the Commission for Social care Inspection in relation to this home prior to the site visit. The inspection was an opportunity to look at all the core standards of the National Minimum Standards (NMS) and was made to make a judgement on the quality of the service provided by the home. Prior to the inspection the provider completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment and a dataset that is filled in once a year. It is one of the main ways that the CQC (Care Quality Commission) obtains information from providers about how they are meeting outcomes for people using their service. The AQAA also provides the CQC with statistical information about the individual service and trends and patterns in social care. This self-assessment gave the manager the opportunity to tell us what they feel they do well, what they needed to do better and what they had improved upon in the last twelve months. Service user and staff surveys were provided for distribution before the inspection and seven were returned from service users/relatives and none from members of the staff. Comments from these surveys have been included in this report where possible. The visit was unannounced and took place over the course of seven and a half hours on Thursday 9th July 2009. During the course of this visit time was spent sitting and chatting with people who use the service, some of the staff including the registered manager and visitors to the home. A selection of records were looked at , including care plan records, medication and staff training, other records were looked at in relation to the running of the home, health and safety and a partial tour of the premises was made. What the service does well: People were given information about the home to help them make a choice about where to live and their needs were fully assessed before they were offered a place and moved in to Lady of The Vale. This meant that people knew their needs could be met. People spoken to who use the service during this visit including relatives were satisfied with the standard of care provided at the home. The seven people Lady Of The Vale DS0000006715.V377794.R01.S.doc Version 5.2 Page 6 who filled in surveys said they always received the care and support they needed and the staff always listened and acted on what they said. One person added, “The staff here are excellent at caring, the staff are very willing and they create a good atmosphere.” People were positive in their remarks about the staff generally and stated that the staff respected their need for privacy. People said they liked their bedrooms and commented during the visit that that the home was always kept clean and was well looked after. One person said, “The home is always kept in a clean and homely way that I feel very comfortable here.” The home has open and flexible visiting arrangements and relatives stated they were always made to feel welcome. The management encourage people to stay in touch with relatives and friends. A choice of food is available at each meal and the people spoken to were happy about the choice, quality and quantity of food provided. The home do have a procedure to follow to raise any concerns or complaints. The people accommodated at Lady of The Vale, staff and relatives benefit from the commitment of the management team. What has improved since the last inspection? Since the last inspection improvements had been made to the record keeping in relation to risk assessments, including those for pressure monitoring and bed rails. Since the last inspection the policy and procedures regarding medicines had been reviewed and revised. Improvements had been made to the arrangements for the management of medication and some checks were being made and recorded to make sure people are given their medicines as prescribed. Some improvements have been made to auditing various aspects of care practices, for example, medication systems, care plans, staff files, accident/incident monitoring since the last inspection. There was some improvement in the recreational activities provided and the record keeping for these activities. Some improvements had been made to the procedure in place for the recruitment and supervision of staff employed. Lady Of The Vale DS0000006715.V377794.R01.S.doc Version 5.2 Page 7 The manager needs to gain the views of people who use the service so they can be assured the service is run in their best interests by developing the quality assurance system. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Lady Of The Vale DS0000006715.V377794.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 Lady Of The Vale DS0000006715.V377794.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with information about the home and are confident they will have their needs assessed before admission is agreed. EVIDENCE: A Statement of Purpose and Service User Guide is available and contains the information required in the National Minimum Standards. Each room had a copy of the Service Users Guide to give people information about the service provided. Wherever possible, people who use the service receive information before admission to the home. From information received in the surveys, five out of seven people said they had received enough information to help them decide if Lady of The Vale was the right place for them. In the home’s self assessment the manager wrote that prospective people are able to visit the Lady Of The Vale DS0000006715.V377794.R01.S.doc Version 5.3 Page 10 home as often as they feel necessary, they can come on a trial visit and stay overnight or longer if they wish. For residents who are referred through Care Management arrangements the home obtains a summary of the Care Management Assessment prior to admission. An initial assessment of the person’s needs was available for three people looked at. Copies of the inter agency care plans were available and the information was generally transferred into a long-term needs assessment form completed by the staff at the home. There was evidence that the admission process included involvement of the prospective resident, his/her representatives and any relevant professionals. The home does not provide an intermediate care service. Lady Of The Vale DS0000006715.V377794.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive care and support in a way that meets their expectations. The principles of respect, dignity and privacy are put into practice so they can be confident they will be well cared for. EVIDENCE: The care plans for four people living at the home were looked at and where possible these people were spoken to. Although the records were generally more up to date than found at the previous inspection there were some shortfalls identified. The care plans did give staff instructions on how to meet each person’s needs. As raised at the last inspection the care plans still lacked some personalised detail and the likes and dislikes of the individual. One care plan stated, “Daily body wash”, “Sleeps well takes sedation”, “needs two for hygiene”. A discussion was held with the manager about making these more person centred so they included the individual preferences of the person Lady Of The Vale DS0000006715.V377794.R01.S.doc Version 5.3 Page 12 accommodated. There was some improvement seen in keeping the care plans up to date however further work is needed to ensure the monthly evaluations accurately show any changing needs of the person. The need for a more person centred approach to the care plans would show the individual needs of the residents. For one person the professional visit showed the GP was to arrange blood tests. There was no record of these having been done in the care plan or in the daily diary. The nurse in charge stated she would follow this up but people’s needs may not be met in full if the records are not accurate and may be confusing for staff in charge of shifts. A number of risk assessments were in place including moving and handling, falls and nutrition and since the last inspection these included a risk assessment for bed rails. It was obvious there were improvements to the record keeping for risk assessments although for one person looked at the moving and handling risk assessment was only partially filled in and the person was being hoisted for all transfers. There was no nutritional risk assessment even though there was a note the GP had been informed this person was, “refusing their meals” and the staff were monitoring this person’s food intake on a chart. A review of the AQAA showed that not all people had nutritional screening upon admission to the home. The manager stated that two staff members had undertaken training in nutritional assessments and staff were in the process of developing these. A recommendation was made for this to be addressed to minimise the risk of people not being appropriately monitored in relation to their nutritional needs and any other identified risks. The manager does recognise that the care plans and risk assessments could be further developed to ensure the care planning system in place is used to its full potential, she did state that some training was planned and these shortfalls would be addressed. A discussion highlighted the need to make sure that appropriate risk assessments are in place to monitor all aspects of the health needs of the people accommodated. The care plans showed that other health care professionals and services were provided to people at the home including the involvement of speech and language therapists, the tissue viability nurse and dieticians. In the AQAA the manager stated that “Staff are able to act sensitively and ensure personal care is delivered in a private environment at a time and pace directed by the resident, where possible.” From observations made during the visit the people seemed comfortable and content and the staff were seen to encourage them to maintain some independence and dignity. Some of the staff were seen listening and talking to people in a supportive and patient manner. People living at Lady of The Vale did feel that the staff respected them and treated them well. Lady Of The Vale DS0000006715.V377794.R01.S.doc Version 5.3 Page 13 During a partial tour of the home people who could express a view were happy with the care they received and comments included, “The staff are the best, they do keep a good eye on me.” A relative wrote in a survey that, “The home has always had a good reputation for nursing. They are excellent at caring, the staff are very willing and there is a very good atmosphere here.” Care plans reviewed in relation to wound care showed these to be clearly recorded, updated and evaluated on a regular basis. A sample audit of the medication administration records and the blistered medication showed that most medication was being administered as prescribed. Since the last inspection the manager had increased the auditing of the medication practices. The quantities of medicines held for each resident were recorded when the medication came into the home and when it was disposed of. From the sample of medicines looked at the records showed that medicines were accounted for. We found that the records for a sample of controlled drugs which were checked could all be accounted for and these controlled drugs were stored correctly. The two requirements and one recommendation made at the last inspection had been addressed in relation to medication. Lady Of The Vale DS0000006715.V377794.R01.S.doc Version 5.3 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People find the lifestyle in the home generally matches their expectations and preferences. Some activities/excursions were provided and people were able to maintain contact with family and friends. EVIDENCE: In the AQAA the manager stated that they planned to, “Find out residents lifestyles and interests prior to admission to Lady of The Vale.” Information about people’s daily life and social activities should be recorded in the care plans including detail of a person’s family life, past employment, hobbies and interests for example. Although this detail was not well recorded discussions with staff members showed they were aware of the social history of a number of people at the home. Since the last inspection the manager has increased the number of hours staff can spend on activities, two staff members provide an additional four hours on activities. Once every two weeks a physiotherapist was visiting the home to provide some therapeutic input to a group of people at the home. One person said, “I really enjoy time with the physio, we don’t always do exercises but it is fun.” A recommendation was made at the last Lady Of The Vale DS0000006715.V377794.R01.S.doc Version 5.3 Page 15 inspection for people to be consulted about a programme of activities and that a record should be made in the individual care plan to show their participation. Attempts had been made to address this as some peoples activities diaries were filled in. The manager did recognise that providing social activities in the wider community was something she hoped to expand upon in the next twelve months. Some staff had been out with people on local shopping trips and another person spoke of a summer barbeque they had enjoyed. A recommendation made at the last inspection stated the home should ensure residents are consulted about a programme of activities and a record should be made in the individual care plan to show their participation. People living at the home who could express a view said, “Oh I am happy where I am and am not bothered about activities” another person said, “Sometimes I wish there was more for me to do. I keep sitting here and thinking a lot which is not always a good thing.” Of the seven people who completed a survey, four people said there are “always” activities arranged they can take part in, the three other people said there are “sometimes” or “never” activities provided. The manager stated she did recognise that providing a full and stimulating lifestyle with options was something she would like to provide for people at the home. One staff member stated they had tried to improve the information provided in the care plans to identify the past life experiences of people who use the service. One care plan did give some information about the persons childhood, working life, relationships, marital status and family dynamics as well as hobbies and past interests. Family members and/or staff should be encouraged to continue to do this as it may assist the staff in understanding the people they are caring for. The home supports the residents to meet their religious needs whilst living at Lady of the Vale. Attending Mass in the chapel on site on a daily basis was said to be an important part of the daily routine for a number of residents living at Lady of the Vale. Meals are served from a hot trolley and the aim of meal times according to the manager is to keep them relaxed and flexible. Menus had been developed in line with peoples likes and dislikes and they were offered a varied, wholesome and nutritious diet. Comments made during the visit were positive in relation to the meals provided and four people who expressed a view said the food was good and they were never made to feel hurried. A choice of meals was available at each mealtime and the chef confirmed that if people did not want the choices on the menu he would prepare an alternative. Staff were seen to support people appropriately when eating their meals in a discreet way. In Lady Of The Vale DS0000006715.V377794.R01.S.doc Version 5.3 Page 16 response to the question in the survey, “Do you like the meals at the home? Four people stated “Always”, three “usually” and one person “never”. Since the last inspection the menus have been reviewed and more choice has been provided by the chef visiting people more regularly to find out their likes and dislikes. Since the last inspection people were being encouraged to make use of the dining room and some people were seen to use this room during the visit, particularly those people who were accommodated on the ground floor. The relatives of people who use the service said they were always made to feel welcome whenever they visited Lady of The Vale. This encourages people to maintain contact with their family and friends. Lady Of The Vale DS0000006715.V377794.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were confident their concerns would be listened to and staff training in the protection of vulnerable adults ensured that people were safeguarded from abuse. EVIDENCE: The complaints procedure was available on display and is included in the Service User Guide to the home. The Commission had not received any complaints since the last inspection. There was evidence that the home had a procedure and policy in place for the Safeguarding of Vulnerable Adults and a policy on Whistle Blowing. Staff spoken to during the visit were aware of the action to take in the event of an allegation of abuse and felt confident that if they observed poor practice they would readily report this. The manager confirmed that all staff had undertaken Adult Protection training. Of the seven surveys returned, all knew how to make a complaint about the care provided. One relative added, “I have never needed to make a complaint.” In the AQAA the manager stated she had, “An open door policy, visitors are welcome to come and see us at anytime to discuss concerns/suggestions. All of these are then taken on board and listened to.” Lady Of The Vale DS0000006715.V377794.R01.S.doc Version 5.3 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lady of The Vale provides a safe and comfortable home that is well maintained, comfortable, clean and homely with large well maintained gardens. EVIDENCE: A partial tour of the home was carried out. This showed that the bedrooms of people living at the home and the lounges provided a homely environment with well-maintained grounds. Bedrooms were personalised with photographs and ornaments. Some people spoken said they were pleased with their rooms and they enjoyed spending time in their privacy of their bedroom. During the visit it was clear that a programme of redecoration and refurbishment was ongoing to make the environment better for the people who live at the home. There are two double bedrooms at the home which have privacy screens and people only Lady Of The Vale DS0000006715.V377794.R01.S.doc Version 5.3 Page 19 share if they choose to. Three people spoken to said, they felt the staff respected their need for privacy at all times. On the days of the inspection the home was clean and free from odours. The home employed domestic and laundry and these were seen to be busy throughout the home. Of the seven residents/relatives who returned surveys said, “The home is always fresh and clean.” One person added, “I think they are very good at keeping the environment very pleasant for everyone at the home.” A variety of equipment including hoists, specialist baths and beds was available in the home to ensure the physical care needs of the people living there could be met. The manager stated in the AQAA that 33 staff had received training in infection control and staff spoken to confirmed they had done this training. In the AQAA the manager stated they were in the process of purchasing a sluicing disinfector/macerator and a recommendation was made for this to be addressed to minimise the risk of cross infection. Lady Of The Vale DS0000006715.V377794.R01.S.doc Version 5.3 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive care and support from staff that have the skills to support them correctly. EVIDENCE: At the time of the site visit the home provided care and accommodation for 36 people requiring nursing care and two people were due to be admitted to the home. On the day of the inspection the numbers of staff on duty and the skill mix appeared appropriate to meet the needs of the people accommodated. Some agency staff are used at times to address shortfalls in the staffing levels however where possible they try to use staff who have worked at the home before. The staff stated they felt well supported by the home’s management team, the registered manager was present during the visit. Domestic, laundry, catering, administrative staff and a maintenance person also supported the staff team. Relatives and people living at the home were positive about the staff team. All seven people who returned surveys recorded that, “The staff are always available when I need them and the staff do listen and act on what we say.” Lady Of The Vale DS0000006715.V377794.R01.S.doc Version 5.3 Page 21 A recommendation was made at the last inspection was for the manager to make sure that staff were in receipt of appropriate supervision on a regular basis so that their competencies and training needs are addressed. Records were seen of two staff who had received supervision and the manager did say that a new format for these was being developed. The responsibility for supervision was being shared with two senior care workers, a recommendation was made for these staff to receive some guidance/training in relation to carrying out supervisions for other staff. Since the last inspection the manager stated she had plans to update and transfer all recruitment files from a paper system to an electronic system. The manager had started to develop a training matrix to show when staff had attended a particular training course and when this was due to be updated. In the AQAA the manager recorded that they did plan to develop this further to include mandatory training and then to develop a training plan and follow this. The manager stated she was in the process of developing individual training records for each staff member. The application form had been updated to include a statement by the staff as to their physical and mental health so they are considered fit to work at the care home. Other recommendations addressed following the last inspection included the manager checking the professional personal identification numbers of the registered nurses more regularly than just annually and the staff files included a passport size photograph of the applicant in line with the regulations. The manager told us that 10 staff currently has completed NVQ level 2 training in Care and 8 staff hold NVQ level 3. One person is currently undertaking NVQ 3 and a further 2 are signed on to start this training. Available records showed that most staff had received training in fire safety, safeguarding vulnerable adults, infection control and moving and handling. Some staff had undertaken training in first aid and End of Life Care. Other updates staff had attended included Mental Capacity, medication and care planning training for qualified staff. The manager has plans to address dementia care training for all staff. Staff spoken to said they enjoyed training, one staff member said, “I do sometimes feel there could be more training because I am very keen to learn and feel it helps me in my work to understand everything.” Lady Of The Vale DS0000006715.V377794.R01.S.doc Version 5.3 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager and staff ensure Lady of The Vale is run in the best interests of the people who live there. EVIDENCE: The registered manager clearly takes her role and responsibilities seriously and is keen to improve and review the service where shortfalls have been identified by the home’s self audit and following this inspection. There are no changes to the management structure of the home. The manager has the relevant qualifications to run and manage a care home and is currently studying for further management qualifications. The staff said that Lady Of The Vale DS0000006715.V377794.R01.S.doc Version 5.3 Page 23 the manager was supportive and they did hold meetings, minutes of which are taken. A discussion with the manager highlighted that she planned to extend this to people accommodated and visitors in the next 6 months. The manager and the deputy manager have an open style of communication and relatives and people accommodated stated they were encouraged to express any concerns or issues that need addressing. Two relatives spoken to during the visit were very satisfied with the care of their relatives. Policies and procedures were in place to protect the personal allowances of the people accommodated. The manager talked about the policy in place in relation to money management and that people manage their own money wherever possible. A system is in place for people’s pocket monies, a sample of which were checked and a review of the records held showed these were accurately recorded. Copies of reported accidents/incidents were made in an appropriate logbook. A recommendation was made at the last visit for these to be monitored and a record of any improvements to prevent recurrence or plans to improve practice to be made so residents’ safety is addressed. The manager stated she audited these now on a monthly basis and then made any necessary changes to the persons care plan. Evidence provided in the pre inspection questionnaire showed that equipment and health and safety checks are made on an ongoing basis. A sample of service reports were looked at and this included fire safety records which were found to be satisfactory. Fire safety checks were being carried out on a regular basis. Staff had attended a fire drill on the 22/4/09. There was no record of water temperature checks, the manager stated these are all thermostatically controlled and were therefore satisfactory. A recommendation was made for these checks to be carried out at regular intervals even though the thermostats are in place to minimise the risk of any shortfalls in water temperatures. The manager did use both informal and formal quality assurance systems. She stated that whenever possible she spent time talking to people accommodated and relatives to ask their views of the service. More formally she would send out a questionnaire however there was no evidence to show that a quality assurance questionnaire had been sent out since the previous inspection. In the AQAA the manager recorded that the home planned to improve and develop the quality assurance tool. A recommendation was made for this quality monitoring system to be developed so that we are aware the views of people using the service are taken fully into account. Accident records were appropriately completed. The manager audited these on a monthly basis and reviewed the residents care plan/risk assessment following this. Lady Of The Vale DS0000006715.V377794.R01.S.doc Version 5.3 Page 24 A requirement was made at the last inspection for the manager to make sure that appropriate systems are in place to check the care practices and to improve the shortfalls identified. A recommendation made was that the manager should ensure that suitable auditing procedures are in place, for example, for care plans, accidents/incidents and medication practices to make sure the people accommodated are safeguarded. The records showed there was some improvements in the auditing of care practices throughout the home. Lady Of The Vale DS0000006715.V377794.R01.S.doc Version 5.3 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 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 3 X 3 X X 3 Lady Of The Vale DS0000006715.V377794.R01.S.doc Version 5.3 Page 26 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. Standard Regulation Requirement Timescale for action 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 Care plans should be kept under review and changed as needed so that changes in people’s care needs are clearly recorded and met. The manager should have in place for each person detailed risk assessments which are up to date including risks for nutrition and moving and handling. This will ensure their health and well being are appropriately monitored. A sluicing disinfector should be installed to minimise the risk of cross infection to people who use the service. A recommendation was made for staff to receive some guidance/training in relation to carrying out supervisions for other staff. A recommendation was made for a quality assurance/monitoring system to be developed so that we are aware the views of people using the service are taken DS0000006715.V377794.R01.S.doc Version 5.3 Page 27 2. OP8 3. 4. OP26 OP36 5. OP33 Lady Of The Vale fully into account. 6. OP38 A strong recommendation was made for water temperature checks to be carried out at regular intervals, even though the thermostats are in place to minimise the risks of injury to people accommodated. Lady Of The Vale DS0000006715.V377794.R01.S.doc Version 5.3 Page 28 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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