Care Home: Old Vicarage Nursing and Residential Home

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What the care home does well The delivery of personal care is individual and flexible. Staff respect privacy and dignity and are sensitive to changing needs. The service listens and responds to individuals` choices and decisions about who delivers their personal care. Staff listen to people who live in the home and take account of what is important to them. Service users spoke of their confidence in the staff that care for them. The service ensures that all staff receive relevant training that is focussed on delivering good outcomes for people using the service. The manager communicates clearly and is able to evidence a sound understanding and application of the service`s operational systems, particularly in relation to improvement, customer satisfaction, and quality assurance. Equality and diversity issues are given priority by the manager who is aware of the varying strands this involves. What has improved since the last inspection? Care planning and provision is more person centred and regularly reviewed. Management audits are recorded and have a running theme of service improvement. The development of life histories will enhance the social provision of care. Staff will demonstrate how they understand individuals` preferences better. New laundry equipment has been installed. What the care home could do better: CARE HOMES FOR OLDER PEOPLE Old Vicarage Nursing and Residential Home Station Road Gobowen Oswestry Shropshire SY11 3JS Lead Inspector Pat Scott Key Unannounced Inspection 1st July 2008 09:45 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 Old Vicarage Nursing and Residential Home DS0000051235.V367596.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. Old Vicarage Nursing and Residential Home DS0000051235.V367596.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Vicarage Nursing and Residential Home Address Station Road Gobowen Oswestry Shropshire SY11 3JS 01691 655254 01691 658467 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) Sure Care (UK) Ltd Mrs Melanie Amanda Maddocks Care Home 37 Category(ies) of Dementia (37), Old age, not falling within any registration, with number other category (37) of places Old Vicarage Nursing and Residential Home DS0000051235.V367596.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care (with nursing) and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories; Older people (OP 37) Dementia (DE 37) The maximum number of service users to be accommodated is 37. 2. Date of last inspection 19th April 2006 Brief Description of the Service: The Old Vicarage is situated in the village of Gobowen, near Oswestry. Accommodation comprises the original building with an extension, which offers double and single rooms on two floors, accessible via a shaft lift. Whilst being immediately adjacent to open fields with pleasant views, the Home is conveniently accessible to a variety of village amenities, including pubs, post office, shops, local bus route and train station. Entry to the home is not restricted. There are key pad locks on two internal doors on the ground floor corridor within the main dementia wing. The service has a statement of purpose which provides people with information about the services of the home. The most recent inspection report is available at the entrance to the home. The fees for The Old Vicarage are: £500-650. Old Vicarage Nursing and Residential Home DS0000051235.V367596.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 *TWO star good service. This means the people who use this service experience good quality outcomes. We, the commission, used a range of evidence to make judgements about this service. This includes: information from the manager in the annual quality assurance assessment (AQAA), staff records kept in the home, medication audits, survey results from people who use the service, discussion with the manager, tour of the premises, previous inspection reports, quality assurance processes, Fire Authority reports, Environmental Health Office reports, observation of care experienced by people using the service. An ‘expert by experience’ from Help the Aged, participated in this inspection. This is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector, to help them get a picture of what it is like to live in, or use the service. What the service does well: The delivery of personal care is individual and flexible. Staff respect privacy and dignity and are sensitive to changing needs. The service listens and responds to individuals’ choices and decisions about who delivers their personal care. Staff listen to people who live in the home and take account of what is important to them. Service users spoke of their confidence in the staff that care for them. The service ensures that all staff receive relevant training that is focussed on delivering good outcomes for people using the service. The manager communicates clearly and is able to evidence a sound understanding and application of the service’s operational systems, particularly in relation to improvement, customer satisfaction, and quality assurance. Equality and diversity issues are given priority by the manager who is aware of the varying strands this involves. Old Vicarage Nursing and Residential Home DS0000051235.V367596.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. Old Vicarage Nursing and Residential Home DS0000051235.V367596.R01.S.doc Version 5.2 Page 7 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 Old Vicarage Nursing and Residential Home DS0000051235.V367596.R01.S.doc Version 5.2 Page 8 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): Key Standard 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective people can be confident that the care home can support them. This is because there is a complete assessment of their needs that they, or people close to them, have been involved in. Prospective people will be able to feel that they can live the life they choose in the home. This is because the assessment is person centred and shows an understanding and respect for their diversity. EVIDENCE: The manager conducts full assessments of need prior to offering people a place at the home. Examples were seen in the care files of 3 recent admissions. For persons admitted through the care management arrangement i.e non-self funding, the manager obtains the assessment papers from the relevant professionals involved so that risks are identified and the suitability for the home assessed. Old Vicarage Nursing and Residential Home DS0000051235.V367596.R01.S.doc Version 5.2 Page 9 The service is implementing a new scoring system for assessing the mental health status of individuals. Residents spoken with told us that they had settled in well at the home and had been satisfied with all information given to them. Old Vicarage Nursing and Residential Home DS0000051235.V367596.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): Key Standards 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service aims to address and meet assessed need through the continued development of plans of care, so that people are provided with more person centre care. The manager understands the need to comply with safe medication systems and staff practice ensures that the home’s procedures are complied with and that residents’ health matters are safely addressed. The actions of staff and their approach to care ensures that people are treated with respect and their right to privacy is upheld. EVIDENCE: All residents have care plans derived from the initial assessments. We looked at three in detail. Each plan has a dated monthly review of the elements of care. The plans provide detail as to how care is to be delivered by staff in a Old Vicarage Nursing and Residential Home DS0000051235.V367596.R01.S.doc Version 5.2 Page 11 way that the person prefers. The recording of clinical interventions in care is clear. Daily records monitor the progress of individuals which provide indications of how a person has spent their day. The plans demonstrate contact with healthcare professionals such as the community psychiatric nurse, general practitioner or diabetic specialist nurse. The manager conducted a diabetes audit in February 2008, the outcome of which concludes that the service is able to closely monitor changes and has a good support system in place from other supporters for review and advice. People spoken with stated that support is flexible as they spoke of the various bed/rising times which are accommodated and always delivered in a way that respects their privacy. People are allocated a nurse and care assistant as key workers to address their overall well being. The service conducts audits of care plans which has identified shortfalls which the manager has addressed with the named nurse concerned. Mandatory and professional training is provided for staff so that they are equipped with the skills to deliver good care. The manager ensures that there are forums for discussion of resident need such as handover, staff meetings and supervision. Residents all appeared well groomed with their hair, nails and clothes looking clean. The hairdresser was on site. No issues were identified in discussions regarding approach of staff or being assisted with intimate tasks. The service accepts responsibility for administering medication to residents and has improved practice in this area. The service has suitable storage facilities for all prescribed drugs and for homely remedies. Written records for receipt, administration and disposal of medication are in place. The service audits the medication system on a regular basis for compliance and errors. The expert by experience had a conversation with a lady visiting her mother and she stated: “Problems can arise but they are rare and the staff deal well with problems as they arise”. Old Vicarage Nursing and Residential Home DS0000051235.V367596.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. Staff support people to keep in touch with family, friends and representatives so that they have appropriate relationships. People state they are as independent as they can be, and the service demonstrates that they lead their life in a chosen way so that they have the opportunity to make the most of their abilities and interests. The food in the home is of good quality so that the dietary needs of people are met. EVIDENCE: The assessment process demonstrates that social/leisure pursuits are addressed prior to admission in a personalised way for the individual. Once living at the home, social activities are provided and the service shows that this is based on service user consultation through regular service user meetings regarding all aspects of living at The Old Vicarage. Planned activities are displayed around the home. A comment in a returned survey reads: ‘ I am happy with everything and enjoy the outings that are organised.’ Old Vicarage Nursing and Residential Home DS0000051235.V367596.R01.S.doc Version 5.2 Page 13 People spoken with say they like the food and it is always nicely cooked. Quality surveys conducted by the service identified service users are satisfied with the meals that the chef cooks. The main meal of the day is displayed on a board and the chef talks to people about what they would like to eat. The expert by experience visited the lounge areas and offers the following comment: ‘Both contain large screen televisions; at the time of the visit only one of these was on and the volume was set at a low level that did not appear to be intrusive to any residents in the room. In the other lounge operatic arias were being played on a cd player. Again the volume was not intrusive. The menu for the day was on display in one of the lounges. There was no option shown and on questioning I was told that provision was made for vegetarians or diabetics and that if people didn’t really like the meal on offer an alternative would be prepared. Also on display were the minutes from a bimonthly “menu” meeting and the monthly residents meeting. The question of choice had been raised in the menu meeting. The dining room was very small and only contained three tables. I queried how many residents used the dining room for taking meals and was told “that most of our residents prefer to have their meals in one of the lounges”. I asked if it would not make for improved social activity if residents had the option of sharing tables during meal times but was told that as many residents need to be in wheel chairs there would have to be a lot more space than presently available.’ The manager tells us that plans are in hand to purchase additional land adjacent to the home to allow an extension to be built which will include a much larger dining area. At present residents do not have a choice. The expert by experience also spoke with the activity co-ordinator who has been at the home for fourteen years. Activities on offer include: regular Bingo sessions, walks with residents still able into the village, trips out e.g. Chirk Castle, Cosford Museum and supermarkets, an outside entertainer makes regular visits and reminiscence quizzes are popular. Work is ongoing on “life” histories of residents. There is a lot of enthusiasm to the activities work and the co-ordinator has one-to-one talks with residents mainly confined to their rooms. Residents have access to local newspapers and interest magazines provided by the home. Old Vicarage Nursing and Residential Home DS0000051235.V367596.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): Key Standards 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure that is up to date and accessible so that anyone associated with the service can complain or make suggestions for improvement. EVIDENCE: People spoken to say they would go to the manager or one of the staff if they had a problem. All expressed confidence that issues would be dealt with. There is a good level of accessibility to the manager at this home which ensures that concerns can be dealt with very quickly. The manager has opened new communication channels such as resident/relative meetings, menu meetings, day to day contact and care plan reviews. Adult protection is covered after recruitment and discussed at supervision. Staff training records seen show that staff are provided with regular updates in adult protection. Old Vicarage Nursing and Residential Home DS0000051235.V367596.R01.S.doc Version 5.2 Page 15 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): Key Standards 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The décor and furnishings are reviewed so that residents live in a safe, clean and comfortable environment, which encourages independence. EVIDENCE: The manager spoke of the on going upkeep to maintain the old building in a satisfactory state of repair and decoration. All areas seen around the home are clean and rooms personalised and decorated according to the wishes of those residents occupying them. Staff wear uniforms and aprons to minimise cross infection when dealing with personal care. Bedrooms do not have en-suite toilet facilities and many commodes are used. Commode pots are emptied and cleaned in the sluice rooms. The provider has installed new laundry machines. Old Vicarage Nursing and Residential Home DS0000051235.V367596.R01.S.doc Version 5.2 Page 16 The manager conducts regular infection control audits and a member of staff is the ‘link nurse’ for this topic who holds specific responsibilities. The assisted bathing facilities consist of a sit-in shower and two baths for 37 people. A further step-in shower room is being used as a store room. The expert by experience noted the following: ‘I asked how any residents using the lounges could attract the attention of staff if needed. Although there were buttons on some walls the residents I saw would have been incapable of reaching these. I was told that “staff regularly check on the lounges”. Old Vicarage Nursing and Residential Home DS0000051235.V367596.R01.S.doc Version 5.2 Page 17 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): Key Standards 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. Staff get access to training, supervision and support they need from the manager so that people receive planned care. Staff in the home are trained and recognise the importance of care planning so that peoples’ changing needs are identified and acted upon. EVIDENCE: There is a good skill mix of regular staff enhanced by bank staff. They work in teams in pairs with the nurse in charge responsible for medication and assisting more independent people. The manager has developed a training spreadsheet for 2008 and topics attended include: skin tears, medication management, nutrition, continence, first aid and dementia awareness. The home has achieved accreditation with Investors in people. Old Vicarage Nursing and Residential Home DS0000051235.V367596.R01.S.doc Version 5.2 Page 18 We received a recent communication regarding the homes use of staff who are under 18 years and that communication/messages are mixed with unclear guidelines and lack of training. From records seen staff have regular forums at which to air there views either through handover, meetings, supervision. Work experience people have been delivering personal care to people. The manager states that all staff are suitably trained and appropriately supervised where necessary. People receiving care told us that their choices are respected (as far as possible) with regards to who performs personal care tasks for them. Three staff files looked at show that all required checks had been completed. A comment from a relative in a survey returned to the commission, states:’ My Husband has been in the old vicarage for two and a half years, the care is wonderful, such a friendly atmosphere, the home is very well organised and seems to be run like clockwork because the staff are relaxed having regular breaks.’ Another states:’ The family are very well satisfied with the friendliness and level of care here.’ Old Vicarage Nursing and Residential Home DS0000051235.V367596.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 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. The management and administration of the home is based on openness and respect and with effective quality assurance systems and audits in place, service users are assured that the overall conduct of the home is being well managed. EVIDENCE: The service has a registered manager. Her practice is service user focussed and customer satisfaction is high on the agenda. This is evidenced by the commitment to conducting service user surveys and regular service user meetings that are minuted. Surveys results seen are collated and an action Old Vicarage Nursing and Residential Home DS0000051235.V367596.R01.S.doc Version 5.2 Page 20 plan developed to address any points raised. Changes are then made in the daily management of the home to reflect the outcomes of the surveys, for example: the outcome of a menu meeting resulted in the home using a gravy boat so residents could help themselves and provision of alcohol drink of choice i.e. one resident wanted to have a lager when curry is on the menu. The annual quality assurance assessment by the home identified where the provider suggests they could do better. The manager has an action plan to address these areas and the assessment is on view for residents/relatives to see if they wish to. Record keeping systems are good. All records seen are written in a way that shows the service listens to the people who use it. What people say is heard, acted upon and reviewed. Fire and hot water testing records are in order. A float of money is kept for each resident to cover the costs of hairdressing and to purchase toiletries. A register of expenditure is kept maintained by staff and the money is kept in a locked safe. The manager conducts audits to ensure that practice meets the policies of the service. She compiles monthly manager reports which monitor accidents, health and safety, adult protection, outcomes of meetings and medication compliance. Whilst in a lounge, the expert by experience observed the staff bringing people in for lunch; this involved the use of a hoist and sling and the staff involved were efficient and sensitive in their handing of frail residents. However, he noted that the braking systems on wheelchairs were rarely if ever used during this transfer process. Old Vicarage Nursing and Residential Home DS0000051235.V367596.R01.S.doc Version 5.2 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 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 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 Old Vicarage Nursing and Residential Home DS0000051235.V367596.R01.S.doc Version 5.2 Page 22 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 OP15 Good Practice Recommendations Consideration to increasing the capacity of the dining area should be given to cover the interim period prior to an extension being built. The provider should confirm their intention of increasing the table seating capacity. At present not all residents have a choice of where to take their meal. The food on offer is well prepared but a choice should be considered. The provider should consider upgrading the ground floor shower/storage room into a functional walk in shower room for residents. The provider should consider a system of mobile alarm pendants in the lounge to avoid the possibility of residents DS0000051235.V367596.R01.S.doc Version 5.2 Page 23 2 3 4 OP15 OP19 OP19 Old Vicarage Nursing and Residential Home 5 OP38 in distress being missed The provider should confirm procedures for wheel chair handling and ensure that staff comply with these. Old Vicarage Nursing and Residential Home DS0000051235.V367596.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Old Vicarage Nursing and Residential Home DS0000051235.V367596.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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