Care Home: Old Vicarage The

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What the care home does well Prospective residents are only offered a place at the home following a thorough assessment of their needs and if it is considered that their assessed needs can be met. The health care needs of residents are met, including the provision of pressure care equipment and the safe administration of medication. Residents are encouraged and supported to live their chosen lifestyle and to take part in appropriate activities. This includes one to one activities for those people who like to go out for a walk or to remain in their own room. The home is well maintained, clean and hygienic, providing comfortable and safe surroundings for residents. Most staff have either achieved or are working towards NVQ Level 2 or 3 in Care. In addition to this, domestic staff are working towards NVQ Level 2 in Housekeeping. The home is well managed and the quality assurance system gives residents and others the opportunity to affect the way that the home is operated. The health and safety systems in place are audited on a regular basis to ensure that they are effective. What has improved since the last inspection? The recruitment and selections systems at the home are more robust and now protect residents from the risk of harm by only employing people who have had safety checks to ensure that they are suitable to work with vulnerable adults. An activities co-ordinator is employed twice a week and there is evidence that people enjoy taking part in the activities on offer, including one to one time spent taking people out for a walk. Relatives and friends are encouraged and supported to take people out. More staff training has taken place during the last year although more effort should be made to ensure that all staff undertake core training as soon as possible after they commence work at the home. What the care home could do better: Medication administration records should be completed immediately after medication is given to each individual resident, and these records should be stored in the medication room. This would reduce the risk of errors being made on medication records. A medications fridge would enhance the security of medication and ensure that medication is stored at the correct temperature. A record should be made in individual care plans of a person`s preferred time to get up and go to bed. This would help to ensure that people are not getting up earlier than they wish to do so in a morning. There should be a true choice of meal at each mealtime so that residents are offered as much variety as possible. Receipts should be given to relatives when they hand money to the home for safekeeping, and when money is handed to residents by the home, to protect all parties concerned. CARE HOMES FOR OLDER PEOPLE Old Vicarage The 75 High Street Airmyn Goole East Yorkshire DN14 8LD Lead Inspector Diane Wilkinson Key Unannounced Inspection 5th September 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 The DS0000019751.V371915.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 The DS0000019751.V371915.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Vicarage The Address 75 High Street Airmyn Goole East Yorkshire DN14 8LD 01405 763699 F/P01405 760399 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) Jumacare Limited Mrs Amanda Pepper Care Home 22 Category(ies) of Dementia - over 65 years of age (22), Old age, registration, with number not falling within any other category (22) of places Old Vicarage The DS0000019751.V371915.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th September 2006 Brief Description of the Service: The Old Vicarage is a care home situated in a village close to Goole, in the East Riding of Yorkshire. It is registered to provide care and accommodation for 22 older people, both male and female, including those with dementia related conditions. The home has two lounges, a separate dining room and an additional lounge/dining area. A small patio area is available adjacent to the lounge along with a larger paved courtyard and gardens. Private accommodation is provided in a range of shared and single rooms, many of which have en-suite toilet facilities. Three bathrooms are provided for service users, two of which are adapted for residents with mobility problems. Information about the home is provided in a statement of purpose and a service user’s guide; these inform residents and others about the scope and nature of the care and facilities on offer. The current accommodation fees range from £390.00 to £436.50 per week; this does not include costs for hairdressing and chiropody. Old Vicarage The DS0000019751.V371915.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 star. This means the people who use this service experience good quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last Key Inspection of the home on 26th September 2006, including information gathered during a site visit to the home. The unannounced site visit was undertaken by one inspector over one day. It began at 9.45 am and ended at 4.30 pm. On the day of the site visit the inspector spoke on a one to one basis with three residents, three visitors, one member of staff, the registered manager and the registered provider. Inspection of the premises and close examination of a range of documentation, including three care plans, were also undertaken. The registered provider and registered manager submitted information about the service prior to the site visit by completing and returning an Annual Quality Assurance Assessment (AQAA) form. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. As part of the inspection process we sent survey forms to some residents and staff; five were returned by residents and seven were returned by staff. Responses in surveys and comments from discussions with residents and staff were mainly positive, for example, ‘The staff are always very caring’ and ‘the place is always clean and smells nice’. Other anonymised comments are included throughout the report. At the end of this site visit, feedback was given to the registered manager and provider on our findings, including recommendations that would be made in the key inspection report. What the service does well: Prospective residents are only offered a place at the home following a thorough assessment of their needs and if it is considered that their assessed needs can be met. Old Vicarage The DS0000019751.V371915.R01.S.doc Version 5.2 Page 6 The health care needs of residents are met, including the provision of pressure care equipment and the safe administration of medication. Residents are encouraged and supported to live their chosen lifestyle and to take part in appropriate activities. This includes one to one activities for those people who like to go out for a walk or to remain in their own room. The home is well maintained, clean and hygienic, providing comfortable and safe surroundings for residents. Most staff have either achieved or are working towards NVQ Level 2 or 3 in Care. In addition to this, domestic staff are working towards NVQ Level 2 in Housekeeping. The home is well managed and the quality assurance system gives residents and others the opportunity to affect the way that the home is operated. The health and safety systems in place are audited on a regular basis to ensure that they are effective. What has improved since the last inspection? What they could do better: Old Vicarage The DS0000019751.V371915.R01.S.doc Version 5.2 Page 7 Medication administration records should be completed immediately after medication is given to each individual resident, and these records should be stored in the medication room. This would reduce the risk of errors being made on medication records. A medications fridge would enhance the security of medication and ensure that medication is stored at the correct temperature. A record should be made in individual care plans of a person’s preferred time to get up and go to bed. This would help to ensure that people are not getting up earlier than they wish to do so in a morning. There should be a true choice of meal at each mealtime so that residents are offered as much variety as possible. Receipts should be given to relatives when they hand money to the home for safekeeping, and when money is handed to residents by the home, to protect all parties concerned. 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 The DS0000019751.V371915.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 Old Vicarage The DS0000019751.V371915.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 was not assessed, as there is no intermediate care provision at the home. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are assessed prior to their admission to the home and only admitted if it is considered that their assessed needs can be met. EVIDENCE: Five residents returned a survey to the CSCI and all recorded that they had received enough information about the home before they moved in to help them decide if it was the right place for them. One of the residents added that they had previously had respite care at the home. We examined the care plans for three residents. All included a full care needs assessment that had been completed by staff at the home; these had been completed for residents that were funded by the local authority as well as Old Vicarage The DS0000019751.V371915.R01.S.doc Version 5.2 Page 10 those people who were self-funding. The registered manager recorded in the Annual Quality Assurance Assessment (AQAA) that the needs assessment is carried out ‘in a place of the service users choice, either at their home, in hospital or at The Old Vicarage. Opportunities to visit the home and/or have a trial period of residency are promoted and encouraged’. Where the local authority had commissioned this service or had been involved in the assessment of the resident, a copy of their community care assessment and care plan had been obtained. Information is also gathered from health care professionals, relatives and others as part of the assessment process. All of this information is used to formulate an individual care plan for each resident. Old Vicarage The DS0000019751.V371915.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Health care needs are met in a way that respects a person’s privacy and dignity; this is recorded in and supported by well-maintained care planning documentation. Some minor improvements in the recording and storage of medication would improve security. EVIDENCE: We examined the care records for three residents; these included an individual care plan that was based on the care needs assessment undertaken by the home as well as information gathered from care management and family members. Care plans include risk assessments for moving and handling, pressure care and self-medication, as well as risk assessments that are specific for the individual resident; these are reviewed and updated on a regular basis. There is evidence that residents and/or relatives are involved in the care planning process; residents sign to record their agreement to the content of Old Vicarage The DS0000019751.V371915.R01.S.doc Version 5.2 Page 12 their care plan whenever they are able to do so. We noted that care plans include a photograph of the resident concerned; a photograph assists new staff to identify residents and assists the emergency services should someone go missing from the home. When asked in a CSCI survey, ‘Do you receive the care and support you need?’ four residents that returned a survey responded ‘always’ and one responded ‘usually’ – one resident added, ‘The staff are always very caring’. A member of staff recorded in a survey, ‘Staff are given appropriate information about service users and each service user has an in-depth care plan relating to their specific needs’. Care plans record the areas where a person is able to self-care and detailed information about the level of assistance needed with personal care and continence care. Daily records are thorough and include information on food/fluid intake, a person’s sleep pattern and how and where they choose to spend their day. We noted that key workers record a detailed review of a residents care plan on a monthly basis and that care plans are reviewed formally every six months; and all interested parties are involved. Relatives told us that they are always invited to attend review meetings. We noted that reviews are held more frequently if this is identified as a need. Care plans evidence that residents are weighed on a regular basis as part of nutritional screening and a person’s nutritional requirements, such as the need for a diabetic diet, are also recorded. A member of staff recorded in a survey, ‘the home is run very, very well. It is a very warm, comfortable and friendly place. It meets all the needs of the service user’s requirements e.g. very keen on personal hygiene and dietary needs’. We observed that residents had been provided with pressure care equipment to assist with tissue viability, such as pressure care mattresses. One person had been cared for in bed for a long period of time and the registered manager told us that they are assisted by district nurses to monitor tissue viability and the need for further intervention. There is a record of any visits from or contacts with health care professionals, including the reason for the contact, and detailed information is held regarding advice given by health care professionals following surgery or hospital visits. One daily diary entry recorded, ‘Staff exercised fingers as recommended by hospital’. When asked in the survey returned to the CSCI, ‘Do you receive the medical support you need?’ all five residents recorded, ‘always’. On the day of this site visit we observed the administration of medication by a senior carer – we noted that they signed medication administration records after they had seen the person take their medication, but that this is not necessarily done after each individual has been assisted to take their medication. This could lead to mistakes being made on medication administration records and could result in there not being an accurate record of Old Vicarage The DS0000019751.V371915.R01.S.doc Version 5.2 Page 13 the medication taken by residents, although we noted that there were no gaps in recording for the current month. Medication administration records are not currently stored in the medication cupboard; we recommend that this is the case, as this could reduce the risk of medication administration records not being signed immediately after a resident has been assisted to take their medication. The registered manager told us that two of the nine staff that administer medication have completed accredited medications training and that the remaining seven staff are in the process of undertaking this training via Selby College. All staff have done in-house training on the safe handling of medication. Sample signatures should be held for the group of staff that have responsibility for the administration of medication, so that records can be checked for accuracy and authenticity. We observed that staff are given information on various topics relating to medication, including the use of homely remedies and contraindications. Medication is stored securely in a locked cupboard within a locked cupboard. There are suitable storage arrangements for controlled drugs, although none of the residents are currently prescribed these. The senior carer was able to explain how controlled drugs would be recorded if a resident were to be prescribed them. Medication that requires storage at a cool temperature is currently stored in a container in the kitchen fridge. We recommend that a special medications fridge be purchased, as this would ensure that medication is locked away securely and also that it is stored at the correct temperature. We saw evidence that unused medication is returned to the pharmacist but noted that there is no record made of these returns; the registered provider agreed to discuss this with the pharmacist and to ask for a record to be made of all returned medication in future. We observed on the day of the site visit that residents are spoken to sensitively with regard to personal care, and that staff respect a person’s privacy by knocking on bedroom doors and by closing doors when people were using the toilet and bathroom. We observed that resident’s are treated as individuals, with consideration given to their personal relationships and particular lifestyle choices. Residents and visitors that we spoke to confirmed this, and all of the residents that completed a survey told us that staff listened to them and acted upon what they said. Old Vicarage The DS0000019751.V371915.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are encouraged and supported to maintain their chosen lifestyle and to continue with their hobbies and interests, and visitors to the home are always made welcome. Residents tell us that meal provision at the home is good. EVIDENCE: We have received information via recent complaints made to the CSCI that residents are assisted to get up before they want to get up. However, residents told us that they can get up and go to bed at a time chosen by them, and that this can vary from day to day, depending on their preference. The registered manager told us that residents are assisted to get up at a time chosen by them, but agreed to consult with all residents about their preferred time to get up and go to bed and to record this information in their individual care plan to avoid any misunderstandings. Old Vicarage The DS0000019751.V371915.R01.S.doc Version 5.2 Page 15 There are quiet areas of the home where residents can meet with visitors to give them privacy. Relatives and visitors told us that they are able to visit the home at any time, and are always made welcome – they said that they are always offered ‘tea and cake’, and that they are also invited to social events. Relatives told us that staff ‘go out of their way’ to assist them when they want to take their relatives out. A local lay preacher visits some of the residents on a regular basis; they told us that they are always made welcome by staff and residents and it was evident that residents enjoy their visits. The registered manager told us that the activities coordinator works on two half-days per week. She explained about the activities available to residents, such as board games and dominoes, as well as one to one time being spent with those residents who prefer to remain in their room or to go out for a walk. Residents confirmed in the survey that there are activities that they are able to take part in. Some residents have had a telephone installed in their own room; they told us that this helps them to remain in contact with family and friends. Most residents have a television in their bedroom and the registered manager told us that two residents who share a room regularly sit in there to watch a video. Bedrooms seen on the day of the site visit are a reflection of a person’s hobbies and interests, such as model making and CB radios. Information about advocacy services is displayed in the home; this enables people to access these services without having to ask someone for the information and promotes privacy and independence. Discussion with the registered manager on the day of the site visit evidenced that appropriate advice and assistance is sought for residents when personal issues are identified. Care plans record a person’s likes and dislikes regarding food and the registered manager told us that the cook has a record of this information in the kitchen. We noted that there is a varied menu in place but that, although there is a choice of meal at teatime, there is no choice on offer at lunchtime. The registered manager told us that the cook prepares an alternative meal for someone if they do not like what is on the menu that day. Ideally, there should be a true choice of meal available at lunchtimes and residents should be made aware of this; the registered manager agreed to pursue this. We observed that people were offered fruit juice to have with their meal, and that ample drinks were made available throughout the day; some people had a jug of juice at the side of their chair whilst sitting in the lounge or in their bedroom. Three people are provided with a liquidised diet – they have their meals earlier than the other residents but the registered manager assured us that meals are well spaced out throughout the day and that these people are offered supper just before they go to bed. Old Vicarage The DS0000019751.V371915.R01.S.doc Version 5.2 Page 16 We observed that people were allowed to take their time when eating their meals and that staff offered appropriate assistance where needed. Meal times are not hurried and residents are encouraged to see this as ‘social’ time. Two residents sit in a separate lounge, as they are both smokers; they also take their meals in this room at the dining table provided. Old Vicarage The DS0000019751.V371915.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents and others know how to use the complaints procedure and residents say that staff listen to them. Residents will be further protected from the risk of being abused when all staff have completed training on safeguarding adults. EVIDENCE: There are appropriate complaints policies and procedures in place, and the complaints procedure is displayed in various areas of the home. Residents and relatives told us that they know how to make a complaint and that they know who to speak to if they are dissatisfied with any aspect of care. They told us that they were confident that their complaints would be listened to and acted upon. One resident added in a survey, ‘I have never needed to complain’. Staff told us in surveys that they know how to advise someone if they have concerns about the home and went on to explain the steps they would take. No complaints have been made directly to the home since the last key inspection, but some have been made to the CSCI. These have been investigated appropriately by the registered provider and manager, and a record has been kept of the details of the complaint, the investigation undertaken and the outcome. None of the complaints were upheld. There have been no recorded allegations or incidents of abuse at the home since the last key inspection. There are appropriate policies and procedures in Old Vicarage The DS0000019751.V371915.R01.S.doc Version 5.2 Page 18 place that are designed to safeguard vulnerable people from all types of abuse. The registered manager has attended the ‘Manager’s Awareness’ training course on safeguarding and some staff have covered this topic on National Vocational Qualification (NVQ) training. The registered manager told us that this topic has also been discussed with staff at staff meetings and in one to one supervision. The registered manager is aware that staff should attend a formal training session on safeguarding adults to ensure that they know what action to take should an allegation or incident of abuse occur, and this has been arranged for staff at the beginning of November 2008. Old Vicarage The DS0000019751.V371915.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is clean, well maintained and well furnished and provides comfortable surroundings for residents. EVIDENCE: There is a handyman employed at the home who is responsible for the day-today maintenance of the premises. The bi-annual audit includes information about maintenance that has been addressed during the last six months and what is due to be addressed in the next six months. In addition to this, the registered manager recorded details of planned maintenance and improvements for this year in the Annual Quality Assurance Assessment (AQAA) that was completed prior to this inspection. We observed that the home is well maintained and there is evidence that equipment is replaced as necessary. Old Vicarage The DS0000019751.V371915.R01.S.doc Version 5.2 Page 20 Communal areas of the home offer plenty of access to sunlight – some lounges have patio doors that open onto an enclosed courtyard. Bedrooms also include access to sunlight and provide views of the surrounding area. Bedrooms are furnished and decorated to reflect the needs of the resident concerned, and many residents have brought small items of furniture from their own home. Furniture and fittings in communal and private areas of the home are domestic in nature and of good quality. One lounge has been identified to be used just by residents that smoke. The door into the hall is kept open so that staff can observe the residents throughout the day. There are patio doors on to the courtyard but these are kept closed during cold or wet weather. An extractor fan would reduce the level of smoke that passes into the hallway, protecting others from the risk of passive smoking. The registered persons agreed to look into this. Information has been received by the CSCI in a recent complaint that one of the patio doors does not lock properly. This was discussed with the registered manager who acknowledged that there was a problem, and agreed that this door would remain locked until it was repaired – this would not affect the safety of residents. There is a domestic assistant and a cook on duty each day; this allows care staff to concentrate on personal care duties and reduces the risk of cross infection. The home was seen to be clean and hygienic on the day of the site visit and no unpleasant odours were detected; we observed good hygiene practices being used by staff. Laundry facilities at the home are good; the floors have an impermeable surface and the walls and floors are easily cleanable. A resident told us in a survey, ‘the place is always clean and smells nice’. Old Vicarage The DS0000019751.V371915.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care staff are recruited in a safe way and receive induction and on-going training to ensure that they are qualified and skilled to care for the residents living at the home, although some training needs to be updated. EVIDENCE: There is a staff rota in place that records the staff on duty each day – there are separate rotas for night staff, domestic staff and catering staff. We recommend that the role of each member of staff is made clear on the rota so that people can easily identify the number of senior carers and care workers on duty. Day staff have a six-week rota in operation – this gives them the opportunity to plan ahead, as they know in advance what their work rota will be. There are usually three staff on duty during the day, with four staff occasionally being on duty at busy times. There are two care staff on duty during the night, and occasionally staffing levels drop to this during the day/evening. When asked in a survey, ‘Are the staff available when you need them?’ four residents responded ‘always’ and one responded ‘usually’. Most staff reported to us that they felt that these staffing levels were sufficient, but one care worker reported in a survey that they felt that there should be three people on duty during the night. Old Vicarage The DS0000019751.V371915.R01.S.doc Version 5.2 Page 22 More that 50 of care staff have completed NVQ Level 2 in Care – three of these staff are continuing with training at Level 3. A further staff member is working towards NVQ Level 3 in Care. In addition to this, two domestic staff are undertaking NVQ Level 2 in Housekeeping; this is good practice. In May 2008 the CSCI received a complaint alleging that staff commenced work at the home prior to satisfactory recruitment checks being in place. This was investigated at the time by the registered provider, and the CSCI were notified of the outcome; this was that staff had commenced work on receipt of a POVA first check but before a satisfactory CRB check had been received. The registered provider told us that these staff were working under supervision in the interim period, which is considered to be acceptable practice. At this site visit we checked the recruitment records for three members of staff, including two newly recruited staff. These evidenced that a satisfactory application form that includes details of a person’s employment history, their previous experience and their training achievements is completed. A staff interview assessment form is used to record the applicant’s performance at their employment interview. In all instances, a Protection of Vulnerable Adults (POVA) first check and two written references had been obtained prior to the person commencing work at the home. The registered persons were reminded that, in normal circumstances, a satisfactory Criminal Records Bureau (CRB) check should be obtained prior to staff commencing work at the home, and that a POVA first check should only be used in exceptional circumstances. Staff records include information about the induction training that they have undertaken when they first commence work at the home. This is satisfactory but would be improved if the home used the induction training programme recommended by Skills for Care. This training ‘cross references’ to NVQ training and therefore assists care staff with achieving their award. Staff records also include information about the training courses they have attended, and a copy of the training certificate is retained for future reference. There is a training and development plan in place that records the training achievements of staff, training arranged for staff and the date that any training is due to be updated. The registered manager told us that all staff (apart from a few new staff) have now completed moving and handling training and that refresher training has been booked for those staff that are considered to need it. New staff are booked on this training on either the 7th or the 14th October. Other training that is booked for the near future is Infection Control, First Aid, Safeguarding Adults and Basic Food Hygiene. Old Vicarage The DS0000019751.V371915.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is well managed and the health, welfare and safety of residents and others are protected by the systems in place. EVIDENCE: The registered manager is experienced and qualified to manage the care home; she has completed the NVQ 4 Registered Manager’s Award and keeps her practice up to date by attending training along with the staff group. She has recently attended the manager’s course on safeguarding adults. We observed on the day of the site visit that staff and the manager worked well as a team, and staff told us in surveys that they are well supported by the manager and that communication channels within the home are good. A Old Vicarage The DS0000019751.V371915.R01.S.doc Version 5.2 Page 24 member of staff recorded in a survey, ‘the management have a healthy interest in staff development. Regular supervisions are held between individual staff and management discussing areas that may require help or problems that may have arisen, and the best way to alleviate them’. Residents and relatives told us that the manager is ‘helpful and approachable’. The home has achieved the Quality Development Scheme (QDS) Parts 1 and 2; this is a quality scheme operated by the local authority. The quality assurance systems in place at the home enable residents and others to affect the way in which the home is operated. Surveys were distributed to residents and health and social care professionals in March 2008 and the results of these will be analysed and fed back to residents and others. Residents meetings are held every month and staff meetings are held every 3 months. Relatives told us that they are invited to events held at the home, and to review meetings where their relative’s care plan is discussed and updated. There is a quality assurance plan in place for each year, and various audits are undertaken as part of this; all of this information is fed into the home’s 6monthly service report. The registered manager was reminded that a copy of collated quality assurance information should be forwarded to the CSCI. We examined the records for monies held on behalf of residents and crosschecked these with actual monies held - both were found to be accurate. Receipts are obtained for any purchases made on behalf of residents, and when they have the services of a hairdresser or chiropodist. We recommend that a receipt be given to relatives when they hand money to staff for residents for safekeeping and when money is handed to residents, to protect all parties concerned. We examined health and safety documentation for appliances, equipment and services at the home. These were all up to date, including the fire alarm test, portable equipment testing, the gas safety inspection and the servicing of hoists. There is a fire risk assessment in place and records showed that this is due to be reviewed in July 2009. We saw that audits take place on health and safety topics and that these are recorded as part of the home’s quality monitoring system. The CSCI are being informed of accidents and incidents at the home via notification under Regulation 37 of the Care Homes Regulations 2001. There are risk assessments in place to record safe working practices and this information is updated appropriately. As previously recorded, refresher training is currently being organised on some health and safety topics. Old Vicarage The DS0000019751.V371915.R01.S.doc Version 5.2 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 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 The DS0000019751.V371915.R01.S.doc Version 5.2 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 OP9 Good Practice Recommendations Medication administration records should be signed immediately after each individual resident has been assisted to take their medication to reduce the risk of errors occurring. Medication administration records should be stored in the medication cupboard to reduce the risk of medication not being recorded immediately. Ideally, there should be a medications fridge in use – this would enable medication to be kept securely and at the correct temperature. There should be a sample signature recorded for each member of staff that has responsibility for the administration of medication; this allows medication records to be checked for accuracy and authenticity. It would be good practice to record a person’s preferred time to get up and go to bed in their care plan. DS0000019751.V371915.R01.S.doc Version 5.2 Page 27 2. 3. 4. OP9 OP9 OP9 5. OP12 Old Vicarage The 6. 7. 8. 9. 10. 11. OP15 OP19 OP26 OP30 OP30 OP35 There should be a true choice of meals at each mealtime, so that residents are offered as much variety as possible. The patio doors in one of the lounges should remain locked until they are repaired to enhance the safety of residents and staff during the night. A POVA first check should only be used in exceptional circumstances, not routinely. The Skills for Care induction training pack (or equivalent) should be used by the home. Staff should undertake training on core topics (such as good hygiene, infection control and safeguarding) as soon as possible after their recruitment. Receipts should be given to relatives when they hand money over for safekeeping, and when money is handed to residents, to protect all parties concerned. Old Vicarage The DS0000019751.V371915.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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