Care Home: Old Vicarage, The

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What the care home does well The home has good systems to enable people who use the service to share their views and they continue to look at ways of involving people who use the service and improving individualised services. People who use the service and their relatives comments included `very satisfied with where I stay` `couldn`t do any better` `looks after us all very well` `I am very happy here` `everything is fine` `this home is one of the best places you could live in`. The service gives good support to enable individuals to identify and access health care and has good links with supporting health professionals, who give good health care support. Supporting health professionals comments included `the staff are extremely polite and helpful` `provides a holistic service to individuals within the home` `promotes independency and social interaction` `the home staff and welcoming and responsive to professionals in a professional and polite manner giving timely and appropriate information`. The quality, presentation and choice of food and drinks is good. People who use the service comments included `the food is very tasty` `nice food` `plenty food`. People who use the service are supported and given the opportunity to experience activities and leisure pursuits and are supported where necessary to continue with hobbies and interests. People who use the service said, and it was seen, that staff were kind, considerate and supportive comments included `the staff are first class` `they are some of the best staff around` `good staff` `staff couldn`t be faulted`. The staff training programme has been developed and this has enabled the manager to have an overview of staff skills and knowledge and help them to provide individual care for people who use the service. The majority of staff have completed or are undertaking National Vocation Qualification in Care Level 2, 3 or 4 (NVQ) exceeding the minimum standard and providing people who use the service with a skilled and knowledgeable staff team. The home is well managed and the views of people who use the service and their families are supported and underpin the development of the home and their health, safety and welfare are protected. What has improved since the last inspection? The care plans are reviewed on a more regular basis this has enabled staff to have updated information on individual needs. The care plans have been developed to make them more user friendly and to increase the involvement of people who use the service and their families. The risk assessments have been reviewed and updated for all individuals who use the service. This will help protect people who use the service. The medication policies, ordering, administration and staff training has been reviewed and updated to ensure safer practices and help protect people who use the service. The internal quality assurance audits and monthly provider visits are undertaken more consistently and this has helped protect people who use the service, relatives and staff. Maintenance and safety certificates have been undertaken at the recommended timescales this will help protect people who use the service, relatives and staff. The manager has addressed all of the previous requirements and recommendations. What the care home could do better: To review the temperature of the room where medicines are stored to ensure that they are appropriately kept. To ensure that the garden is adequately maintained as this will improve the appearance for services users, families and visitors. To implement the redecoration, refurbishment and rebuild plan for the home, which has been identified by the provider, and when completed will provide more comfortable and pleasant surroundings for people, who use the service. To submit an action plan and complete the phased improvements to the passenger lift, this will help protect the safety of people who use the service, staff and visitors. Key inspection report Care homes for older people Name: Address: Old Vicarage, The 2 Waterville Road North Shields Tyne & Wear NE29 6SL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Mary Blake     Date: 1 9 0 5 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Old Vicarage, The 2 Waterville Road North Shields Tyne & Wear NE29 6SL 01912570937 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): sdewan@tiscali.co.uk Dr Sandeep Dewan Name of registered manager (if applicable) Alwin Joan Fidler Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability old age, not falling within any other category Additional conditions: Two learning disability beds are currently occupied by named residents. If any of these residents vacate the beds CSCI must be notified and action will be taken to revert those places to the category of OP. Date of last inspection Brief description of the care home The Old Vicarage is a privately owned care home that is situated in a residential area of North Shields, close to the town centre. The home provides personal care for up to 25 older people of both sexes. The accommodation is provided over two floors. The original building was extended and en-suite facilities are provided in the new part of the home only. Residents living in the home include people who require care due to old age and physical frailty, people with memory loss including dementia type illnesses, Care Homes for Older People Page 4 of 26 Over 65 6 0 17 0 2 0 Brief description of the care home and some with physical disabilities. Weekly fees vary and are available from the home. A guide to the homes services and inspection reports are available at the home. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations. This will only happen when it is considered that people who use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Before the visit we looked at information we have received since the last inspection, how the service dealt with any complaints & concerns since the last visit and any changes to how the home is run. Care Homes for Older People Page 6 of 26 We looked at the providers view of how well they care for people, the views of people who use the service & their relatives, staff and other professionals. This included the use of surveys of which eight service users, six staff and three supporting health professional surveys were returned. During the visit we talked with people who use the service, relatives, staff, the manager/provider & visitors. We looked at information about the people who use the service & how well their needs are met and looked at other records which must be kept. We checked that staff had the knowledge, skills & training to meet the needs of the people they care for and looked around the building/parts of the building to make sure it was clean, safe & comfortable. We told the manager what we found. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? The care plans are reviewed on a more regular basis this has enabled staff to have updated information on individual needs. The care plans have been developed to make them more user friendly and to increase the involvement of people who use the service and their families. The risk assessments have been reviewed and updated for all individuals who use the Care Homes for Older People Page 8 of 26 service. This will help protect people who use the service. The medication policies, ordering, administration and staff training has been reviewed and updated to ensure safer practices and help protect people who use the service. The internal quality assurance audits and monthly provider visits are undertaken more consistently and this has helped protect people who use the service, relatives and staff. Maintenance and safety certificates have been undertaken at the recommended timescales this will help protect people who use the service, relatives and staff. The manager has addressed all of the previous requirements and recommendations. 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. Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 who use the service have updated information about the home and admissions are appropriately managed. Evidence: Pre-admission assessments are undertaken and reflect the needs of the people who use the service. The last person admitted to the home had sufficient pre-admission information for the home to be satisfied that they could meet their needs and this was appropriately documented. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal and health care support is provided in the way that people who use the service prefer. Evidence: Three care plans were examined and case tracked. This means we spoke to the individual service user or observed their care and then looked to see how this was recorded in the care plan. The care plans were satisfactory, with relevant risk assessments for the prevention of falls, nutrition, moving and assisting and continence promotion. The plans had been consistently reviewed and updated on a regular basis. These plans were clear and easy to understand. The individual health needs of people who use the service are identified and people are supported to access community health services such as doctor, district nurse, dentist, and optician. The care plans showed that people who use the service have access to all NHS services and facilities if required. A number of assessment tools are Care Homes for Older People Page 12 of 26 Evidence: in use. Daily reporting of peoples care was good with any changing health care being reviewed and updated in the care plan. Health professionals comments included holistic approach to care could improve communication friendly and professional could have a friendlier approach to MDT members. Staff ensure that personal support is flexible and is able to meet changing needs and people have their wishes recorded on how they prefer their care. The care plans include a comprehensive risk assessment, which is regularly reviewed and updated. The management and staff had a positive attitude to risks and risks are managed to help people who use the service lead the life they want. The quality of the information was consistent and detailed. There is good liaison with supporting professionals. The system for ordering, storage, administration and disposal of medication is well organised. Internal and external audits are undertaken. Staff undertake appropriate training. The previous requirements had been met but there remains an issue with the temperature of the room where medicines are being stored and this is under review. Staff have a good knowledge of the needs of the people living in the home and the senior staff are giving good direction. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 who use the service are enabled to participate in appropriate activities of their choice and to maintain relationships with friends and family. Evidence: People who use the service are offered the opportunity to join in a range of social and leisure activities both inside and outside of the home. They have the opportunity to use community facilities for leisure activities e.g. going to the shopping, eating out, visits etc. They are offered the opportunity to experience new activities and leisure pursuits as well as supported where necessary to continue with hobbies and interests. Staff assist and encourage people who use the service to maintain family links and previous friendships, respecting individual wishes. People who use the service are able to have their spiritual needs met with good links being established with the local churches. Care Homes for Older People Page 14 of 26 Evidence: Staff support people who use the service to maintain existing friend and social relationships. Staff seek permission prior to entering individual rooms and were communicating well with people who use the service. People who use the service were observed to move freely around the home. Each individual has completed within their care plan their history and social needs assessment which outlines their interests and activities they have taken part in on a daily basis. Relatives and people who use the service felt that there was a good social activities both within and outside of the home and this was thoroughly enjoyed by all. This covers activities during the day and evening and included quiz nights, gentle exercise, film nights and crafts. As well as the weekly activities there is regular entertainment including singers and entertainers. Individuals have the choice to follow their spiritual beliefs and attend church services and during the inspection were enjoying singing hymns with the local church group. People who use the service were positive about the quality and choice of food available. They were observed having a leisurely lunch and coffee in a relaxed and social setting with good staff support evident. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 views of people who use the service and their relatives are taken seriously. This helps to protect them. Evidence: The home ensures that people who use the service and their relatives are aware of the complaints policy by making it available in a variety of places. Complaints are managed satisfactorily and the necessary action taken and recorded. The complaints procedure is displayed in the home and available to individuals and their families. There had been one complaint which was appropriately managed. People who use the service and the relatives that were spoken to know how and who to complain to and were confident that their concerns would be dealt with. The provider has a good profile at the home and takes time to talk individually with service users and their families. The manager was aware of the need to protect people who may not be able to make individual decisions, the mental capacity and deprivation of liberty legislations and their implications. Staff have undertaken training on the Protection of Vulnerable Adults and there is Care Homes for Older People Page 16 of 26 Evidence: further training planned. Staff were aware of the whistle blowing policy and said they felt able to raise concerns if necessary. The manager was aware of the need to protect all people who use the service. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 facilities meet the needs of the people who use the service and are homely and clean. Evidence: The location and layout is suitable for the people who use the service. There is a lounge and dining area. These are pleasantly decorated and furnished but some of the areas are showing sign of wear and this was commented upon by the people who use the service and staff. Comments included the interior decor could be updated invest in more comfortable furniture for the dining room bring the home up to date decorate and modernise the home refurbish. The manager and provider stated that there are plans for building alterations and refurbishment which should address these concerns. People whose the service were able to move freely around the communal areas and there was a range of television and audio equipment available for their use. Individuals are involved in personalising their own rooms. The rooms are of a good standard, well maintained and adapted to meet the wishes of the individual. People who use the service have access to the garden area but this was overgrown Care Homes for Older People Page 18 of 26 Evidence: with weeds and was not adequately maintained. The home was clean and staff have good hygiene practices. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are adequate numbers of appropriately recruited, skilled and experienced staff to care for the people who use the service. Evidence: The home operates with sufficient skilled staff to meet the needs of the people who use the service and staffing rotas showed that there are enough staff on duty to meet the necessary staffing levels for the current number of people who use the service. When sickness and staff holidays occur home staff provide cover. Agency staff are not used. There is a minimal staff turnover which provides consistent care for people who use the service. Staff have experience of working with all of the people who use the service enabling a consistent approach to care. Staff were observed to be kind and caring in their dealings with people who use the service. People who use the service, relatives and staff comments included the staff are first class they are some of the best staff around good staff staff couldnt be faulted. Staff comments included care is excellent caters for all needs relating to residents Care Homes for Older People Page 20 of 26 Evidence: and staff nice homely environment providing care and support always try to go that little extra way to make sure each individual is happy and make visitors and guests feel welcome staff team work is good ongoing training courses provided I enjoy working here home runs well puts you on all courses ongoing training is very good staff team work is good we all work together. Three staff recruitment and training files were examined and satisfactory recruitment procedures are in place. A review of external and internal training that staff have completed or require has been undertaken and further training has been identified enabling a skilled, consistent staff team to be provided. Staff undertake induction, mandatory training, National Vocational Qualifications in Care (NVQ) and other training. This was clarified from the sample of records inspected and discussions with staff. Staff spoke knowledgeably about the individual needs of people who use the service. All but one staff member had completed NVQ level 2, most have level 3 and three have level 4 exceeding the minimum standard. Each staff member has an individual training plan, has had supervision and will receive an annual appraisal. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this 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 views of people who use the service and their families are supported and underpin the development of the home and their health, safety and welfare are protected. Evidence: The manager is only responsible for The Old Vicarage. Observations of staff and people who use the service showed that they felt confident with the openness and approachability of the manager. Comments included the door is always open will try and help professional and supportive. The manager is experienced and communicates a clear sense of direction and leadership and has implemented positive changes to the practices within the home. In house and external quality audits are in place and covered areas such as health and safety and fire. Monies are held on an individual basis, two signatures are obtained, receipts are kept, Care Homes for Older People Page 22 of 26 Evidence: and the system is audited and accountable. Accidents are recorded and risk preventions are being undertaken to safeguard people and these had been reviewed with further information identified within individual care plans. Staff supervisions have taken place and further supervisions and staff appraisals were planned. Fire testing and fire drills were taking place on the recommended intervals. The fire risk assessment had been reviewed and updated. Other testing systems had been undertaken at the recommended timescales and systems established for maintenance to be undertaken when necessary. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 13 To submit an action plan and complete the phased improvements to the passenger lift. This will help protect the safety of people who use the service, staff and visitors. 21/07/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 9 19 To review the temperature of the room where medicines are stored to ensure that they are appropriately kept. To ensure that the garden is adequately maintained as this will improve the appearance for services users, families and visitors. To implement the redecoration, refurbishment and rebuild plan for the home, which has been identified by the provider, and when completed will provide more comfortable and pleasant surroundings for people, who use the service. 3 19 Care Homes for Older People Page 25 of 26 Helpline: 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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