Care Home: The Old Vicarage

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What the care home does well There is a good staff team, who are familiar with people`s individual needs and preferences. People who use the service were happy with the care that they receive and complimentary about the staff. Comments people made, included, "everything needed is provided", "The staff are very quick to answer the bell either during the day or night". The atmosphere within the home was relaxed and people`s choices and preferences in relation to daily routines and meals are respected. A good range of activities is provided to take account of people`s individual interests and needs. All areas of the premises are clean, comfortable and decorated and furnished to a good standard. The gardens are very attractive and well maintained. The service is well managed, with peoples` views being listened to and taken into account. What has improved since the last inspection? A DVD has been produced which tells people about the service. This may be particularly useful in cases where someone is not able to visit in person prior to admission. It contains some pictures of the home and gardens and comments from people using the service. Improvements had been made to the care plans in that they were reflective of people`s needs. Advice has been given regarding further improvements that can be made. Some of the improvements identified by the registered manager are that more funding has been allocated to increase time spent in promoting gentle physical exercise as well as those activities which increase cognitive awareness via visiting outside therapists. More funds have also been allocated to increased visits by outside entertainers. During the inspection work was being carried out to replace the gravel pathways in the gardens. People were looking forward to easier access to the attractive gardens. What the care home could do better: While the care and support that people receive was found to be very good, improvements in the record keeping, would help to ensure that it remains consistently good by making it easier to find relevant information and to track the care and support that people are receiving. Key inspection report Care homes for older people Name: Address: The Old Vicarage The Old Vicarage Weekly Village Kettering Northants NN16 9UP     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: Kathy Jones     Date: 0 6 0 7 2 0 0 9 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 25 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: The Old Vicarage The Old Vicarage Weekly Village Kettering Northants NN16 9UP 01536484378 01536485168 admin@theoldvic.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Royal Bay Care Homes care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: No one falling within the category of OP may be admitted into the home for nursing care where there are 38 persons in the category of OP already accommodated within the home with nursing needs. No one falling within the category of OP may be admitted into the home for personal care where there are 38 service users accommodated in the home Date of last inspection Brief description of the care home The Old Vicarage is a care home providing personal care and accommodation and in some cases nursing care for 38 older people over the age of 65 years. The home is owned by Royal Bay Care Homes. The Old Vicarage care home is situated in the village of Weekley, close to the town of Kettering in Northamptonshire. The building is a listed building that has been adapted to meet the needs of the nursing and residential clients living there. The home has both single and shared bedroom accommodation with all rooms having en-suite facilities. There are a variety of communal rooms for the use of people living at The Old Vicarage, a well tended, Care Homes for Older People Page 4 of 25 Over 65 38 0 Brief description of the care home pleasant garden and patio area for use when the weather permits. Information about fees is available with the statement of purpose and service user guide and you are advised to check this for current information and further detail. As a guide, the fees at the time of the inspection in July 2009 were as follows: Residential care from £450 to £575 per week. Nursing care from £625 to £850 per week. A third party top up fee is required for people funded by the local authority. Chiropody and hairdressing services can be arranged and are charged separately. Other costs would include newspapers, clothing, toiletries, and purchases from the shop. Further information about the home is available at the home in the form of the Statement of Purpose, the Service Users Guide, and the most recent published inspection report. Care Homes for Older People Page 5 of 25 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 focus of inspections undertaken by the Care Quality Commission is upon outcomes for people who use the service, taking in account their views and experiences of the service provided. Prior to the inspection we reviewed the information we had received about the service, through correspondence or contact with the service and people associated with the service. This information was collated and taken into account as part of the inspection. This inspection visit was unannounced and carried out over one weekday, by one Regulation Inspector. We used a method of inspection called case tracking, which involves selecting samples of peoples records and tracking their care and experiences. We also looked at the management of peoples medication through checking a sample of prescribed medication against the associated records. Observations of the homes routines and care provided were made and views on the Care Homes for Older People Page 6 of 25 care provided were sought from people who use the service, visitors and staff. To help us gather the views and experiences of people who use the service, an expert by experience accompanied us. An expert by experience 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. During the inspection we looked at shared areas such as lounges and dining rooms and a sample of peoples bedrooms. We also looked at management and administration which included looking at a sample of staff files to check the adequacy of the recruitment procedures in safeguarding people who use the service and at the training staff receive. Verbal feedback on our findings was given to the manager during the inspection. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? 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 8 of 25 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 9 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessment and admission process helps to ensure that peoples needs and expectations can be met. Evidence: People who are considering using the service are provided with a brochure which contains information about The Old Vicarage and the services provided. Information about the fees and some of the benefits people may be entitled to are also included. A DVD is available which features comments from people using the service and contains pictures of some of the rooms and part of the gardens. This provides people with a good idea of what can be expected. A statement of purpose and service user guide are also available, and provide more detailed information about the service, and what is provided. Copies of these documents and the most recent inspection report were displayed in the hall. People are encouraged to visit to help them to decide if it is the right place for them. Care Homes for Older People Page 10 of 25 Evidence: Prior to admission an assessment of peoples needs is carried out to establish if they can be met. We looked at the assessments that had been carried out for two people who had been recently admitted. We found that relevant information had been gathered about their individual needs which is important in establishing if their needs can be met. The information also provides a good basis for planning and delivering the required care. Care Homes for Older People Page 11 of 25 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. The overall care provided is good, with health care services being accessed as appropriate. Evidence: Positive comments were received about the care provided and indicated that people receive care and support when they need it. Comments included, everything needed is provided. The staff are very quick to answer the bell either during the day or night. We found through talking to staff and looking at records, that staff are aware of peoples assessed needs and are providing the care and support that they need. Care plans and risk assessments are in place to guide staff in the care and support required, and these were based on and reflective of peoples assessed needs, helping to ensure that peoples needs are met. The care planning and record keeping systems, particularly in relation to pressure area care and people with complex needs would benefit from some alterations to make it Care Homes for Older People Page 12 of 25 Evidence: easier for staff to monitor and evaluate peoples care and health needs. Overall there was evidence that people are receiving the care that they need. For example, there had been improvements to a serious pressure ulcer which someone had at the point of admission. Some of the entries relating to pressure care were quite general and there was not a separate care plan and evaluation for pressure ulcers. This made it more difficult to track changes and for staff to evaluate the effectiveness of the treatment. Records show that advice is sought as and when necessary from relevant health professionals, which includes professionals specialising in particular areas. Examples included Mc Millan nurses and a nurse specialising in multiple sclerosis. We looked at the systems in place for checking the management and safekeeping of medication, and found that most of the prescribed medication, is supplied by the pharmacist in a blister packed monitored dose system for a 28 day period. For a medication that had not supplied in the monitored dose system, we found that the quantity of medication carried forward from one medication cycle to the next had not been recorded, which meant that there was no clear audit trail. A sample check of the medication and medication records confirmed that prescribed medication was available and that staff are recording when this has been administered. Staff were observed to provide gentle encouragement to people, when taking their prescribed medication. The storage space for controlled drugs was very small for the quantity of drugs stored. The registered manager advised that they were looking to replace the controlled drug cabinet which would alleviate the problem. During the inspection we observed staff to be responsive to peoples needs and to treat people with sensitivity, dignity and respect. A nurse contacted a health professional for advice about someones treatment, and immediately on completing the telephone call was heard providing quiet reassurance about the outcome. Care Homes for Older People Page 13 of 25 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. Visitors are encouraged and welcomed into the home, the food is good with a choice of meals and peoples preferred routines are respected. Evidence: People have their preferences respected, for example one person was able to tell us that they could choose where they had their meals and where they spent their time. Staff are aware of peoples individual needs and preferences and the different levels of support that they need in their daily routines. Another person told us that they rarely ever had to ask to go outside for a cigarette as the staff always remember to ask if they would like to go out for a cigarette. The atmosphere was relaxed and people told us that they were appreciative of staff, who made time for them. An example was given of a cleaner who always found time to chat to people, particularly those who prefer to stay in their rooms or are nursed in bed. From discussion with some people using the service and staff we were able to see that a range of activities are provided. Events are posted on noticeboards throughout the Care Homes for Older People Page 14 of 25 Evidence: home. There are some group activities such as music and exercises sessions and also quizzes. One person commented that they loved the exercises especially when music was involved Others said that they preferred to spend time in their rooms reading, and that a mobile library visited every two to three weeks. In addition to an activities organiser, sessions are provided by a holistic therapist which include head and hand massage. Gentle exercises to assist people with maintaining mobility are provided by a lady who people using the service referred to as the yoga lady. One Roman Catholic stated the Roman Catholic lady came in every Sunday to give her communion. She also brought the St. Edwards weekly newsletter so that she could keep in touch with the Church. People spoken with were happy with the meals and the selection offered. They said what a wonderful breakfast they had each day and one person summed up her daily life with My fads and fancies with food and living are happily accommodated. Care Homes for Older People Page 15 of 25 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. Concerns and complaints are managed well, which helps to safeguard people and staff are aware of their responsibilities in relation to safeguarding vulnerable adult procedures . Evidence: There is a complaint procedure and people who use the service and their relatives knew who they can speak to if they have a concern or a complaint. The Care Quality Commission have received no complaints about the service. We looked at records kept at the service, relating to concerns and complaints. These records indicate that people feel able to raise any concerns, are listened to and that their concerns are acted on. Discussion with a relative confirmed that concerns and complaints are well managed and dealt with promptly. Staff know what to do if they suspect a colleague of poor practice and as a team the staff have had recent training on the implications of the Mental Capacity Act that serves to protect people who may not have the capacity to make decisions that will directly affect them. Staff have also had training on safeguarding vulnerable adults. Care Homes for Older People Page 16 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Old Vicarage is well maintained, clean and comfortable with attractive and well maintained gardens, providing people with a pleasant place to live. Evidence: This is an old building with character which has been extended and had some internal modifications to meet the needs of people living in the home. There are two lounges, two dining rooms and one lounge/dining area on the ground floor. There is an ongoing decoration and refurbishment programme and these areas and a sample of peoples bedrooms seen were decorated and furnished to a good standard. People are encouraged to bring small personal possessions, such as photographs, pictures and ornaments to personalise their rooms. The Old Vicarage is set within extensive gardens, which are very attractive and exceptionally well maintained. At the time of the inspection, work was in progress to replace the gravel paths in order to make more of the gardens accessible to more people. People spoken with were looking forward to increased access to the gardens and were mindful of the current difficulties for carers in pushing a wheelchair through gravel. Care Homes for Older People Page 17 of 25 Evidence: We found that the premises were clean and comfortable throughout. There were no odours, either in the communal areas or in private bedroom space. Staff were observed to use protective gloves and aprons helping to reduce the risk of transferring infection. Following an infection control study day the registered manager is to implement some assessment tools in order to define more clearly infection risks. Being aware of risks and keeping up to date with current practices helps to reduce the risks of infection for people using the service. Care Homes for Older People Page 18 of 25 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. Peoples needs are met by a caring and professional staff team. Evidence: At the time of the inspection staffing levels appeared to be sufficient to meet peoples needs. Feedback from people who use the service was that they receive the care and support that they need in a timely way. Staff on duty at the time of the inspection presented as being caring and professional in their approach to people who use the service. People told us that staff are aware of and responsive to their individual needs. One person commented they do everything they can for me. A sample check of staff recruitment records found that new staff have the appropriate Criminal Records Bureau clearance and references on file. We gave some advice about making some changes to the application form to help ensure that applicants are aware of all of the information that they are required to supply. This would include a full employment history and reasons for leaving employment which involves working with vulnerable people. This would make it easier to ensure that all information required to help safeguard people has been obtained Discussion with staff and a sample check of records confirmed that the importance of Care Homes for Older People Page 19 of 25 Evidence: staff training in helping to ensure that they have the necessary knowledge and skills is appreciated. A recently recruited member of staff confirmed that they had received the necessary induction training and support to help them in their role. A sample check of records and discussion with staff show that they receive training in areas appropriate to their roles and the needs of people using the service. This training included, training in safe working practices, safeguarding vulnerable adults, management of medication, pressure area care, training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff spoken with during the inspection were working towards a National Vocational Qualification in care. Discussion identified that the registered manager and other staff were supportive of people undertaking training. Care Homes for Older People Page 20 of 25 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 service is managed in the interests of people using the service. Evidence: There is an experienced registered manager in post. The registered manager is a registered nurse and has completed the Registered Managers Award and keeps up to date with current information and practice. The registered manager had a good understanding of the individual needs of people using the service and was keen to ensure that as far as possible their choices and rights are upheld. People who use the service and relatives spoken with made positive comments about the manager which included wonderful, kind, and attentive. The registered manager was receptive to advice given during the inspection. While the care people received was found to be good, she confirmed that she will review the care planning systems and record keeping keeping relating to peoples care with a view to improving the ability to track changes in peoples health. Care Homes for Older People Page 21 of 25 Evidence: The registered manager had completed an annual quality assurance self assessment (AQAA) prior to the inspection. The self assessment contained a good level of detail. It identified aspects that the service feels that they do well, things that have improved, things they could do better and plans for improvement. The information demonstrated an understanding of the importance of keeping up to date with changes to care practices and expectations. The quality assurance system includes seeking feedback from people who use the service, relatives and professionals. This is done on a day to day basis, through annual questionnaires and meetings. Monthly unannounced visits are carried out by a representative of the company to look at the quality of care being provided. This includes talking to some of the people who use the service about their experiences. There were no Health and Safety issues identified during this inspection with regard to staff practice. Staff receive training in safe working practices which includes movement and handling, first aid, fire safety, food hygiene and infection control. Care Homes for Older People Page 22 of 25 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 23 of 25 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 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 9 A clearer audit trail for medicines should be in place as part of the safe management of medication. Care Homes for Older People Page 24 of 25 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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