Care Home: The Old Vicarage

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What the care home does well The home has organised records and systems in place to safeguard people. The manager has a good understanding and knowledge of peoples needs. The manager listens to what people have to say about the service and makes improvements and changes when necessary. She works alongside staff and is committed to improving outcomes for people. There is good information about the home so people know what the home offers. Trial stays are offered as this helps people make a decision about moving in. The assessment and care planning systems are thorough and detailed. This means that staff have the information they need to give the right support. Regular review of care plans means that any changes are picked up early and acted on quickly. Staff said that they are happy in their roles and enjoy key working, which helps them to get involved in the administration and some areas of the running of the home. What has improved since the last inspection? A keyworker system has been introduced. This has improved staff awareness and involvement in planning and carrying out support of the service users. Service users now have input to their care plans. Dementia training for staff has increased awareness and understanding. Several areas of the home have been decorated and have new funiture and soft furnishings. What the care home could do better: People said that they are generally happy with the activities on offer and speak well of the activity coordinator. There were some suggestions received on the comment cards for an increase and more variety of things to do. More outings and less reliance on TV was suggested. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Old Vicarage Vicarage Lane Tilmanstone Deal Kent CT14 0JG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Geoffrey Senior     Date: 1 8 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 Vicarage Lane Tilmanstone Deal Kent CT14 0JG 01304611241 01304615323 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Pathmanathan Elango,Mrs Rajakala Elango care home 39 Number of places (if applicable): Under 65 Over 65 0 39 dementia old age, not falling within any other category Additional conditions: 39 0 The maximum number of service users to be accommodated is 39. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - (OP) Dementia (DE) Date of last inspection Brief description of the care home The Old Vicarage provides residential care for 39 older people and people with Dementia. The Home is a large, extended detached house located in a rural area between the coastal towns of Dover and Deal. There is a shaft lift to provide access to most of the first floor but there are still 6 steps to access the rooms on the mid floor. Six of the bedrooms have en suite facilities. There are spacious well-maintained garden areas including a pond where residents enjoy sitting in the better weather. Other facilities Care Homes for Older People Page 4 of 25 Brief description of the care home such as hospital, shops library, theatres etc are within a fifteen minutes drive and the Home has an appropriately adapted minibus. The current fees for the service at the time of the visit range from £328 to £453 per week. Information on the Homes services and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. There is no e-mail address of the home currently available. 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: This was a key inspection of the service, which included an unannounced visit to the home by one inspector. The site visit took about seven hours. We spoke to the manager, staff and chef . We spoke to some service users in the lounge and others in private. We also spoke with visiting relatives. We assessed the key Minimum Standards. We sampled records, looked at information about the home and had a look around the home and garden. A number of comment cards were sent to the home for distribution to service users, staff and relatives. Eight were received from staff, five from relatives and four from service users. As many individuals living at the home would have to rely on another person to complete a questionnaire, or give an opinion of their experience of the home, we used Care Homes for Older People Page 6 of 25 a tool called the Short Observational Framework for Inspection (SOFI) to help us get a feel for what it is like to be a resident of this home. To do this, we spent time in a communal area, observing the lifestyles, engagement and staff interactions residents experienced. We used a formal way to collect and analyse information, and our observations lasted for almost two hours. Using this, and other feedback, the views and experiences of people who live at the home are included throughout this report. We looked at other information including any notifications and incidents and accidents and the Annual Quality Assurance Assessment or AQAA. The AQAA is completed by the manager and tells us what the service does well and what they think could be better. It gives evidence about what they do well and how they intend to improve the service. 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 set out 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be sure that a thorough assessment of their needs will be carried out. The service user and family members may contribute to the assessment and planning process. There is written information about the home to help people decide about moving in. Evidence: A sample number of service user care plans were viewed. We saw that the manager and deputy carry out detailed assessments of peoples support needs prior to admission. The information is then recorded as part of the care plan. This means that staff have a good idea of what is required before the person moves in and the manager can decide if the home has the skill and experience to meet the persons needs. We were told that service users, and, if they need help, family members, are invited to Care Homes for Older People Page 10 of 25 Evidence: be involved in the assessment process so that they can have a say about the support they want and need. We spoke with one visiting relative who said that he had been able to help his mother communicate what she needed and that the staff had obviously listened as she was enjoying her stay and had no complaints. People who are interested in living at the home can get to know the service through day visits and short stays. They can meet the other residents and the staff and find out what life is like in the home. We saw that assessments are regularly reviewed to make sure the support is still meeting the persons needs or, if there are any changes then staff are made aware. To help them make a decision all service users are given written information about the home, its facilities and services offered as well as a satisfaction questionairre to be filled in after they have moved in. The home does not offer intermediate 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. Peoples needs and preferences are recorded and kept under review so staff know what support people want and need. Robust medication administration and training systems are in place. People are treated with respect and supported in a manner that maintains their privacy and dignity. Evidence: We saw that each person has a detailed service user plan which is developed from the initial assessment and from information gathered after they move in. We sampled the service user care plans, spoke to people living in the home and to a visiting relative. Information is recorded in detail and is accessible so that staff know what support people need and want. We found that plans are reviewed thoroughly every month by the keyworkers and regularly audited by the manager. This means that any change in support can be picked up at an early stage and acted on. Keyworkers chat with their service users and their families to obtain background Care Homes for Older People Page 12 of 25 Evidence: information about people and their life experiences. This means that staff have a better picture of who the person is and the life they have had and so, have a better understanding of the person. Staff will support service users to attend healthcare appointments. Outcomes are recorded and care plans amended as necessary We looked at how medication is managed and saw that there are secure storage cupboards that only designated staff have access to. Medication administration records were clear, complete and up to date. The Manager told us that only staff who have had training and are competent are allowed to be involved with the medication. The staff training plan showed when the next training courses and up dates are due. Using SOFI observations we saw staff being attentive to residents and responding to their needs with dignity and in a private manner. Other service users also said that the staff are friendly but respectful and are mindful of their dignity. Staff were seen to knock on bedroom doors before entering and address people in the way they preferred. For example by christian name, surname and title or familiar name. Service users said that staff are wonderful, very caring, kind and attentive. Staff were seen to aleviate a service users agitation and distress with a calm, reassuring and consistent approach that was a result of good communication and guidance. 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. Service users have opportunity to have a varied lifestyle with choices in all aspects of their lives. Visitors are welcome and the food is good. Evidence: The home has a varied activities programme in place for service users, ranging from keep fit to cake decorating and pat dogs to musical entertainers. The range of individual activities is enhanced by the appointment of an activities coordinator, and one to one sessions are available. An adapted mini bus is available for outings and for visits to the hospital when needed. Service users made comments such as, activities are very good here, music, shows, crafts, exercises on Thursday, and music and lunch with families invited. A visitor said, there are enough activities as some people like to sit in peace. Another said that relatives are always invited to join in when something special is going on or they are having a celebration tea. Some comments received suggested that ther could be more variety and trips out and less reliance on the TV for entertainment. The local vicar visits the home to administer Holy Communion, and other Care Homes for Older People Page 14 of 25 Evidence: denominations are encouraged to visit. The home will support any service user who wishes to practise their religious and spiritual beliefs, whatever these may be. Families and friends are welcomed into the home. Visitors commented that, they make you so welcome, I come at all different times, and I can visit when I like. Contact with the outside community has increased as the home now take service users out at least twice a month for country drives and allocate time for the manager and staff to take service users out to restaurants, pubs, theatres and places of interest. Service users and staff confirmed that service users are given choices in all aspects of their daily lives. Service users, or their families or powers of attorney, deal with their own financial affairs. They are able to bring some of their own personal belongings into the home with them to personalise their rooms to their own taste. The home has two cooks who produce nutritious, balanced and well-presented meals. The cook of the day visits all service users each morning to check their choice of meals for the day. Service users said, I have no complaint with the food, we get good portions, the food is pretty good, and the food is very good. Visitors said that, Mum always says the meals are good. Staff also feel the food is good and said, The meals are excellent,varied and plentiful. Service users who need assistance at mealtimes are helped sensitively. Specialist plates are available when needed to avoid food falling over the edge. Liquidised food is served in separate portions to give the appearance of a regular meal. Currently the home provides diabetic food where necessary but no other specialist, ethnic or cultural diet is required. 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. People know their complaints will be listened to an acted on. People are safeguarded from harm and abuse. Evidence: We found that service users and their families are given written information on how to make a complaint or raise a concern if there is something they are not happy with or are worried about. The Manager said that she listens to all comments and takes steps to make sure any complaints are dealt with quickly and satisfactorily. The Manager makes sure that she and staff speak to every one each day to get feedback about how things are or about the meals provided. This means that they can act quickly if someone is not happy about something. Everyone we spoke to said they had no complaints about the service. They said if they did have a complaint they would speak to staff and are confident something would be done. We have had no complaints about the service since the last inspection. Staff have clear guidelines about what they should do if they suspect harm or abuse. Staff have training in how to recognise and respond to abuse and safeguard vulnerable people. The Manager and Deputy said that the dementia awareness training has helped staff to understand and recognise when service users are worried or distressed. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, tidy and, for the most part, well maintained. Wheelchair damage to hallway and bathroom paintwork does not enhance the appearance of the home. Evidence: The home is well maintained and has furniture and fittings of good quality. The provider and manager both told us of the programme of maintenance and refurbishment that has seen several areas redecorated and with new furniture. One of the bathrooms on the first floor has been refurbished and is now a well used wet room for showering. All radiators have had new covers fitted. There are a number of areas that show signs of wear and tear and need attention. Damage caused by wheelchairs was particularly noticeable in the busier areas such as groundfloor hallways and bathrooms. A broken window pane was seen in one of the bedrooms. The manager said that it would be dealt with without delay. She also agreed to review the homes fire risk assessment in consultation with the appropriate authority, to ensure compliance regarding closures on some of the bedroom doors. Service users spoken with said that they feel comfortable in their surroundings and have a choice of three lounges in which to sit. Two commented particularly on the garden and how much pleasure the rabbits and guinea pigs give them. They can also be watched from one of the lounges. The garden is laid mainly to lawn with solid paths for ease of access. There are areas where service users may sit in the open or in the Care Homes for Older People Page 17 of 25 Evidence: shade if they wish. Bedrooms are for single occupancy unless people wish to share. Each room is lockable and service users are given the choice to manage their own key. Six rooms have en suite toilet facilities. Bedrooms are decorated and personalised according to the individuals choice and preference. One service user told us how she likes having all her familiar things around her, including pieces of furniture brought from home. Another said that she was very happy with the choice of rooms she had been offered. Service users and visiting relatives commented positively on the cleanliness of the home. One visitor said that the lack of odour was one of the things that helped his mother make a decision about moving in. 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. Service users are supported by trained staff in sufficient numbers. Robust recruitment systems are in place to protect the service users. Evidence: We spoke to the staff and manager and saw the staff rota. There are usually four care staff on duty plus the manager. The cook, laundry assistant and cleaner work in the mornings and early afternoon. Service users said, and we observed using SOFI, that staff attend promptly when someone calls them. A visiting relative commented that staff are always friendly, keen and enthusiastic, even when under pressure. Feedback from the service user, relatives and staff surveys included comments that the number of staff on duty meant that the opportunities to go out or to have more activities are sometimes limited. No one expressed that they felt safety or welfare to be at risk. We found that 11 staff have a National Vocational Qualification in Health and Social Care. All of the staff are up to date with mandatory training which includes safeguarding vulnerable adults, first aid, fire training and health and safety. New staff are supported to complete an induction programme. This means that staff have the skills and competencies to support peoples needs. We sampled staff files and found that checks are carried out before people start work at the home. This includes references and Criminal Records Bureau checks. This protects service users. The manager said the home is well staffed so they do not Care Homes for Older People Page 19 of 25 Evidence: very often have to use agency staff. This means that people are supported by staff they know and receive consistent care and support. Staff spoken with were clear about their roles and responsibilities as keyworkers and supporters. They said that they have regular individual supervision and attend group meetings where they discuss how things are going and can communnicate any changes to support plans for service users or house routines. 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 home is managed in the best interest of the service users. Systems are in place to safeguard the health,safety and welfare of service users, staff and visitors. Evidence: The manager has worked at the home for 21 years. Recent years have seen her in the role of deputy, until the registered manager resigned last year. She was appointed as manager and has been in day to day control of the home since April 2008. She is supported in her role by a Deputy and a dedicated staff team. The Registered Providers are regular and frequent visitors to the home. We were told that she is making application to the Commission to register as manager. The manager spoke with knowledge and understanding of service users needs and her intention to maintain and improve the good standard of service offered by the home. She is aware if the requirements of the National Minimum Standards and is working with staff to meet and exceed those standards. The Manager has introduced a number of changes to the home. She has introduced Care Homes for Older People Page 21 of 25 Evidence: the role of keyworker to increase care staff involvement in working with service users and their families. They also attend meetings with care managers and deal with GPs and community nurses. The manager also works alongside staff to observe, monitor and advise. This means the staff team are kept informed and are well managed. The manager attends training to keep up to date with good practice and is seeking to complete the leadership and management of care course. Information, documentation and records are well organised and to hand when people need them. The requirements made at the last inspection have been met. Service users and visitors were complimentary about the manager and about the way the home is run. The manager completed the Annual Quality Assurance Assessment or AQAA. This was well completed and gives evidence of what they feel they do well, how the home has improved and how it intends to improve further. The AQAA shows an awareness of issues relating to equality and diversity and how they intend to promote this. The AQAA gives evidence of how the home is good value for money. We found that people have the opportunity to air their views about the service. The manager organises regular meetings with service users, relatives and then staff to feed back any issues raised. The Quality Assurance questionairre has been revised since the last inspection. It contains more relevant questions and makes reference to the national minimum standards. It is the policy of the home not to handle any service user finances. All services such as haidressing and chiropody are invoiced monthly and sent to service user, family or power of attorney as agreed. The AQAA shows that the required health and safety checks of premises and equipment are up to date. 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 20 The manager said that a broken window pane in room 26 would be dealt with without delay. She also agreed to review the homes fire risk assessment in consultation with the appropriate authority, to ensure compliance regarding closures on some of the bedroom doors. Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!