Care Home: The Old Vicarage (Askam)

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What the care home does well The people living at the Old Vicarage have a well maintained, homely and comfortable place to live. We found the home to be generally clean and tidy, and people living there had been able to bring in some of their own things and make their rooms more personal and familiar with pictures, ornaments, photographs and some small items of their own furniture.The Old Vicarage (Askam)DS0000048089.V377641.R01.S.docVersion 5.2Staff members were aware of people’s individual needs and were familiar with these and particular personal interests and how people wanted to be supported. There were clear care plans and management plans for staff to use to provide the care and support people want and need. This can also help staff as they support people in their daily lives and in maintaining their outside interests and contacts in the community. People living there go out into the community and follow their own interests, take holidays and see their friends and families as they want. The service works well with other agencies, District Nurses and GP’s and specialist health professionals to try to get help and support for people when the need is identified and to enable them to provide appropriate care and support to people with challenging or specialist needs. Care plans have been kept under review making sure that any changes in need are recorded and a consistent service maintained. Regular checks or audits of medication and care plans are done and this helps make sure situations are monitored and followed up and changes addressed to help keep people safe. The service has clear recruitment processes to help make sure staff taken on are suitable to work with vulnerable people living there. The staff have had the appropriate security checks and references taken before they work in the home to help make sure they are suitable to work with vulnerable people. What has improved since the last inspection? Since the last inspection the management team have continued to review and improve many of its written policies, procedures and the written information about the service given to people. The aims and objectives of the service are now made clearer in its Statement of purpose along with the range of needs the home caters for and the additional services they can arrange for people. We found that people’s increased involvement in their care planning and views on their care needs, we saw started at the previous inspection, had been maintained. The manager and staff have continued to improve this approach to care to better represent the individual’s views and understanding of what they needed. Improvements have been made to the way the home manages medicines people may need when they are away from the home such as on holiday or away with family. This reduces the risk of errors occurring from secondary dispensing, that is removing medicines from their original containers for people to take later. Since the last inspection the management team have continued to monitor and review the support available for staff to raise concerns through whistle blowing and grievance procedures to try to help ensure they felt able to report any poor practice to the manager. The improvements made by the management team found at the last visit, in dealing with complaints and working with staff The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.2 to ensure people living in the home are safe, have been maintained and continue to be reviewed. Internal redecoration has continued and more bedrooms have been redecorated and refurbished to improve the environment for people living there. Some rooms have new flooring that was attractive and easily cleanable and new furniture, such as wardrobes and chest of drawers have been provided in several rooms. The ‘study’ was formerly a room used by people who wanted to smoke but the room was difficult to supervise effectively and smoke fumes had a negative effect on the environment outside the room and in the foyer. There is now a covered ‘gazebo’ in the open internal courtyard that people who want to smoke can use. This has seating, is sheltered and is easily supervised by staff. The use of safety glass in the study door now means staff can easily see into the room as they go about their duties and make sure people are safe and do not need their assistance. Hand gels and liquid soap and paper towels are available in the home to promote good hand hygiene. A lockable cubicle has been built in one of the bathrooms to store cleaning items and it is planned this will have a sink designated for washing and disinfecting items. We found that the management team had improved the training on offer to staff by using a more formal, better planned and structured system for ensuring all staff have the training they need. This improvement has been maintained and built upon since the last inspection and this indicated to us the management’s commitment and better forward planning. We could also see from records, talking to people and the staff rotas that the management had been taking steps to improve the activities on offer to people, especially those who were not as able to go out for entertainments. The manager is now keeping records of the monthly report done by the responsible individual for the service required by Regulation 26 of the care homes Regulations and also sends these to CQC to keep us informed. What the care home could do better: We recommended that the manager should hold more formal meetings for people living there from time to time and advertise this in advance. This way families and friends would know of the meetings in good time if they wanted to attend and be involved. A record of all meetings and consultations with people living there and ‘minutes’ should be kept so any issues raised can be dealt with. We did find that that records for external medicines such as creams and shampoos were not always completed on the medicine records so we could not be sure they had been given as directed. Care records indicated when some had been applied as part of care, such as after baths, but the application of creams and lotions prescribed for individuals should be recorded with medication records for clarity and an audit trail. Some medicines wereThe Old Vicarage (Askam)DS0000048089.V377641.R01.S.doc Version 5.2 prescribed to be taken ‘as required’ to relieve particular symptoms. There are no clear instructions or ‘protocols’ for staff to follow about such medicines and when and why they should be given. The manager should consider doing this to help ensure such medicines are only given when really needed. During the visit we observed a member of staff use the bathroom sink to wash out a commode pot after emptying. This is not safe practice and does not promote good hygiene. We strongly recommended to the provider that the designated sink, planned for the new cleaning area, be installed quickly and in the meantime a risk assessment completed to identify and then minimise the cross infection risks when cleaning during the interim. Two people sign any transaction to check and a sample is checked regularly for accuracy. We recommended that when the checks are done they are recorded to give clear records and an audit trail should an error be found. Key inspection report CARE HOMES FOR OLDER PEOPLE The Old Vicarage (Askam) Ireleth Road Askam In Furness Cumbria LA16 7JD Lead Inspector Marian Whittam Key Unannounced Inspection 26th October 2009 09:30 DS0000048089.V377641.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.2 Page 2 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 The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Vicarage (Askam) Address Ireleth Road Askam In Furness Cumbria LA16 7JD Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01229 465189 tov.askam@btopenworld.com Vicarage Care Ltd Mr Carl Terence Raine Care Home 30 Category(ies) of Dementia - over 65 years of age (12), Learning registration, with number disability (1), Mental disorder, excluding of places learning disability or dementia (3), Old age, not falling within any other category (26) The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The home is registered for a maximum of 30 service users to include: up to 26 service users in the category of OP (Old age, not falling within any other category) up to 12 service users in the category of (DE(E) (Dementia over 65 years of age) up to 3 service users in the category of ME (Mental disorder, excluding learning disability or dementia) 1 service user in the category of LD (Learning disability) 26th January 2009 Date of last inspection Brief Description of the Service: The Old Vicarage is a residential care home providing care for people with a range of care and support needs. The home is in a residential area on the edge of the village of Ireleth. It is within walking distance of the local shops and a public house and the small sea side town of Askam with more shops and a post office. The home is in a large detached house and is on two floors with a single storey extension and a conservatory to one side of the house. There is a stair lift to provide access to the first floor for less mobile residents. There is a secure garden area at the side of the home with seating for people living there. The grounds are well maintained, have seating for residents and are wheelchair accessible. There is also a sheltered inner courtyard patio area with a gazebo used by people who smoke and seating. Information is available to people and their families thinking of using the home in the Statement of purpose and the service users guide. These and the latest inspection reports are available in the home. The fees charged by the home range from £398.00 to £462.00 per week, as at the date of the inspection. An additional charge is made for personal toiletries and cigarettes, newspapers, magazines and any individual personal travel expenses. The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience Good quality outcomes. This site visit forms part of a key inspection carried out at The Old Vicarage on 26th October 2009. We (The Commission for Social Care Inspection, CSCI) were in the home for a total of seven hours. Information about the service was gathered in different ways: • An Annual Quality Assurance Assessment document completed by the manager, identifying what the service does well and what could be improved. All providers of registered services provide this self assessment annually. The service history and what the registered manager of the service has told us about things that happened in the service. These are called notifications and are a legal requirement. We also looked at how the providers kept us informed about any changes in the organisation. We sent out surveys to people living in the home and to their relatives to get their views of the home and what it is like to live there. Observations made by us in the home during the visit and during the time we spent talking with people living there and staff working there on the day of the visit. Information we have about any complaints made about the service. • • • • We looked at care planning documentation to ensure the level of care provided met the needs of those living in the home and made a tour of the building to inspect the environmental standards. Staff personnel and training files were examined and a selection of the service’s records required by regulation. We also assessed the handling of medicines through inspection of relevant documents, storage and meeting with the manager, other staff and residents. What the service does well: The people living at the Old Vicarage have a well maintained, homely and comfortable place to live. We found the home to be generally clean and tidy, and people living there had been able to bring in some of their own things and make their rooms more personal and familiar with pictures, ornaments, photographs and some small items of their own furniture. The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.2 Page 6 Staff members were aware of people’s individual needs and were familiar with these and particular personal interests and how people wanted to be supported. There were clear care plans and management plans for staff to use to provide the care and support people want and need. This can also help staff as they support people in their daily lives and in maintaining their outside interests and contacts in the community. People living there go out into the community and follow their own interests, take holidays and see their friends and families as they want. The service works well with other agencies, District Nurses and GP’s and specialist health professionals to try to get help and support for people when the need is identified and to enable them to provide appropriate care and support to people with challenging or specialist needs. Care plans have been kept under review making sure that any changes in need are recorded and a consistent service maintained. Regular checks or audits of medication and care plans are done and this helps make sure situations are monitored and followed up and changes addressed to help keep people safe. The service has clear recruitment processes to help make sure staff taken on are suitable to work with vulnerable people living there. The staff have had the appropriate security checks and references taken before they work in the home to help make sure they are suitable to work with vulnerable people. What has improved since the last inspection? Since the last inspection the management team have continued to review and improve many of its written policies, procedures and the written information about the service given to people. The aims and objectives of the service are now made clearer in its Statement of purpose along with the range of needs the home caters for and the additional services they can arrange for people. We found that people’s increased involvement in their care planning and views on their care needs, we saw started at the previous inspection, had been maintained. The manager and staff have continued to improve this approach to care to better represent the individual’s views and understanding of what they needed. Improvements have been made to the way the home manages medicines people may need when they are away from the home such as on holiday or away with family. This reduces the risk of errors occurring from secondary dispensing, that is removing medicines from their original containers for people to take later. Since the last inspection the management team have continued to monitor and review the support available for staff to raise concerns through whistle blowing and grievance procedures to try to help ensure they felt able to report any poor practice to the manager. The improvements made by the management team found at the last visit, in dealing with complaints and working with staff The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.2 Page 7 to ensure people living in the home are safe, have been maintained and continue to be reviewed. Internal redecoration has continued and more bedrooms have been redecorated and refurbished to improve the environment for people living there. Some rooms have new flooring that was attractive and easily cleanable and new furniture, such as wardrobes and chest of drawers have been provided in several rooms. The ‘study’ was formerly a room used by people who wanted to smoke but the room was difficult to supervise effectively and smoke fumes had a negative effect on the environment outside the room and in the foyer. There is now a covered ‘gazebo’ in the open internal courtyard that people who want to smoke can use. This has seating, is sheltered and is easily supervised by staff. The use of safety glass in the study door now means staff can easily see into the room as they go about their duties and make sure people are safe and do not need their assistance. Hand gels and liquid soap and paper towels are available in the home to promote good hand hygiene. A lockable cubicle has been built in one of the bathrooms to store cleaning items and it is planned this will have a sink designated for washing and disinfecting items. We found that the management team had improved the training on offer to staff by using a more formal, better planned and structured system for ensuring all staff have the training they need. This improvement has been maintained and built upon since the last inspection and this indicated to us the management’s commitment and better forward planning. We could also see from records, talking to people and the staff rotas that the management had been taking steps to improve the activities on offer to people, especially those who were not as able to go out for entertainments. The manager is now keeping records of the monthly report done by the responsible individual for the service required by Regulation 26 of the care homes Regulations and also sends these to CQC to keep us informed. What they could do better: We recommended that the manager should hold more formal meetings for people living there from time to time and advertise this in advance. This way families and friends would know of the meetings in good time if they wanted to attend and be involved. A record of all meetings and consultations with people living there and ‘minutes’ should be kept so any issues raised can be dealt with. We did find that that records for external medicines such as creams and shampoos were not always completed on the medicine records so we could not be sure they had been given as directed. Care records indicated when some had been applied as part of care, such as after baths, but the application of creams and lotions prescribed for individuals should be recorded with medication records for clarity and an audit trail. Some medicines were The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.2 Page 8 prescribed to be taken ‘as required’ to relieve particular symptoms. There are no clear instructions or ‘protocols’ for staff to follow about such medicines and when and why they should be given. The manager should consider doing this to help ensure such medicines are only given when really needed. During the visit we observed a member of staff use the bathroom sink to wash out a commode pot after emptying. This is not safe practice and does not promote good hygiene. We strongly recommended to the provider that the designated sink, planned for the new cleaning area, be installed quickly and in the meantime a risk assessment completed to identify and then minimise the cross infection risks when cleaning during the interim. Two people sign any transaction to check and a sample is checked regularly for accuracy. We recommended that when the checks are done they are recorded to give clear records and an audit trail should an error be found. 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. The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.3 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.3 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 1, 2, 3, 4 and 6. People using the 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’s needs are being assessed before they come to live in the home to make sure they can be met and relevant information is provided to help people make an informed decision about living there. EVIDENCE: A Statement of Purpose and service user guide is available for people thinking of coming to live at the Old Vicarage and this pack includes the home’s complaints procedure and information on advocacy services. A copy of the contract/terms and conditions of residency are also in the pack and we saw that signed contracts were retained securely. These sources of information are subject to review so information can be updated to make sure the information is the most current. These documents can be made available in large print if requested. A copy of the last inspection report is available in the home for The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.3 Page 11 people. The aims and objectives of the service are made clear along with the range of needs they cater for and the additional services they can arrange for people. We looked in detail at the pre-admission assessments for four people living in the home, including those done for a person due to come and live in the home. This was to make sure that a full assessment of their needs had been done by an experienced member of staff before the decision was made to offer them a place and that the individual had been involved in this assessment. Involving the person in this process makes it less impersonal and allows for their feelings on this life change to be considered. We found that all the people had pre admission assessments in place and these had been used as the basis from which the individuals care plan was developed after they came in. Individual care plans showed that before coming to live in the home people had their personal, health and social needs assessed to make sure the home was able to meet an individual’s needs. The pre-admission assessments we looked at contained clinical and personal information from which to develop an individual care plan. The level of information was detailed and had included the individuals and their families in the process. This level of information helps ensure that support staff are aware of the level of care required to meet the different needs. Where assessments had been done by a social worker through care management arrangements the home had a copy on file. There was also useful information obtained from specialist nursing and medical professionals who were involved in that person’s care. The home has a settling in/trial period followed by a review to make sure needs are being met and the home suits the resident. We looked at the records of these reviews done with the individual, their family and people involved in their care to make sure the home was meeting their needs and expectations. Prospective residents and/or their families are invited and encouraged to visit, to speak with the manager and staff and other people living in the home. The service does not provide intermediate care. The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.3 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7, 8, 9 and 10. People using the 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 health care needs of people living at The Old Vicarage are being managed to help ensure they receive the care and support they need in the way they prefer. EVIDENCE: All people living in the home have an assessment of their daily living needs and a care plan setting out the care they need and their individual preferences. During the visit we looked at a sample of four people’s care plans in detail. We found that people’s increased involvement in their care planning and views on their care needs we saw started at the previous inspection had been maintained. The manager and staff had also continued to improve this more personalised approach to care that tried to represent the person’s thoughts and understanding of what they needed and wanted. This was evidenced in the The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.3 Page 13 care records that had individualised information and plans. The care plans we looked at were person centered and showed sensitivity to different behaviour and people’s insights into their behaviour. Management plans were in place to help make sure staff could offer consistent support and understanding. For example, one person’s view of how their condition could affect them was made clear and what they wanted staff to do and be aware of when they showed that particular behaviour. It also covered day to day choices about preferred daily routines and pastimes. All the care plans examined were up to date and had been regularly reviewed and updated as changes occurred. Changes were clearly recorded, signed and dated, which is good practice. Observing staff going about their duties and talking with residents during the day we could see that they knew people well and were polite and respected individuals’ privacy. We could see during the day a level of friendly and informal banter going on between people living there and staff which helped make a friendly and relaxed atmosphere. One person living there we spoke with told us, “It’s a wonderful place, the staff are wonderful and it’s clean”. Families and friends are made welcome in the home. We received only positive comments in the surveys we sent out to people who lived at the home and especially their relatives. Including: “It offers superb care in a very personal, friendly and professional manner”. (Relative) “I am satisfied with the service we receive; my sister is looked after very well” (Relative). “My Dad seems contented and happy. It has given us considerable peace of mind to know he is well looked after”. (Relative) The staff keep a record of all health interventions including any specialist assessments. The home works closely with a range of health professionals to ensure people’s individual needs are being responded to appropriately. There were good examples of staff making timely referrals to other agencies when needs have been assessed, including specialist nurses and GP referrals. We checked the way that medicines were handled through inspection of relevant documents, storage and meeting with staff and people living there. Improvements have been made to the way the home manages medicines people need when they are away from the home such as on holiday or away with family. This reduces the risk of errors occurring from secondary dispensing, that is removing medicines from their original containers for people to take later. We counted a sample of medicines and compared them with records. The sample we checked were in order and showed that medicines had been given in the correct dosage as prescribed. We looked at records of receipt, administration and disposal of medication and these were satisfactory. They showed the medication received by residents, those returned to the pharmacy and reasons for omission. We did find that records for some external medicines, such as creams and shampoos, were not The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.3 Page 14 always completed on the medicine records so we could not be sure they had been given as prescribed. Care records indicated when some had been applied as part of care, such as after baths, but the application of creams and lotions prescribed for individuals should be recorded with medication records for clarity and an audit trail. The manager does audits of medication records and care plans to help identify any errors or omissions. Some medicines were prescribed to be taken ‘as required’ to relieve particular symptoms. There are no clear instructions or ‘protocols’ for staff to follow about such medicines and when and why they should be given. We recommend that the manager consider doing this to help ensure such medicines are only given when really needed. There were no people using controlled drugs, those liable to misuse, at this visit but the home has suitable storage and recording systems should there be. The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.3 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12, 13, 14 and 15 People using the 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 living at The Old Vicarage are able to enjoy a range of social activities and maintain their interests both in the home and in the local community. EVIDENCE: The routines in this home are generally flexible to meet the needs of those living there that wish to go out or pursue their own hobbies and interests and maintain their contacts and friendships outside the home. We could see from records, talking to people and the staff rotas, that the management had been taking steps to provide resources to improve the activities on offer to people, especially those who were not as able to go out for entertainments. We spoke to the person supporting activities that day and as the hairdresser was also in the home they were doing one to one things with people like manicures. A record is kept of what activities, social events and outside interests people had chosen to do or take part in. The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.3 Page 16 The home does not have in-house religious services but people living there are able to join in a prayer and hymn session on Sundays if they want to. The staff will arrange for people to attend their own religious services if they want or for their own clergy or priests to visit them. People’s religious preferences or requests are recorded and records indicate that these are being met as people want. Staff do support people, who are more able, to be independent and join in the local community. The day before our visit several people living there had been out to an Autumn fair at the local community hall with some staff. One person told us about their visit and how much they had enjoyed it and showed us the things they had bought. There is a planned activities programme within the home for people who are less able to go out into the community or do not wish to. A large notice board has been put up in the foyer so it is easier for people to see what is planned that day and events that are being advertised. There is a staff member designated on each afternoon shift to support people to participate. The programme included singing groups and ‘music for health’ provided by an outside organisation where people could participate with different musical instruments and join in the singing. People were going out for walks during the visit and there are also gentle exercise sessions using beach balls and hoopla. Recently some people went to a ballet production of ‘The Nutcracker’ at a nearby arts centre and there are also art sessions within the home. We saw some of the drawings people had done at these. There was good information for staff on people’s social interests and former occupations, backgrounds and what was important to people in their lives, such as their faith, happiest memories and significant life events. People had detailed ‘pen pictures’ so staff had useful information about people and what was important to them. This kind of information helps staff to support individuals to do things that hold meaning for them. One person with an interest in gardening was able to grow some vegetables and herbs in the gardens. The people living in the home have a choice of meal at each mealtime and there is a four-week menu in place. The menus are displayed in the home and staff ask the day before what people would like. People we spoke to and survey responses confirmed they had a choice of food at meal times and we received positive comments on the quality and variety of food provided. The service catered for special diets such as diabetic. The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.3 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16, 17 and 19 People using the 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 interests and safety of people living at The Old Vicarage are protected by the complaints and safeguarding procedures in place, which are understood by staff. EVIDENCE: There are policies and procedures in place for dealing with complaints and these have continued to be reviewed. The complaints policy and procedure is included in the guide for the people using this service along with information on advocacy services available to them. A copy of the complaints procedure is on display and information on The Mental Capacity Act and Deprivation of Liberty are easily available. There have been no complaints made to management since the last inspection and we have not received any about the service. We looked at the new system the management has put in place for logging any complaints. This included date and nature of the complaint as well as timescales for responses and acknowledgement and where to find supporting information and investigation details on file. Since the last inspection the management team have continued to monitor and review the support available for staff to raise concerns through whistle blowing The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.3 Page 18 and grievance procedures to try to help ensure they felt able to report any poor practice to the manager. The staff we spoke to felt the management were approachable and that they could talk to them and generally staff felt they would be supported. The service has policies and procedures for the Protection of Vulnerable Adults (POVA) and for referral to the POVA register and a copy of the Department of Health guidance ‘No Secrets’. There is also a procedure for staff on reporting incidents of bullying in the workplace to the management. Training records show staff have been given training on recognising and acting on suspicions of abuse and staff we spoke to were clear about what they would need to do if they came across it in their work. Updates on working with people with challenging behaviour and safeguarding adults had been given as planned as part of an improved and better organized training programme. In the last year the manager has referred two matters to social services under safeguarding procedures to promote the safety and welfare of people living there and these have been investigated by the appropriate agencies. The staff and management of the home worked well with other agencies to promote the best interests and safety of people living there. The improvements made by the management team found at the last visit, in dealing with complaints and working with staff to ensure people living in the home are safe, have been maintained and continue to be monitored. The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.3 Page 19 The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.3 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 19, 20, 21, 22, 23, 24, 25 and 26. People using the 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 Old Vicarage is being maintained and updated to promote a safe and tidy environment but delays in completing some environmental improvement projects could undermine the standards of hygiene. EVIDENCE: We made a tour of the premises and we could see that routine redecoration and general maintenance of the home is being done and servicing records are being kept. Internal redecoration has continued and more bedrooms have been redecorated and refurbished to improve the environment for people living there. Some rooms have new wood effect flooring that was attractive and easily cleanable and new furniture, such as wardrobes and chest of drawers The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.3 Page 21 had been provided in several rooms. Overall, the home provided a clean and comfortable place for people to live. People living there are encouraged to personalise their rooms and we saw that many have done so with personal items, pictures, ornaments and photographs. People have their pictures and names on their bedroom doors to help them identify their own personal room and orientate them in the home. There are three bedrooms that can be shared but this is only done with the agreement of the people when they come to live there. Curtains are now provided in all the shared rooms for privacy and dignity when delivering personal care. There are a range of equipment and adaptations in the home to help residents make the most of their independence and to get about the home, including hand rails, bath hoists and a stair lift. Over half the bedrooms have en-suite facilities and there are sufficient toilets, assisted baths and showers for people to use. People’s bedrooms are fitted with locks for their use, if they choose, and we found several people used this and locked their rooms when they went out of the home. The home has two large lounges with a large conservatory and dining areas on the ground floor and a smaller lounge/dining area on the first floor. This room is also used for staff training as few people use it. There is also a ‘study’ on the ground floor which is quieter than the main lounges. The ‘study’ was formerly a room used by people who wanted to smoke but the room was difficult to supervise effectively and smoke fumes had a negative effect on the environment outside the room and in the foyer. The management looked at how they could improve this situation for people and still offer people who smoked somewhere safe and accessible to go. There is now a covered ‘gazebo’ in the open internal courtyard that people who want to smoke can now use. This has seating, is sheltered and is easily supervised by staff. The use of safety glass in the study door now means staff can easily see into the room as they go about their duties and make sure people are safe and do not need their assistance. The home has infection control procedures in place and the staff were seen to be following appropriate procedures, using gloves and appropriate protective clothing for personal care and these were available in bathrooms and toilets as well. COSHH substances, these are substances that may be hazardous to people, were locked away for safety. We looked at the home’s laundry facilities, and talked with care and cleaning staff about their duties and safe disposal of waste. Staff were aware of infection control and handling cleaning substances and the appropriate bags to use to prevent cross infection risks. Hand gels and liquid soap and paper towels are available in the home to promote good hand hygiene. Staff attend to laundry during the day and one person is designated on the rota to oversee this is done. A lockable cubicle has been built in one of the bathrooms to store cleaning items and it is planned this will have a sink designated for washing and The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.3 Page 22 disinfecting commode pots and urinal. During the visit we observed a member of staff use the bathroom sink to wash out a commode pot after emptying. This is not safe practice. We brought this to the attention of the provider who has a responsibility to make sure that there are adequate cleaning facilities to prevent cross infection in the home. We strongly recommended to the provider that the designated cleaning sink, planned for the cleaning area, be installed quickly and in the meantime a risk assessment completed to identify and then minimise the cross infection risks during the interim. The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.3 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27, 28, 29 and 30 People using the 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 people living at The Old Vicarage receive support from staff who know them well and have been thorough a robust recruitment process. EVIDENCE: During this visit we looked at staff recruitment records and found them to be in good order. Prospective staff had completed an application form, supplied referees and attended for interview. Security checks, such as Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) first had been done prior to new staff starting work. This helps to make sure that the right staff are employed and the safety and protection of those living in the home is promoted. We spoke with several staff members during the day and they confirmed the recruitment procedure and that they thought it was fairly done. We examined staff training records and the overall training plan in place to make sure training was up to date. The training plan was on the staff room wall and dates for planned training sessions. We found that the management team has improved the training on offer to staff by adopting a more formal, better planned and structured system for ensuring all staff have the training The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.3 Page 24 they need. This improvement has been maintained and built upon since the last inspection and indicated to us better forward planning. Staff we talked with were positive about the training offered and their comments indicated improvement in the system. They all told us they had good access to it. One staff member told us “There is some training going on every month” and another that “Training is kept up to date now”. One person told us they had made a request for some additional training at supervision and this was being arranged for them. We could see that staff had induction training records and there was information on what training staff had done and when it had been done. Staff also confirmed what training they had received including up to date moving and handling training, adult protection, infection control, medication, first aid awareness, health and safety, food hygiene and dementia training. Staff told us that they had access to NVQ courses at levels 2 and 3. Staff training records showed several had completed these courses and others were enrolled on it. The service has achieved over 75 of care staff with NVQ level 2 in care or above. We looked at the staff and supervisor rotas and observed the use of staff in the home during the visit and found these to be satisfactory for the current number and physical needs of the people living there. The skill mix of staff was appropriate and there was a good mix of newer and experienced staff on the rotas and on shift during our visit. One person working 8am until 4pm was responsible for ensuring activities took place in the afternoon. The service has two domestic assistants and two cooks covering the week. There are two waking night staff on the rota to support people at night. Staff told us the manager would always get extra staff if needed or due to sickness and if needed, “They (management team) will come out themselves”. There were also staff being made available to support people to attend appointments and to go out. This indicated that thought was being put into using the staff effectively to meet people’s needs and expectations. Staff we spoke with told us they did work additional hours to offer this kind of personal support for people and they were paid to do this. The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.3 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 31, 31, 33, 35, 36, 38. People using the 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 current management systems help to make sure that the home is being run in the best interests of the people living there and to provide ongoing improvement of the service. EVIDENCE: The home has a registered manger, Mr Carl Raine, who has the relevant qualifications and management experience to run the home. The management team running the home consists of the registered manager and his two brothers who undertake different roles and responsibilities in the team to run the home. The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.3 Page 26 We talked with staff in the home and their comments indicated that the management team was accessible and “they are all approachable”. The staff have a grievance process and policies and procedures on bullying to use if they feel they need to. The changes the management have made on complaints processes and systems and support for whistle blowing procedures indicate that they are serious about working to raise staff understanding and awareness around raising concerns and confidentiality. We saw in the records, care planning, the reviews that had been done and a more systematic and better organised approach generally that the management team had a clearer understanding of the key principles and focus of the service. The management team and staff have been working to continuously improve the services they offer. Staff confirmed to us that they received support and formal supervision looking at practice and procedural issues and their training and development. Records also supported this. Staff also have regular staff meetings and some people told us these were useful for general matters but supervisions were valuable so they could discuss less public issues. There are quality monitoring systems in place to help the management team measure success in meeting the service’s aims and objectives. Policies and procedures have been subject to review and a system put in place to help make sure reviews and revisions take place appropriately. Satisfaction surveys have been used this year to get the views of people using the service and their families. An analysis of the results has been done and the results placed on the notice board for all to see. The findings have been acted upon where an improvement was indicated changes have been made. For example, access to information has been improved for people and the range of activities extended. People using the service have the opportunity to make suggestions or give their opinions at informal discussion groups. For example when changes were proposed to the use of the ‘study’ people living there were consulted and comments asked for on making it non-smoking. We recommended that the manager should also hold more formal meetings for people living there from time to time and advertise this in advance so families and friends had the information in advance if they wanted to attend and that minutes were kept of these more ‘formal’, organised meetings. This is to make sure that the wider home community can be involved if they want. People are supported to handle their own money where possible or with help from their families and representatives. Where any small amounts of spending money are kept for people to use for such things as to spend when they go out or see the hairdresser this is kept securely. We checked a sample of people’s monies and records and these were in order. Two people sign any transaction to check and a sample is checked regularly for accuracy. We recommended that when the checks are done they are recorded to give clear records and an audit trail should an error be found. The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.3 Page 27 We looked at records of accidents and incidents and these were being kept securely. The manager is now keeping records of the monthly report done by the responsible individual for the service, required by the regulations and also sends these to CQC to keep us informed. Fire training records showed that both day and night staff have up to date fire training and the manager has updated the home’s fire risk assessments and in line with changes in fire regulations. For better supervision of people using the downstairs lounges the doors are open but close automatically should the fire alarm go off. The service records and contracts held indicated that moving and handling equipment, emergency equipment and gas and electrical appliances were being serviced and maintained appropriately to help promote a safe environment for people. The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.3 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 2 3 X 3 The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.3 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP9 Good Practice Recommendations The manager should make sure that the application of creams and lotions prescribed for individuals is clearly recorded with medication records. We recommend that the manager consider providing clear instructions or ‘protocols’ for the use of ‘as required; medicines to help ensure such medicines are only given when really needed. We strongly recommend to the provider that the designated cleaning sink, planned for the cleaning area, be installed quickly and in the meantime a risk assessment completed to identify and then minimise the cross infection risks posed during the interim. We recommend that the manager should hold formal ‘residents’ meetings for people living there and advertise this so families and friends may attend. Minutes should be kept of these meetings. We recommended that when the checks are done on DS0000048089.V377641.R01.S.doc Version 5.3 Page 30 3. OP26 4. OP33 5. OP35 The Old Vicarage (Askam) people’s monies they are recorded to give clear records and an audit trail should an error be found. The Old Vicarage (Askam) DS0000048089.V377641.R01.S.doc Version 5.3 Page 31 Care Quality Commission Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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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