Care Home: The Old Vicarage Care Home

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What the care home does well People that are admitted to the home have their needs assessed prior to admission, which means staff will be able to plan for their individual needs and know how to care for them. People living in the home have up to date and relevant care plans to enable staff to deliver the appropriate individual care and people are happy with the care they receive. Medication procedures are safe. The home has an activities organiser who arranges person centred activities with people living in the home. There is a weekly activities schedule on display in the hall and people living in the home have meetings to decide where they would like to go that month. There is a designated activities room which is used regularly. There has been a recent strawberry tea held in the garden of the home, a river trip, external entertainers, a church service and a themed `tropical evening`. What has improved since the last inspection? Staff have received training in dementia. A group of people living in the home are in a local league for `Boccia`, a type of bowling and they regularly attend the group sessions. The home has developed a 12 month environment plan that includes areas in need of re-decoration and this plan has been produced with the consultation of people living in the home. What the care home could do better: All staff should receive training on caring for people with diabetes. Senior care staff should be trained in how to use the current local safeguarding referral procedures to make referrals to the external organisation. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Old Vicarage Care Home Newcastle Avenue Worksop Nottinghamshire S80 1NJ     The quality rating for this care home is:   three star excellent 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: Lynda Dyer     Date: 2 4 0 6 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 26 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 26 Information about the care home Name of care home: Address: The Old Vicarage Care Home Newcastle Avenue Worksop Nottinghamshire S80 1NJ 01909475521 01909483316 oldvicarage@schealthcare.co.uk 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) : Southern Cross Care Homes No 2 Ltd care home 38 Number of places (if applicable): Under 65 Over 65 0 26 dementia old age, not falling within any other category Additional conditions: 12 0 Service Users shall be within categories (OP) 26 beds or DE over 55 years of age (12) beds Date of last inspection Brief description of the care home The Old Vicarage is a care home providing personal care and accommodation for 39 older people, 12 of whom have dementia. The home provides short and long term care. The home is owned by Southern Cross Care Homes No 2, which is a limited company. The home is located in a residential area of Worksop and is a former vicarage. 39 of the homes bedrooms are single, and 23 of the bedrooms have en-suite facilities. Bedrooms are located on 2 floors and there are 2 passenger lifts. The home has gardens that are well maintained and easily accessible. Care Homes for Older People Page 4 of 26 Brief description of the care home There is ample car parking available. The manager said on 24/06/09 that the current fees for the service range from £392 £501 per week depending on dependency needs. There are additional charges for hairdressing and chiropody. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people who live at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. We, as it appears throughout the Inspection Report refers to The Care Quality Commission. One inspector carried out an unannounced site visit to the home, which took place between the hours of 10am and 4pm. Care Homes for Older People Page 6 of 26 We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people who live there and how they can and intend to improve their service, this is called an AQAA (Annual quality assurance assessment). The last time we visited this home was July 5th 2006. We received the AQAA back from the manager in good time. The form was completed well and gave us all the information we asked for. We also sent out surveys called, have your say, to people who use the service, staff that work there and relatives. This meant we could get an idea of what people thought about the way the home was run. We had six completed surveys back and we have included some of the comments in this report. We have not included comments that could identify the writer as we want people to feel they can be open about the way they feel the service is run. The staff were very friendly and helpful on the day of the inspection and this helped us to find the information we needed. We also reviewed all of the information we have received about the agency since we last made a visit to them and we considered this in planning the visit and deciding what areas to look at. The main method of inspection we use is called case tracking, which involved us choosing three people who use the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. We spoke with the manager, four members of staff, six people who live in the home, two visitors and a volunteer to help us to form an opinion about the quality of the service being provided to people. We read documents as part of this visit and looked at the environment and facilities of the home to form an opinion about the health and safety of people who use at the service. The Commission have a focus on Equality and Diversity and issues relating to this are included in the main body of the report. 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 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that are admitted to the home have their needs assessed prior to admission, which means staff will be able to plan for their individual needs and know how to care for them. Evidence: The manager told us in the homes Annual Quality Assurance Assessment (AQAA) that they always receive a care management assessment and copy of a social services care plan before an individual is admitted to the home and that they also do their own assessment. They also said that they ensure the resident and their families receive information about the service by giving them brochures, service user guides, statement of purpose, activities plan, sample of menus and inspection reports. On the day of the inspection we viewed information that was available in the reception area for people enquiring about care. This included a newsletter for the home, a Care Homes for Older People Page 10 of 26 Evidence: brochure, company newsletter, statement of purpose and service user guide. We viewed the care plans of three people living in the home and they all contained a full needs assessment that was completed prior to admission. We spoke with a person living in the home and they told us that they had stayed for a short stay in the home before deciding to move in. We spoke a relative about the admission process and they confirmed that they had received a variety of information before admission. We asked in the surveys we sent to people if they had received enough information about the home before deciding to live there and one person said, The staff were very informative. We spoke with staff working at the home and they told us that they always received information about people before they were admitted to the home and that they had the chance to read about their needs in the care plan that was developed. The home does not offer intermediate care and so this standard is not applicable. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have up to date and relevant care plans to enable staff to deliver the appropriate individual care and people are happy with the care they receive. Medication procedures are safe. Evidence: The manager told us in the homes Annual Quality Assurance Assessment (AQAA) that all staff have received basic training for care planning and evaluate care plans on a monthly basis and that all care plans include a risk assessment for the prevention of falls, and other areas to enhance peoples daily lifestyle and are completed with the full involvement of the resident. We viewed the care plans of three people living in the home and they all included information that was important to them and showed how individual choices around daily living were being maintained. The care plans contained risk assessments and information on what care support is Care Homes for Older People Page 12 of 26 Evidence: needed and how staff will deliver that care to ensure the risks are managed. They also contained some reference to the Mental Capacity Act 2005 with information such as what was important to people before their capacity to make some decisions deteriorated. We saw evidence in peoples care plans of external health professionals being involved in peoples care and we saw this in practice on the day of the inspection. One relative told us that they were always kept up to date with the information in their relatives care plan and that staff kept them informed of any changes in their relatives health. One volunteer we spoke with told us, The care they gave to my relative when they lived here was second to none. One health professional told us, Residents are monitored, with risk assessments and care plans completed. They also said Education on self administration of medication is given to residents and they are not left to administer independently until staff are happy they are competent. The health professional felt that the staff always responded to the needs of the people living in the home including needs relating to disability, age, gender, race and ethnicity, sexual orientation and faith. We observed staff administering medication and we looked at the homes medication procedures. This provided us with evidence that the medication systems in the home are being managed safely. We observed staff being respectful to people living in the home and respecting their dignity. We also spoke with staff and they demonstrated how they ensures peoples privacy and dignity were maintained. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are given the opportunity to participate in recreational activities and maintain social contacts. People receive a nutritious and appetising diet with individual preferences being met. Evidence: The home has an activities organiser who arranges person centred activities with people living in the home. There is a weekly activities schedule on display in the hall and people living in the home have meetings to decide where they would like to go that month. There is a designated activities room which is used regularly. There has been a recent strawberry tea held in the garden of the home, a river trip, external entertainers, a church service and a themed tropical evening. A group of people living in the home are in a local league for Boccia, a type of bowling and they regularly attend the group sessions. One volunteer we spoke with told us, Staff take people living here to all sorts of places like the local market, river trips and even just go and sit outside the local pub and have a coffee Care Homes for Older People Page 14 of 26 Evidence: Lunch was observed and this showed that the food was freshly prepared in house. There was a choice of meal and it looked very appetising and nutritious. I spoke with four people during lunch and they said the food was always good and that they especially liked the home baked desserts. People living in the home had mentioned in a recent meeting that the menus were very small for them to see. As a result of this the manager has ordered new large chalk boards for each dining room and the cook will update the menu daily. We saw evidence of special diets being catered for and the cook said that when there is a new person admitted to the home, they go and speak with them to find out their requirements and any likes and dislikes. People needing assistance with meals were assisted in a quiet dignified manner. People who were very independent were left to eat their meal in a lovely relaxed environment with staff close by to clear plates and give the next course. The home uses the NUTMEG system for nutrition and the nutritional assessments were seen in care plans. When we asked one person living in the home what the best thing about living there was, they replied, The food is great We saw evidence of visitors being made welcome and we spoke with two who said they could visit anytime and were always made welcome. When asked what the home does well, one health professional said, They allow people to live their lives as they choose. Another said, They respect individuals and give a good service. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service feel able to raise concerns and complaints and can be confident that the manager will act on them. Staff know how to safeguard people living in the home from abuse. Evidence: The home has received eleven complaints in the last twelve months and records were in place to show that the manager has responded well to the complaints raised and that a satisfactory outcome has been obtained for complaints made. The Commission has not received any complaints about the home in the last twelve months. Staff told us in completed surveys and when we spoke with them that they knew what to do if someone raised a concern with them. The home has a complaints procedure on display for people to read. The manager ensures people have opportunities to have their say about the home, what is working well and what needs to improve. This is done through regular meetings held for people living and visiting the home. There are also monthly surveys sent out to relatives and comments received are recorded and acted on. We saw evidence of the manager responding well to concerns and acting upon them. Care Homes for Older People Page 16 of 26 Evidence: One relative we spoke to told us that they had concerns about whether the home could still meet their relatives needs due to the complexity of their health. This had been raised with the manager and the concerns had been recorded in the complaints register. We spoke with the person living in the home and they told us that they were happy there and they felt the staff were meeting their needs well. The staff also feel that the persons needs are being managed well in the home. After discussions with the manager, it was agreed that a formal assessment be obtained from a social worker. There was evidence that concerns raised by this relative had been well managed by the manager. There was evidence of the manager making referrals to the external safeguarding unit and managing the incidents efficiently. She had also notified the Commission of these incidents. We viewed three staff files and found that staff are trained in how to safeguard people from abuse and staff we spoke to had a good range of knowledge of handling potential abuse in the home. The home has the current local safeguarding referral procedures in place and staff have access to appropriate policies. The home is actively involved in Action on elder abuse and does fund raising for this organisation. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good housekeeping procedures provide people with clean, safe and homely surroundings in which to live. Evidence: On the day of the inspection we found the home to be very clean and homely. Most areas viewed were nicely decorated and well maintained. There were a few areas that required re-decorating and the manager showed us a 12 month environment plan that included the areas identified. This plan had been produced with the consultation of people living in the home. The layout and design of the home allows for small clusters of people to live together, with separate day areas and dining areas throughout the home. There is also a well maintained, pleasant garden with seating areas and a gazebo and raised flowerbeds for people living in the home to do some gardening. On the day of the inspection is was a sunny warm day and several people living in the home were using the garden areas. We viewed the bedrooms of three people living in the home and found that they had access to aids and equipment that they needed to support them. Each room was personalised to the individuals taste and they were well maintained and homely. Care Homes for Older People Page 18 of 26 Evidence: People told us that they liked their rooms and were able to bring in personal possessions. The dementia unit has bedroom doors painted in the colour chosen by the person living in the room and the doors have letter boxes and door knockers to give the impression of the person walking through their own front doors. Bathrooms and toilets all held equipment to maintain infection control procedures and there was variety of lifting equipment in place to support people who required assistance with moving around. Staff are trained in infection control procedures and we saw staff observing these procedures on the day of the inspection. One relative told us, It is a very homely atmosphere here, it gives a personal touch. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home operates a safe staff recruitment process and staff are trained effectively in supporting people living there. Evidence: On the day of the inspection there were plenty of staff in evidence on each unit. We received surveys back from staff and spoke with them on the day of the inspection and they said that there was always or usually enough staff on duty to meet the needs of the people living there. One relative told us, There is always a member of staff around. Another relative however, said that there was not enough staff on during the weekends and bank holidays. The information we have received from surveys we sent to staff working at the home told us that staff are properly recruited and when we looked at staff files we confirmed that a robust recruitment procedure is followed in practice which ensures that people are safe from anyone that may be unsuitable to work with them. Staff told us that they receive regular training to enable them to undertake their role and understand the needs of people they care for. We saw evidence of this in the three Care Homes for Older People Page 20 of 26 Evidence: staff files we viewed on the day of the inspection. Staff told us in completed surveys that they had the right support, experience and knowledge to meet the people living in the home including needs relating to disability, age, gender, race and ethnicity, sexual orientation and faith. One health professional told us, Regular training is given. Another said, I always enjoy coming to this care homes as staff are always pleasant and there is a nice friendly atmosphere. Training regarding the Mental Capacity Act 2005, has also been started, but this needs to be cascaded to all staff to make sure that staff understand their role in protecting peoples rights and choices. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of the people living there and people using the service are given the opportunity to express their views and opinions in of how the home is run. Evidence: The manager told us in the homes Annual Quality Assurance Assessment (AQAA) that she has completed her registered managers award and has completed an extensive managers development induction programme which covers operational, financial systems and quality assurance. They also told us that the home completes health and safety checks each month and that staff have completed health and safety training in a number of different areas. The completed AQAA contained clear, relevant information that was supported by a wide range of evidence. The information in it let us know about changes the manager has made and where they still need to make improvements. Care Homes for Older People Page 22 of 26 Evidence: The manager has been working at the home for 15 years and holds the required qualifications. She also attends training for her own personal development. We saw evidence of staff being trained in areas of health and safety and we also saw evidence of health and safety systems being maintained. The code of practice is in place for the Mental Capacity Act 2005 and some staff have received training on how to use it. Visits are completed monthly by the operations manager and these visits involve speaking with staff and people living in the home as well as looking at complaints and incidents. An action plan is then given to the manager if any issues are identified as requiring action. Surveys are sent to people living in the home every six months and to relatives every month. The results of these surveys are analysed and put on display in the home and an action plan is put into place to address any issues identified. There is also an extensive monthly audit completed by a manager from another Southern Cross home and they complete a Key outcome inspection tool which rates each outcome of the National Minimum Standards. This is completed by speaking with people living in the home, staff and relatives and by looking at records of the home. The manager is then given an action plan for any improvements identified. One volunteer we spoke with told us, I love coming here and helping out, it is like coming home. When asked what the home could improve on, one health professional said, Improve communications skills and the other said Nothing, they are at full strength and everything is in place. Where required the home will help residents manage their personal allowances. An electronic record is made of each transaction and this is audited by an external manager. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 7 It is recommended that the information in care plans with regard to the Mental Capacity Act 2005, and the effects it has upon the service users lives is expanded to include capacity assessments. When medicine bottles are opened, the date of opening should be recorded on the bottle. Senior care staff should be trained in how to use the current local safeguarding referral procedures to make referrals to the external organisation. 2 3 9 18 Care Homes for Older People Page 25 of 26 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. 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