Care Home: The Old Vicarage, Chippenham

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What the care home does well People told us that they feel well cared for and are treated with respect. When we asked people what the home did well, their comments included `The caring aspect is good` and `We are well cared for here I have found nothing is too much trouble when in need`. Another person we spoke to said that the home was very good at contacting their GP when required. One person told us that the home`s care manager met with them each month to talk about their care and welfare. These meetings looked like a good way of ensuring that people`s needs are kept under review, and they can comment on the care that they receive. People like the meals and can make choices about where to eat and how to spend their time. One person appreciated being able to keep their pet dog in the home. Somebody else was pleased that the home had a place where they could keep their mobility scooter. They said that they used the scooter to go to the nearby church each Sunday. The home is in a quiet location and has a large garden at the back. It is also conveniently situated for those people who can walk to the High Street shops. The bedrooms are mainly large, and furnished as bed sitting room type accommodation. People have brought in their own furniture, possessions and pictures, which give the rooms an individual and homely feel. Some people said that they particularly like their rooms because of the view that they have of the garden and of the park beyond. People appreciate the way in which there are supported, and feel that staff are meeting their needs well. Each person has a main carer who normally attends to them. People told us that this system worked well for them, and that they saw another carer if their main carer wasnt working. What has improved since the last inspection? Some new information has been produced for people who are interested in moving into the home. This includes a photo album that can be taken to people who are in hospital and be used as a talking point about the home. Work has taken place to make the garden more user-friendly and accessible to people. There are also some new ornamental features which add to people`s enjoyment of the garden. Improvements have been made within the home, including changes to the laundry so that it is easier to keep clean and be a good working area. The medication facilities have moved to a new location, which is quieter and where staff are less likely to be distracted when dealing with people`s medicines. National Vocational Qualifications (NVQ) are being promoted, so that the people who use the service benefit from staff who are developing their skills and knowledge.We were told in the AQAA about other improvements that have been made in the running of the home. Changes have been made to some of the policies and procedures, so that they reflect new guidance and people`s rights better. What the care home could do better: The home is aware of the importance of assessing whether people are at risk, for example because of their poor mobility or fluid intake. However, there is a lack of detailed information, which means that it is difficult to monitor how well their needs are being met in these areas. Changes to the home`s procedures and record keeping should improve this. One person has been assessed as needing care and attention from staff regularly throughout the day. This includes receiving support that helps to prevent them from developing a pressure sore. This aspect of the person`s care needs to be better recorded, to ensure that there can be no misunderstandings about whether they have received the care that they need. The home needs to ensure that their staff recruitment process is always fully implemented, so that the people who use the service are well protected from staff who may be unsuitable. There was an oversight, that was later addressed, which meant that a staff member had started working in the home before all the necessary checks had been carried out. Not all staff are up to date with their mandatory training. They need this to ensure that they are competent in the work they carry out. Arrangements have been made with a training consultancy firm to provide training across a range of subjects. The health and welfare of the people who use the service are generally protected, although a more pro-active approach is needed in some areas. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Old Vicarage, Chippenham St Mary`s Street Chippenham Wiltshire SN15 3JW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Malcolm Kippax     Date: 1 7 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 32 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 32 Information about the care home Name of care home: Address: The Old Vicarage, Chippenham St Mary`s Street Chippenham Wiltshire SN15 3JW 01249653838 01249651173 oldvicwilliams@hotmail.com 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) : The Old Vicarage (Chippenham) Ltd care home 20 Number of places (if applicable): Under 65 Over 65 20 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 The Old Vicarage is a care home for up to 20 older people. The home is owned by The Old Vicarage (Chippenham) Ltd. The company directors are Miss C. Williams, Mrs Y. Williams and Mr L. Williams. Miss Williams is also the homes registered manager. Miss Williams, Mrs Williams and Mr Williams owned the home themselves before forming a limited company. They continue to be closely involved in the day to day running of the home and have their own accommodation within the building. The Old Vicarage is a period property opposite a church and within easy walking distance of the town shops and amenities. The accommodation is on three floors, with a lift available. Each person who uses the service has their own room. The bedrooms are mostly large with en-suite areas, and are furnished as bed sitting rooms. The communal areas include a lounge, a dining room and a separate television room. There is a large garden with patio areas, which leads down to the River Avon. Miss Williams manages the home with the support of a care manager. People who use the service receive support from a permanent staff team. A key worker system is in operation, with each staff member providing personal Care Homes for Older People Page 4 of 32 Brief description of the care home care and carrying out cleaning tasks in the home. The range of fees is from 450 to 510 pounds a week. Information about the home is available in a Statement of Purpose. Copies of inspection reports are available from the home and can also be seen on the Commissions website at www.cqc.org.uk Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Before visiting The Old Vicarage, we had asked the home to complete an Annual Quality Assurance Assessment known as the AQAA. This was their own assessment of how they were performing. It told us about what has happened during the last year and about their plans for the future. We sent surveys to the people who use the service, so that we could get their views about the home. We had nine surveys back. Some people had been helped by relatives with completing their surveys. We looked at all the information that we have received about the home since the last inspection. This helped us to decide what we should focus on during an unannounced visit to the home, which took place on 17th June 2009. Care Homes for Older People Page 6 of 32 During the visit we talked to the people who use the service and to three staff members. We went around the home and looked at several records. The registered manager, Miss C. Williams was away at the time. We made a second visit to the home in order to complete the inspection and to give feedback when Miss Williams could be there. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visits. The previous inspection of The Old Vicarage took place in June 2007. What the care home does well: What has improved since the last inspection? Some new information has been produced for people who are interested in moving into the home. This includes a photo album that can be taken to people who are in hospital and be used as a talking point about the home. Work has taken place to make the garden more user-friendly and accessible to people. There are also some new ornamental features which add to peoples enjoyment of the garden. Improvements have been made within the home, including changes to the laundry so that it is easier to keep clean and be a good working area. The medication facilities have moved to a new location, which is quieter and where staff are less likely to be distracted when dealing with peoples medicines. National Vocational Qualifications (NVQ) are being promoted, so that the people who use the service benefit from staff who are developing their skills and knowledge. Care Homes for Older People Page 8 of 32 We were told in the AQAA about other improvements that have been made in the running of the home. Changes have been made to some of the policies and procedures, so that they reflect new guidance and peoples rights better. 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 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a range of information about the home, so that they can decide whether it will be suitable for them. Changes are needed to some of the information to ensure that it is accurate. The home has procedures in place, which enable it to obtain information about the needs of a prospective user of the service. Evidence: All the people who completed surveys confirmed that they had received enough information to help them decide if the home was right for them before they moved in. One person who commented about their move said it was the Best thing I ever did. We saw that there was a lot of information in the homes front hall that would be of interest to the people who use the service and their visitors. This included copies of the homes Statement of Purpose and Service Users guide. Care Homes for Older People Page 11 of 32 Evidence: We looked at the Statement of Purpose, which was dated 14th June 2009. The home is run by a limited company, and Miss C. Williams is registered as manager. However, the Statement of Purpose referred to Miss C. Williams, Mrs Y Williams and Mr L. Williams as being the Registered Providers/Managers. The Statement of Purpose included the required sections. The section Range of needs that the home is intended to meet stated that the home provides services to the following categories of resident: Sensory Impairment and Old Age. However the homes actual registration is limited to Old age. Some people who currently use the service have needs in relation to their mental health. The Statement of Purpose does not include information about the admission of people who may have needs in this area. Miss Williams confirmed that she would change the information in the Statement of Purpose to ensure that it accurately reflected the homes registration. We made two recommendations at the last inspection concerning the contents of the Service Users guide. These had not been actioned, but Miss Williams said that they would now be followed up. We were shown other information that was given to people who may be interested in moving into the home. This included a brochure, a sample menu, and a checklist for comparing different care homes. A new photo album about The Old Vicarage had been produced, which could be taken to people in hospital and be used as a talking point about the home. This looked like a good way of engaging with people who may find it difficult to ask questions directly. People who were interested in the home also received an application form and a selfassessment form to complete. The self-assessment contributed to the homes own preadmission assessment. We saw the assessment records on peoples care files in the home. One file also included a more specialist, care management assessment, which the home had received in respect of the persons mental health. The assessment information was used to produce an initial care plan after the person had moved into the home. Care Homes for Older People Page 12 of 32 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 feel that they are well cared for and treated with respect. Overall, the care records show that peoples health and welfare receive good attention and are kept under review. However some records lack detail and a consistent approach, which makes it difficult to monitor how well some of peoples needs are being met. People are supported with managing their own medication. The homes own facilities and procedures for medication have improved, although one aspect is not yet meeting the required standard. Evidence: We looked at the care records for four people who use the service. Each person had an individual care plan, which summarised their care needs and the areas in which support was required. There were care plan review forms, which had been completed following meetings with the people who use the service. One person told us that the homes care manager met Care Homes for Older People Page 13 of 32 Evidence: with them each month to talk about their care and welfare. These meetings looked like a good way of ensuring that peoples needs were kept under review, and they could comment on the care that they received. Peoples weight was being checked regularly to help identify any changes which could be a cause for concern. People told us that the water jugs in their rooms were being filled up regularly. This was good practice because it encourages and helps people to maintain their fluid intake. They also appreciated that the home used a system of water filtering. People said that they could contact staff when needed using the call alarm system in their rooms. They said that there was a prompt response from staff when they made a call. We saw risk assessment forms that had been completed in respect of Client handling. This helped to ensure that staff had the guidance they needed about how to support people with their mobility. We saw that one person had bed rails fitted to their bed. This was mentioned in their care plan and in the Client handling assessment. There was guidance for staff about how to manage the bedrails, although a specific risk assessment concerning their use had not been completed. Other areas of risks to people, for example in relation to falls, pressure ulcers, poor mobility or nutritional intake were being identified. Some details were being recorded on a Personal Risk assessment form and in the care plans. Miss Williams told us that nobody had any pressure ulcers. It was recorded in one persons care records that they were at high risk and they saw the district nurse regularly. A daily regime was in place to help prevent them from developing a pressure sore and for supporting them with their fluid intake. A record had been set up for staff to record their support for this person throughout the day. However, this was not being completed consistently and the format being used meant that staff recorded their support in different ways. The staff we met all confirmed the support that the person received each day. We also met with the persons relatives, who were very pleased with the care that the home had provided over a number of years. The home operated a system in which each person who uses the service had a main carer who normally attended to them. The people we met with said that this system worked well, and that they always saw another carer when their main carer wasnt working. We asked people in their surveys whether they received the care and support Care Homes for Older People Page 14 of 32 Evidence: that they needed. Seven people responded Always to this question, and two people Usually. One person we spoke to said that the home was very good at contacting their GP when required. We asked people in the surveys whether the home made sure they got the medical care they needed. Eight people responded Always and one person Usually. When we asked what the home did well, one person told us The caring aspect is good. Another person commented We are well cared for here I have found nothing is too much trouble when in need. We looked at the arrangements being made for the safekeeping and administration of medication. The storage facilities had moved to a new area, which was a quieter and more suitable area for the administration of medication. We met one person who was looking after their own medication, and they were pleased that they were able to do this. An assessment for self-medication had been completed and a record of this was on the persons care file. At the last inspection we had discussed the arrangements being made in the home for controlled drugs. We made a requirement for records to be maintained, in accordance with current legislation. We looked at the arrangements again and saw that a suitable book was now being used for the recording of controlled drugs. There were some crossings out in the book, which we discussed with the care manager. The way in which different prescribed drugs were being recorded on the same page made it more difficult to keep a running total. Miss Williams later told us that the recording had been changed to one page for each drug, so that it was easier for staff to make their entries. The majority of the medication came to the home as part of a monitored dosage system. The administration of medication was being appropriately recorded. A suitable trolley was being used for the storage of the non-controlled medication. A new cabinet had recently been obtained so that controlled drugs could be stored separately, but this did not meet the standards required under current legislation. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People like the lifestyle that they experience in the home. They receive support with making choices and with doing things which are important to them. People are generally very satisfied with the meal arrangements, which provide choice about where and what to eat. Evidence: People were mostly spending time in their own rooms when we visited. We met people who had their own telephones and received a daily newspaper. Some people were watching television in their rooms. We spoke to one person and with their relatives who were visiting at the time. There was space and chairs in the room for people to be able to sit comfortably, and for the visit to be a sociable occasion. We met one person who was pleased to have been able to move in with their pet dog, which they kept with them in their room. Arrangements had been made for the dog to be exercised outside the home. Care Homes for Older People Page 16 of 32 Evidence: Another person told us that they had a mobility scooter, and appreciated that the home was able to accommodate this and have a place to keep it. They said that they used the scooter to go to the nearby church on Sundays. Miss Williams told us that a risk assessment had been undertaken in connection with this. The information in the front hall included a social activities file. This contained details of the homes in-house activities, which included gentle exercise sessions, musical entertainments and reminiscence groups. There was also information about local interest groups, and about the University of the Third Age who held sessions in the homes lounge. A communion service was held in the home regularly. During our visit we also saw individuals sitting quietly in the lounge. The lounge was near to the dining room, so it was a convenient place for people to use if they did not want to go straight back to their rooms. When we asked people in the surveys what the home could do better, one person told us More activities and outside visits. They also commented The chairs in the common room are set all around the outside and are not particularly comfortable. We talked to Miss Williams about the chair situation. Most of the chairs were of the same upright style and were arranged in a uniform fashion. Miss Williams said that the seating arrangements had been discussed with people in the past and views would continue to be sought about their suitability. One person we spoke to was aware of the activities they could take part in, but said that they preferred to occupy themselves in their own room. Another person said that they could have a coffee in the lounge, but they chose to have it in their own room. Other people also said that they liked to spend time in their rooms, with their own things around them. One person commented that they were encouraged to participate in meals together and in the social life, but were not frog marched into it. In the surveys, we asked the people who use the service whether the home arranged activities that they could take part in if they wanted to. Six people responded Always, two Usually and one person Sometimes. When we asked What does the home do well?, one person commented Not over intrusive, I like to maintain my own privacy. No restrictions on visitors. Very pleasant environment - babies, dog etc.. Other people also commented on the family atmosphere: One big happy family, and Just like a family here - children around. People told us that they could choose to either have their meals in the dining room, or have them brought to their room on a tray. The days meals were clearly written up on Care Homes for Older People Page 17 of 32 Evidence: a menu board in the dining room. While we were meeting with one person during the morning, a staff member came to their room to ask about their choice of main course for lunch. We were told that there was a choice of two dishes on Mondays, Tuesdays and Wednesdays. There was fish on Fridays, which one person described as Very good and fresh. The arrangements being made for choice at mealtimes had not yet been clarified in the Service Users guide (see Choice of Home section). In their surveys, we asked the people who use the service whether they liked the meals at the home. Four people responded Always and three people Usually. One person commented puddings a speciality. During our visit, people told us that the puddings were often substantial, cooked dishes. One person thought the puddings could be more varied, and they suggested stewed fruit as an alternative to the more filling type of pudding. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know who to speak to if not happy with something. They know how to make a formal complaint, but have not needed to. There are procedures in place which help to ensure that people are protected from abuse. Evidence: The home had a written complaints procedure. This was included in the information that was given to people when they moved into the home. We were told in the AQAA that one improvement during the last year had been to use the care review meetings as a time to explain the homes complaints and protection policies to the people who use the service. All the people who completed surveys confirmed that they knew somebody who they could speak to informally if they were not happy with something. They also confirmed that they knew how to make a formal complaint. We saw that leaflets were available in the front hall, which gave details about local services for older people, including advocacy. Information about advocacy services was also included in the Service Users guide. Care Homes for Older People Page 19 of 32 Evidence: We were told in the AQAA that no complaints had been made to the home during the last year. We have also not received any complaints about the home during this time. There was a file in the home which contained information about abuse, and what staff should do if they have a concern. There was also a DVD on the subject, and a questionnaire for staff to complete about the No Secrets guidance. This guidance covers the local procedures for safeguarding vulnerable adults. We were told in the AQAA that no referrals for investigation had been made under the safeguarding procedures. We met with staff who confirmed that they were familiar with the No Secrets booklet, and that they had seen a copy of this in the home. It was reported in the AQAA that all staff have had safeguarding adults training, but the home needed to ensure that staff had regular update training. A form was being used in staff appraisals, and abuse awareness was included as a subject that needs to be discussed at the appraisal meetings. The home had a policy that male staff members did not provide personal care to female users of the service. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People like their own accommodation, which is homely and can be individually furnished. The environment as a whole is kept clean and well maintained. Evidence: The Old Vicarage is a listed building and was being maintained in a style which was in keeping with the period of the property. The communal areas, including a lounge and a dining room, were furnished and decorated in a formal way which reflected the history of the building. The home is in a quiet location with a large garden at the back. It is conveniently situated for those people who can walk to the High Street shops. One person commented that the parking facilities for visitors could be better. There was limited on-street parking but the home did not have a designated parking area for visitors. There was a pay and display car park a few minutes walk away. People were mostly spending time in their own rooms when we visited. The people we spoke to said that they were pleased with their rooms. The bedrooms varied in size and outlook, but many were large and furnished as bedsitting room type accommodation. Most people had brought a lot of their own furniture, possessions and pictures with them, which gave the rooms an individual and homely feel. Some people said that they liked their rooms because of the view that they had of the Care Homes for Older People Page 21 of 32 Evidence: garden, and of the park and river beyond. One person particularly liked the variety of large trees in the garden, as it meant that their outlook changed with the seasons. Another person commented Very pleasant and friendly environment. Would recommend this home to anyone. Work had taken place in the garden since the last inspection to make it more accessible and user friendly for people. There were also some new ornamental features, which add to peoples enjoyment of the garden. Other improvements have been made within the home, including changes to the laundry so that it was easier to keep clean and be a good working area. Redecoration and maintenance of the accommodation was being carried out on an on-going basis. Some fire doors in the home were fitted with approved hold-open devices, so that they could be kept open safely. Wedges were being used on other doors when we first arrived at the home, which was not a safe way to keep the doors open. More doors have been fitted with the approved hold-open devices since our first visit to the home, to replace the wedges that were being used. We noticed that the bottom step on the main staircase was springy underfoot, which could cause a problem for somebody who was unsteady on their feet. Miss Williams told us that they were aware of this it had been looked into but needed further investigation and the step making good on a permanent basis. We asked people in their surveys whether the home was kept fresh and clean. Eight people responded Always and one person Sometimes. The areas of the home that we saw looked clean and tidy. There were no unpleasant odours. We were told that staff in the role of main carer had a dual role, which included caring and some cleaning of peoples accommodation. Staff told us that they had supplies of disposable gloves. A system of sealed bags was being used for the movement of soiled laundry, to held reduce the risk of cross-infection. Not all the staff had received training in infection control. Miss Williams said that this was included in homes training plan for the year. Care Homes for Older People Page 22 of 32 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. People appreciate the way in which there are supported and feel that staff are meeting their needs well. The homes recruitment practice is normally robust and protects people, although there has been an exception to this on one occasion. Qualifications are being promoted, so that the people who use the service benefit from staff who are developing their skills and knowledge. Further training is being planned for the coming months, to ensure that staff are competent in the work they carry out. Evidence: The staff team included a mix of staff who had worked in the home for several years and others who had been appointed more recently. The deployment of staff was well established and Miss Williams said that staffing levels had not changed since the last inspection. Staff shifts were staggered during the day, with more staff deployed at peak times, particularly during the mornings. Rotas were being kept which showed that the staffing levels were consistent throughout the week. The staffing levels took account of the carers dual role in the home. The home does not use agency staff. Care Homes for Older People Page 23 of 32 Evidence: In their surveys, we asked the people who use the service whether staff were available when they were needed. Seven people responded Always and two people Usually. The staff we spoke to appeared to be knowledgeable about the needs of the people they supported, and about the daily tasks to complete. Written guidance had been produced, which helped staff to work in a planned and individual way with people. This included, for example guidance about evening routines and what the people who use the service wanted in the way of drinks and attention before they went to bed. The home had an induction programme for new staff. This included time spent shadowing one of the more experienced staff members. The period of time worked on a supernumerary basis varied according to the new staff members previous experience and skills. On completion of their induction, staff were expected to obtain a National Vocational Qualification (NVQ). Staff members told us about the qualifications they were undertaking. One of the carers said that they had recently started their NVQ in care at level 4. We were given information in the AQAA about other staff who were undertaking, or had obtained, NVQs at levels 2, 3 and 4. Overall, 17 of the 23 permanent care staff had now achieved their NVQ at level 2, or above. We looked at examples of the staff members employment and training files, and talked to Miss Williams about the homes training plan for the year. Miss Williams said that the focus during the last year had been on NVQ, but there was now a need to ensure that all staff were up to date with their mandatory training. Arrangements had been made with a training consultancy firm to provide training in the coming months across a range of subjects. These included those relating to health and safety, the protection of vulnerable adults, and first aid. We saw documentation in relation to this. The staff members files included their employment application forms and copies of contracts. We reported at the last inspection that the home had a safe system for the recruitment of staff and that clear records were being maintained. Some staff had been appointed since that inspection. We saw files for new staff, which included copies of references, health declarations and proof of identity. Details were being maintained of staff members Criminal Record Bureau (CRB) disclosures and checks of the Protection of Vulnerable Adults (POVA) list. We saw from the CRB and POVA records that one staff member had been working before the home had obtained a CRB disclosure and their name had been checked against the POVA list. Information had been recorded on their file about a previous Care Homes for Older People Page 24 of 32 Evidence: CRB disclosure and POVA list check that was carried out by another employer. Miss Williams said that a new CRB disclosure with POVA check was obtained when they were aware of the error. This new information was also included in the staff members records. A basic recruitment checklist was being kept on the staff members files to show what checks and information had been received. However the checklist lacked information, such as dates, which meant that it could not be relied upon to be a good record of the recruitment process. The home was implementing a software package which would enhance the recruitment process. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People stay in a home which is well run in most areas. They have an opportunity to express their views and benefit from improvements that are being made in the home. Peoples health and safety are generally protected, although a more proactive approach is needed in some areas. Evidence: The home has a well established management team and Miss Williams has been the registered manager for over 18 years. Miss Williams has obtained the Registered Managers Award and completed a National Vocational Qualification in care at level 4. Miss Williams receives good support from a care manager, who has also undertaken relevant qualifications in management and care. Family members, who are the directors of The Old Vicarage Ltd, were also involved in the running of the home. This provided additional support for the people who use the Care Homes for Older People Page 26 of 32 Evidence: service and for staff, particularly when the registered manager or the care manager was away from the home. The staff members we spoke to said that they felt well supported and met with a manager on a regular basis. The management team spoke to the people who use the service on a regular basis to hear their views. Concerns or issues could be raised at Residents meetings, although Miss Williams said that these were not as well attended as she would like. Peoples views were also being obtained through the use of annual questionnaires. These focused on different topics. In 2008 the topic was Entertainment and in 2009 it was Personal Care. Surveys were also given out to visitors and to healthcare professionals. The results of the surveys were being analysed and action taken in response to the findings. We were told in the AQAA that there were plans to involve relatives and staff more in relation to quality assurance. There was also a system of internal audits, which involved one the management team assessing how well the home was meeting certain standards. Each year an Annual Management Review was completed, which looked at the overall findings in respect of quality assurance and how these had been responded to. The home generally has a good track record of making improvements and enhancing the home environment. However some shortcomings have only been addressed following our visits. During this inspection we talked about need to improve the storage of controlled drugs and the way in which risk assessments were being completed. We were told in the AQAA that the home had no involvement in peoples financial affairs. Miss Williams said that relatives were occasionally invoiced for something that had been bought on behalf of a person who uses the service. We were given a lot of information in the AQAA about the arrangements being made for health and safety in the home. This included the monitoring of hot water temperatures, and the completion of health and safety checklists of the environment, both internal and external. We were told in the AQAA that a new window inspection form was being now used. We talked to Miss Williams about the homes fire precaution arrangements. There was a fire risk assessment which had been reviewed in February 2009. As reported in the Environment section, door wedges were being used when we first visited the home, which was not a safe way to keep the doors open. Outside contractors were being used for the maintenance and servicing of some facilities such as the fire alarms, hoists, and lifts. Miss Williams said that the electrical wiring was due to be inspected and checked again this year. We were told that one of the directors tested the portable electrical appliances, and that they were qualified and Care Homes for Older People Page 27 of 32 Evidence: had the equipment needed to do this. The plugs had not been labeled to confirm their testing, and Miss Williams said that she would follow this up. Care Homes for Older People Page 28 of 32 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 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 17 The care and support that people receive must be consistently and fully recorded. This includes the records that are kept in relation to fluid intake and the support that people receive with changing position. This is to ensure that there can be no misunderstandings about the care that people have received, and an accurate assessment can be made of the outcomes for people. 06/07/2009 2 9 13 A cupboard that meets the current storage regulations for controlled drugs, the Misuse of Drugs (Safe custody) (Amendment) Regulations 2007 must be installed. This is so that any controlled drugs that are prescribed can be stored safely. 30/09/2009 Care Homes for Older People Page 30 of 32 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 1 That the Service Users guide is amended to inform people about the choices offered by the home at meal times (recommendation from the previous inspection). That the Statement of Purpose includes further information about the range of needs that the home intends to meet. This would include information about the admission of people who may have needs in relation to their mental health. That the Service Users guide includes a copy of the summary of the inspection report, together with information on how a copy of the full report can be obtained (recommendation from the previous inspection). That the exercise book is replaced by appropriate forms for the recording of the support that one person is receiving throughout the day. This is to ensure that the appropriate information is clearly recorded and it is easier to assess the outcome of the care that has been provided. 2 1 3 1 4 8 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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