Care Home: The Old Vicarage [Frampton on Severn]

What the care home does well The home ensures that people and their relatives have information about the home before they decide to move in, and a detailed pre-admission assessment is completed to help ensure that the home can meet their needs and to plan for the admission day. People can visit the home and a trial period is arranged where both parties have time to decide that the service can provide what they need. A survey returned to us from the relative of a new person told us `I am very happy with the care, anything that I have talked to the staff about has been taken on board and acted upon, my relative is happy and that is all that matters to the family`. The care plans are well recorded, assessments of peoples needs are recorded and there is a continual review to identify changes and the need for additional support from care staff or healthcare professionals. People have regular health checks to include optical, chiropody and dental when required. The people living in the home looked well cared for in freshly laundered clothes and groomed hair. The hairdresser visits regularly to ensure that people can look their best if they choose to. Medication is managed well and staff are trained to help ensure safe handling and administration. Meal times are organised to help ensure people have a pleasant experience in calm surroundings, and that their diet is nutritious and contains fresh fruit and vegetables. The new cook is experienced and people told us they liked the food provided and staff said people usually eat their meals. The meals are served in several separate dining areas. There were plenty of diluted cordial type drinks on each table and a variety of flavours to include lemon, blackcurrant and orange for people to choose from. The home is well maintained and has an ongoing decoration programme to help ensure good standards are maintained. Areas where improvements have been made recently include the following; kitchen decorated, nine bedrooms decorated, the reception, stairs and all corridors on ground floor decorated, the main lounge and main dining room decorated and the carpet changed in the main lounge, two bathrooms and the staff toilet decorated to include two new bath hoists, new curtains in the main lounge, reception and main stairs and re-roofing of the home. The home is clean and free from unpleasant odours as the housekeeper and the domestic staff assess all areas daily and ensure they are clean and safe. People are protected by the practices in the home and staff are trained to identify abuse and know what to do to protect vulnerable adults. The staff told us they knew about the procedures and what to do should they suspect abuse. Any bruising identified is recorded and investigated by the home.The Old Vicarage [Frampton on Severn]DS0000071333.V372765.R01.S.docVersion 5.2Page 7The staff training schedule dated August 2008 and detailing all training completed in the last two years was comprehensive most staff having completed mandatory training and additional training including dementia care and continence care. Approximately 65 percent of care staff have completed the training NVQ level 2 or above in care. Additional support from the Gloucestershire Partnerships for Older People Projects team (POPP`s), which includes healthcare professionals, has helped staff to communicate well and improve record keeping which helps to identify people at risk and ensure continuity of care. The management team consists of a registered manager who is a trained nurse, an assistant manager on day duty, who has started NVQ level 4 training and an assistant manager on night duty with NVQ level 3. There are also seven senior carers that have an NVQ level 3 qualification in care. There are some good procedures and training that have been implemented to help ensure that people are safe and well cared for. Quality assurance is open and transparent and the managers know where improvements can be made to the service. Health and safety is taken seriously and checks are in place to help ensure that systems work. What has improved since the last inspection? New Service. What the care home could do better: Activities could be improved as the activity organiser only works four days each week, and care staff do not have the skills yet to ensure that people have meaningful engagement at other times. The variety of activities could be improved and developing areas of interest throughout the home may be one way of achieving more reminiscence therapy. However, the registered manager has recently completed a six month activity course and will soon train the care staff to provide additional stimulating activities. Additional activity staff may be required to ensure this important aspect of care is completed well. Staff told us that the home needs; more equipment for activities; more trips out in the village; and to make more use of the garden. The results from the relatives Quality Assurance surveys included the following comments; there should be more music and more varied activities, and easier access to the garden with more seating in the garden. The home has a simple complaints procedure that could be improved, and provided in other formats to help ensure that people with disabilities can access and understand it.The environment could be more suitable for people with dementia and include more vibrant colours that could be of therapeutic value, for example rooms with bright definite colours and doors that were painted and didn`t look so stark and perhaps unwelcoming. There was a lack of name plaques or identifying notices on doors to help people with dementia with recognition and finding their way around. One person nursed in bed should have more colourful surroundings or pictures to look at. The manager has identified this as an issue and had started requesting that relatives provide additional decoration for bedrooms. CARE HOMES FOR OLDER PEOPLE The Old Vicarage [Frampton on Severn] Vicarage Lane Frampton On Severn Gloucester GL2 7EE Lead Inspector Mrs Kate Silvey Unannounced Inspection 9:45 23rd & 24 September 2008 th X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Vicarage [Frampton on Severn] Address Vicarage Lane Frampton On Severn Gloucester GL2 7EE 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) 01452 740562 01452 741849 Craigdale Care Ltd Mrs Eileen Winchle Care Home 37 Category(ies) of Dementia (37) registration, with number of places The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Dementia (Code DE) The maximum number of service users who can be accommodated is 37. New Service Date of last inspection Brief Description of the Service: The Old Vicarage Residential Home is situated in the village of Frampton-onSevern. The home has large gardens surrounding the house providing areas for people to walk in. Accommodation is on three floors. There are 31 single rooms and 3 double rooms. A shaft lift and a stair lift provide access to all levels. Communal areas on the ground floor include two main lounges, two dining sitting areas, and a hall and reception area. Bathrooms have a hoist provision and the home has additional portable hoists to assist highly dependant service users. The home is registered as a Care Home with nursing although it has yet to function as such and at present is not employing registered nurses to provide nursing care to service users. The fees for accommodation range from £470.00 - £600.00 per week depending on the accommodation. Additional services charged for separately are weekly hairdressing, chiropody every 6-8 weeks, newspapers, magazines, toiletries, dental treatment, optical treatment, dry cleaning and a charge for staff taking someone to appointments were applicable. The information is in more detail in the homes Service User Guide. The Old Vicarage [Frampton on Severn] DS0000071333.V372765.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 star. This means the people who use this service experience good quality outcomes The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This key inspection took place over two days with one inspector, but on the first day an expert by experience was also involved for a few hours. An expert by experience is part of the Commissions Equality and Diversity Group – Experts by Experience and its commitment to involving people who use services in all areas of our work, to put people first. Experts by experience are people that have experienced a care service or who has had experience supporting people that require specific care. They will act in an advisory capacity helping the Commission to learn about the experiences of people who use services, and influence the work of the Commission to the benefit of people who use the service. The expert by experience looked at what people were doing during the day, how they were supported at meal times, the food provided and the environment. The information provided by the expert by experience has been included in this report. All the people accommodated were seen and many were spoken to during the inspection. Visitors were spoken to and staff were interviewed and observed. The environment and grounds were seen, including the kitchen and laundry facilities. Records were looked at, which included care plans, medication, recruitment, staff training and fire safety. The registered manager sent an Annual Quality Assurance Assessment (AQAA) about the home to the Commission. This service has been registered as a limited company since the last inspection and is registered as a new service. We, the Commission, did not send surveys to people this time as the previous surveys were completed six months ago for the last inspection. We gave out three surveys during the inspection to people visiting the home, and one was returned to us. What the service does well: The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 6 The home ensures that people and their relatives have information about the home before they decide to move in, and a detailed pre-admission assessment is completed to help ensure that the home can meet their needs and to plan for the admission day. People can visit the home and a trial period is arranged where both parties have time to decide that the service can provide what they need. A survey returned to us from the relative of a new person told us ‘I am very happy with the care, anything that I have talked to the staff about has been taken on board and acted upon, my relative is happy and that is all that matters to the family’. The care plans are well recorded, assessments of peoples needs are recorded and there is a continual review to identify changes and the need for additional support from care staff or healthcare professionals. People have regular health checks to include optical, chiropody and dental when required. The people living in the home looked well cared for in freshly laundered clothes and groomed hair. The hairdresser visits regularly to ensure that people can look their best if they choose to. Medication is managed well and staff are trained to help ensure safe handling and administration. Meal times are organised to help ensure people have a pleasant experience in calm surroundings, and that their diet is nutritious and contains fresh fruit and vegetables. The new cook is experienced and people told us they liked the food provided and staff said people usually eat their meals. The meals are served in several separate dining areas. There were plenty of diluted cordial type drinks on each table and a variety of flavours to include lemon, blackcurrant and orange for people to choose from. The home is well maintained and has an ongoing decoration programme to help ensure good standards are maintained. Areas where improvements have been made recently include the following; kitchen decorated, nine bedrooms decorated, the reception, stairs and all corridors on ground floor decorated, the main lounge and main dining room decorated and the carpet changed in the main lounge, two bathrooms and the staff toilet decorated to include two new bath hoists, new curtains in the main lounge, reception and main stairs and re-roofing of the home. The home is clean and free from unpleasant odours as the housekeeper and the domestic staff assess all areas daily and ensure they are clean and safe. People are protected by the practices in the home and staff are trained to identify abuse and know what to do to protect vulnerable adults. The staff told us they knew about the procedures and what to do should they suspect abuse. Any bruising identified is recorded and investigated by the home. The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 7 The staff training schedule dated August 2008 and detailing all training completed in the last two years was comprehensive most staff having completed mandatory training and additional training including dementia care and continence care. Approximately 65 percent of care staff have completed the training NVQ level 2 or above in care. Additional support from the Gloucestershire Partnerships for Older People Projects team (POPP’s), which includes healthcare professionals, has helped staff to communicate well and improve record keeping which helps to identify people at risk and ensure continuity of care. The management team consists of a registered manager who is a trained nurse, an assistant manager on day duty, who has started NVQ level 4 training and an assistant manager on night duty with NVQ level 3. There are also seven senior carers that have an NVQ level 3 qualification in care. There are some good procedures and training that have been implemented to help ensure that people are safe and well cared for. Quality assurance is open and transparent and the managers know where improvements can be made to the service. Health and safety is taken seriously and checks are in place to help ensure that systems work. What has improved since the last inspection? What they could do better: Activities could be improved as the activity organiser only works four days each week, and care staff do not have the skills yet to ensure that people have meaningful engagement at other times. The variety of activities could be improved and developing areas of interest throughout the home may be one way of achieving more reminiscence therapy. However, the registered manager has recently completed a six month activity course and will soon train the care staff to provide additional stimulating activities. Additional activity staff may be required to ensure this important aspect of care is completed well. Staff told us that the home needs; more equipment for activities; more trips out in the village; and to make more use of the garden. The results from the relatives Quality Assurance surveys included the following comments; there should be more music and more varied activities, and easier access to the garden with more seating in the garden. The home has a simple complaints procedure that could be improved, and provided in other formats to help ensure that people with disabilities can access and understand it. The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 8 The environment could be more suitable for people with dementia and include more vibrant colours that could be of therapeutic value, for example rooms with bright definite colours and doors that were painted and didn’t look so stark and perhaps unwelcoming. There was a lack of name plaques or identifying notices on doors to help people with dementia with recognition and finding their way around. One person nursed in bed should have more colourful surroundings or pictures to look at. The manager has identified this as an issue and had started requesting that relatives provide additional decoration for bedrooms. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 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 [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Service User Guide and Statement of Purpose are both generally clear and informative. The pre-admission assessments completed to help ensure that needs are met at the home are detailed and thorough. People are able to visit the home and move in on a trial basis. EVIDENCE: We looked at pre-admission assessments for two people recently admitted to the home. We also discussed another new person with the registered manager and talked to the person and her relative, who was visiting the home, about the admission process. The relative has since returned a completed survey to us, which we gave out on the day of the inspection. The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 11 The records seen were detailed and included mental health assessments and information from the doctor about a person’s mental capacity. There is a ‘capabilities’ assessment completed to enable staff to understand what a person can do for themselves, and for staff to focus on their strengths to promote independence. We found good family histories that the relatives had helped with, and all healthcare assessments had been completed to include, sensory, continence, dietary and medication needs. Any previous falls are recorded to help ensure that any preventative measures are provided before admission. It was good to see the person’s character described and what they liked to be called, and what they enjoyed doing, which is essential information for people with dementia. The records also included pre-admission assessments from the placing authority, in the two looked at this was the Community and Adult Care Directorate (CACD), Gloucestershire. The relative spoken to told us that she had visited the home with her sister and had been given all the information they needed to help them to decide. The person now living in the home had settled in well, and when spoken to appeared content, and was still attending a day centre. We looked at a copy of the homes Statement of Purpose and Service User Guide. The guide is given to people who make an initial enquiry about the home. There is good information provided about the home, which includes the homes policy on admission. There is conflicting information about the initial trial period, Step 4 says ‘a three month settling in trial basis’ and the Policy on Trial Periods indicates a four to six weeks trial. The contract says the first four weeks are the ‘trial period’. We recommend that the length of trial period is the same in all literature. The Commission is referred to as the NCSC, which is incorrect. We looked at sample contracts for people living in the home. We discussed the Statement of Purpose with the manager who agreed that there should be more specific information about how the home cares for people with dementia, rather than state the symptoms. The manager told us that some relatives found the information regarding the symptoms of dementia useful. The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plans are well recorded and regularly reviewed helping to ensure that the outcomes for people are good. The planned further improvements will make them easier to follow and access. The medication is well managed and the regular audits help to ensure good practice. The people living in the home are treated with respect. EVIDENCE: We looked at three care plans in detail and spoke to the people and their keyworker, where possible. A keyworker is a member of staff that has a responsibility to specific people to help ensure that their individual needs are being met. The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 13 There were two formats for care planning in use and the new one looked easier to record in and was well laid out containing some good actions for achieving the identified goals. However, there was a lot of detail in both records. On admission a body map is completed to ensure that any bruises, or potential areas where poor tissue viability may result in a pressure ulcer are identified, so that the appropriate care can be provided and reviewed. Each person has a daily plan of preferences to include their personal hygiene. There is a detailed monthly evaluation and review of all the assessment areas to include; mental health, physical health, personal care risk assessment, manual handling, behaviour, pressure ulcer risk assessment, nutrition, and falls risk assessment. A dependency graph is completed to help identify when needs are increasing and additional measures may be required to meet them. An example of this was repeated accidents, which highlighted a medical problem referred to the doctor, and the use of an alerting device to help prevent injury until medical intervention in hospital is arranged. The record of professional healthcare from a stay in hospital contained information about the medical condition, which was easy to find and supported the evidence and care required. The daily records for this person were detailed, however, any records about doctors visits should be recorded in the professional healthcare records to help ensure continuity. The monthly reviews were well recorded and changes were identified and action taken. All people now have a night assessment and care plan, the night assistant manager had completed some good records and is responsible for any actions required at night being completed by the night staff. We were informed this was working well, and day staff spoken to agreed that this had improved early morning individual care. Two people were being cared for in bed with appropriate multi-supporting beds, and district nurse input when required. Any signs of aggressive behaviour is looked at and recorded to help staff to identify any triggers, this was included in a behavioural care plan. Weight and blood pressure are regularly recorded to help identify the need for professional healthcare support. The district nurses visit the home several times each week and there is a communication book where staff can alert them to any additional problems they need to look at, and the district nurses can add any instructions. Care should be taken about where information is recorded to help ensure data protection issues are addressed and that the individual care plans are accurately maintained. One person with a learning disability has a community psychiatric nurse (CPN) that visits to help support the person and advise staff about dementia care needs. It is recommended that other people are referred for CPN support when required. Apart from the district nurses there is little evidence that other The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 14 healthcare professionals support people as the local doctor visits weekly and supports people as required. Continence care is well managed, the continence adviser assesses everyone three to six monthly, and we looked at the records staff had made to complete the instructions. When a new person is admitted the continence adviser is informed. Five individual charts had been started to record people’s bladder activity to help find out what the optimum time is for toilet support. A detailed toilet activity chart is completed for most people to monitor when staff should support them and the care plan records are updated from this. The record is kept for the continence adviser to see and includes specific hours including the night when people are checked, and what incontinence pad size they use. The home provides additional continence aids when required. An activity care plan was seen and stated that the person must be allowed to walk in the garden, but the need for chiropody had been identified first to ensure safety when walking. There was no evidence in the daily records seen of activities completed, to include any interests they may have had in the past. One person was identified as liking to organise papers, and carried a briefcase around with papers in. There was a good example of a Hospital Discharge Assessment, which had invaluable information. The information would go with a person to hospital in an emergency to help the hospital staff know about them and their needs. The Partnerships for Older People Projects (POPP’s) team from the local PCT have supported the home to improve record keeping, nutrition assessments and the review of falls in the home. The expert by experience saw staff engaged with the people living in the home in a meaningful way, and described staff as using gently modulated speaking voices, and allowing plenty of time for two way interaction when carrying out tasks. This was particularly evident at a mealtime as staff were seen talking to people whilst assisting with their meals, or explaining why they were moving them to more appropriate seating. At all times people were treated with dignity and the environment was calm and caring. When asked one of the people living in the home replied to the question ‘Are you happy here? ‘Oh yes very.’ A survey returned to us from the relative of a new person told us ‘I am very happy with the care, anything that I have talked to the staff about has been taken on board and acted upon, my relative is happy and that is all that matters to the family’. We observed a senior carer administering medication and looked at the records and storage. The medication procedures had recently been updated and were recorded as due for a review in September 2009. There is a good protocol for Controlled Drugs where at each shift change staff check the administration records and audit the amounts. There are protocols for all ‘as required’ The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 15 medication, and we saw specific instructions from the doctor with regard to concealing medication in a drink to aid administration, The supplying pharmacist checked that the procedure was appropriate. The storage was secure, clean and well organised with external and internal medication stored separately to avoid contamination. The temperature was recorded in three places to help ensure correct storage. We looked at the medication audits completed by the assistant manager every three months, and there were no concerns identified. We recommend the home has a 2008 version of the British National Formulary to help ensure medication references are up-to-date. Only senior staff with NVQ level 3 in care administer medication, and they have all completed ‘safe handling of medication’ training. The assistant manager is soon to complete another update with the supplying pharmacist, and is responsible for medication in the home, checking in all medication and completing the medication returns record. To help ensure safe administration when transporting medication around the home when the trolley is not used, it is recommended that a small carry case is used, which can also hold the administration record to identify the person and the medication at the point of administration. This was discussed with the assistant manager and the registered manager and a carry case will be ordered from the supplying pharmacist. The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The activities provided did not always reflect people’s lifestyles and they would benefit from more variety and individual engagement every day of the week. However, all the new skills the registered manager had recently acquired in providing meaningful activities will be implemented soon, there was already some evidence of this having started. Family and friends are made welcome and encouraged to be part of the home and they can have an active part if they wish. People do have choice about how they spend each day and the records indicate that staff try and ensure they are listened to. The meal times are well organised in a pleasant environment and the food is well prepared with daily fresh ingredients, and looks appetising. EVIDENCE: An activities organiser is engaged to provide activities for four days each week, for six hours a day. We saw a nature quiz with six participants and three observers. Despite the best efforts of the organiser after thirty minutes the quiz disintegrated as the concentration powers of the participants waned. We The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 17 were told that crossword puzzles would follow after lunch. We enquired about a programme of activities and was told by the organiser that the home engaged people in the following activities; bingo, singing songs, card making, walks in the village, arm chair exercises and painting. Apparently a painting, the joint work of several people living in the home, is awaiting framing. During the inspection we saw three people going out for walks with staff in the village. We enquired about one to one activities for those people unable to engage in communal activities. We were told a keyworker spent time with people in their own rooms talking to them and reading to them. We recommend that activities are planned with specific emphasis on the ‘life interests’ contained in their care plans or life profile that each resident has on admission to the home. The registered manager told us she has just completed a six months activity course and has many new ideas she is hoping to implement, which will provide a more varied programme with individual activities for people. A recent new activity inclusion was making lavender bags. The activity organiser keeps a record of activities completed, which we looked at and people’s names were recorded, however this should be transferred to individual records. The three days each week when the activity organiser is not on duty it is the responsibility of the keyworker to complete activities and record them. In practice this was rarely happening, however the registered manager was planning to teach the senior carers and the activity organiser the new skills she has learnt on the activity course. The AQAA told us that the staff need to act on spontaneous opportunities to engage in activities with people and that more involvement from family and friends would be also be encouraged. A member of staff told us that the home needs; more equipment for activities; more trips out in the village; and to make more use of the garden. The main meal of the day was served in several separate dining areas. There were plenty of diluted cordial type drinks on each table and a variety of flavours to include lemon, blackcurrant and orange for people to choose from. There were clean tablecloths and napkins. Delegated staff members had responsibility for ‘their specific group of residents’. They assisted the residents to their table and where needed helped them with their meal. The meal consisted of lamb casserole, carrots, mashed potatoes and broccoli. The needs of this client group could mean that meal times are chaotic, it was clear this was not the case from the way it was organised as staff are clearly assigned to groups of people. We interviewed the new cook who had been working in the kitchen for six weeks. We were informed that the kitchen had new wall tiles and a new floor, which made keeping it clean easier for the domestic staff. The cook described the special diets provided and how soft diets are presented and are ready at the same time for the care staff to support those people first. The recruitment The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 18 of a kitchen assistant was imminent, which will help to speed up the serving process. There are six diabetic diets where sugar free ingredients are used to help ensure that people with diabetes have the same choice as everyone else. The Diabetic Nurse for Gloucestershire recently completed a training session with staff about the importance of people on oral medication for diabetes eating their meals. Fresh fruit and vegetables are used daily in the new menus and care staff record when people do not eat their food. The cook has a professional catering qualification and advanced food hygiene training. The cook is soon to complete a two-day course about providing special diets. All the staff that prepare food in the home have completed a food hygiene course. We looked at the four-week menu plan where a variety of food is provided including occasionally ‘finger food’ which helps to encourage some restless people to eat. A senior member of the care staff told us the cook was brilliant with good skills, and that the people living in the home liked the food and liked the sandwiches prepared for snacks. People told us that they had enjoyed their meal and there was mostly clear plates seen afterwards. We looked at the record of the last residents meeting, which told us that people wanted beefburgers taken off the menu. During October 2008 for one week only people will be offered a choice before their meal, which may include pictures of food to try and make sure that people have what they want. This is a pilot scheme and the results will be discussed at the next residents meeting. The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a simple complaints procedure that could be improved, and provided in other formats to help ensure that people with disabilities can access it. People are protected by the practices in the home and staff are trained to identify abuse and know what to do to protect vulnerable adults. EVIDENCE: We looked at the homes complaints procedure, which is in the Service User Guide and is available in the home for everyone to see. The format is appropriately short and clear but should mention that the investigation will be completed within 28 days, and it is good practice to include a written response to the complainant. The procedure should identify the Commission (CSCI) as the next stage and not the CSCI inspector’s name, and ideally include the placing authority details, as a complaint may need to be passed to them to investigate. One person has a learning disability and may require a different format to understand. The AQAA told us the home has had one complaint that was resolved within 28 days and one safeguarding referral in the last twelve months, which we already knew about and was not upheld. We investigated a complaint regarding the support of a person with diabetes who was receiving insulin injections. The registered manager provided us with The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 20 the required information and in future an agreed protocol for all people with diabetes, regardless of medication, will include the district nurses to enable them to give the correct support. The home has a protection of vulnerable adults procedure that includes contacting the local safeguarding team when necessary, and the staff read this during their induction. The manager told us that any bruising found on people living in the home is recorded in the daily records and investigated. A recent example was seen in the record, which was followed up with an occupational therapy referral as a manual handling issue. Subsequently it was identified that two care staff should be using the slide sheets to prevent any further superficial damage. This is good practice and the information was well recorded. The training records for August 2008 indicate that all but one carer has had training in the protection of vulnerable adults, which includes identifying abuse and ‘whistle blowing’. The staff spoken to know what to do if they suspect a vulnerable person is being abused. The manager also told us that soon all staff will have training in the Mental Capacity Act, which is important as many people with dementia lack capacity and may need protection and support to make decisions. The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained and has an ongoing decoration programme to help ensure good standards are maintained. The environment could be more suitable for people with dementia and include more vibrant colours and recognition on doors. The home is clean and free from unpleasant odours as the housekeeper and the domestic staff assess all areas daily and ensure they are clean and safe. EVIDENCE: The expert by experience found the home to be clean, pleasant and free from unpleasant odours, with a genuine feeling of warmth and care. The home, however, lacked appropriate décor and colours that could be of therapeutic value to people with dementia, for example rooms with bright definite colours and doors that were painted and didn’t look so stark and The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 22 perhaps unwelcoming. There was a lack of name plaques or identifying notices on doors to help people with dementia with recognition and finding their way around The bathrooms and toilets were spotlessly clean and appropriate to the peoples needs, however, the expert by experience was told that the top floor has a problem with inadequate hot water for bathing, which means that people are bathed in the bathrooms on the floor below. We checked the flow of hot water in one wash basin on the top floor and it appeared adequate for hand washing. The housekeeper and her staff check all the bedrooms daily to make sure toiletries are safely stored, the beds are made correctly and that there is no soiled linen. We looked at the housekeepers check sheet and fourteen of the bedrooms, some of which appropriately had non-slip flooring, and all the rooms were clean and fresh smelling. The housekeeper told us there are two full-time and one part-time domestic staff and the home is currently advertising for another three days to be filled. The bedrooms are cleaned daily and the carpets cleaned when necessary, which can be almost daily in some cases. The domestic staff have completed a NVQ in cleaning and an infection control course. The home has three new vacuum cleaners and a new efficient carpet shampooer, which has helped to prevent any odours. The domestic staff also complete the cleaning and laundry at the weekends. We looked around the home and in the maintenance book. The home is well maintained and any urgent maintenance issues are dealt with straight away as staff record all safety issues they see in the home. The manager is currently in the process of appointing a new maintenance person. The expert by experience had concerns that the clear glass of the patio doors could prove a hazard should someone bump accidentally against them. Some form of vertical identification that clear glass is there could be used, as visiting children may also be at risk. Areas where improvements have been made recently include the following; Kitchen decorated, nine bedrooms decorated, the reception, stairs and all corridors on ground floor decorated, the main lounge and main dining room decorated and the carpet changed in the main lounge, two bathrooms and the staff toilet decorated to include two new bath hoists, new curtains in the main lounge, reception and main stairs and re-roofing of the home. We looked at the assistant manager’s record of bi-monthly temperature checks around the home, which helps to ensure that people have a comfortable environment. There are detailed instructions for care staff to advance the heating by pushing a button should anyone feel cold or say they are cold in their room. The individual radiator thermostats are gradually being replaced to The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 23 help ensure that people can vary the temperature of their covered radiators to meet their individual needs. Most people have personal possessions in their rooms and some have bright pictures and one a mobile ceiling decoration. We noticed that a person nursed in bed, however, only had a blank wall to look at when nursed on one side. This was discussed with the manager who had already started to assess that people had more interesting things to look at. As suggested in Standard 12 of this report the home could improve by providing areas of interest for people to explore in the communal rooms, with safe objects or memorabilia to touch and talk about. The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has sufficient staff to meet the care needs of the current people accommodated, when there is shortfall regular agency staff, that know the home, are used. The manager has recently recruited additional staff to try and avoid the use of agency staff. Additional staff to complete activities may be required. Recruitment information is well recorded, some minor adjustments would help to ensure that all information is included. Many staff have a NVQ qualification, and mandatory training is completed as soon as possible to help ensure that people are safe. Additional support from the Gloucestershire POPP’s team has helped staff to communicate well and improve record keeping which helps to identify people at risk and ensure continuity of care. EVIDENCE: We looked at the staff rotas and were told that four agency staff were covering shifts during the week of the inspection. The manager told us that two new care staff were due to start soon, and an additional kitchen assistant. The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 25 There are seven staff on duty in the morning and an overlap with the three night staff for one hour which helps to ensure that during peak times of activity there are sufficient staff. When people are dressed and downstairs in the morning a member of the care staff remains to look after them, this new system helps to ensure that people are always supervised and are safe. We observed the handover between the morning and afternoon staff where detailed information was provided, and one senior carer who had been on holiday was well informed about a new person admitted to the home. There are six staff on duty during the afternoon and evening, and any shortfalls are currently covered by agency staff. There is also an assistant deputy manager on night duty, which helps to ensure that records are maintained and staff are supported appropriately to meet peoples needs. The AQAA told us that seventeen of the twentyfive permanent care staff have NVQ level 2 in care or above and one carer is currently working towards it. We looked at the recruitment records for three staff employed and for two staff about to be employed. The records were clear and included an application form where gaps in employment could be seen and explored. One of the care staff on night duty did not have a Criminal Records Bureaux check returned but had a Protection of Vulnerable Adults check, and was being supervised on duty. Interview notes were seen for two staff and the records contained copies of certificates for previous training completed. It is recommended that interview notes are always made to ensure that questions about previous employment and the exploration of gaps in employment can be recorded. Generally the records were good, but the administrator was trying to get a reference from one previous employer without much success. We also looked at all the CRB checks for recent new staff employed. The AQAA told us eleven staff had left the home in the last twelve months, none had been dismissed but one had wanted employment that was more convenient to reach. New staff usually have a three day induction course at a local college. We looked at the homes comprehensive induction pack, which is inline with what Skills for Care recommend. The staff training schedule seen by us, dated August 2008, detailed all training completed in the last two years and most staff had completed mandatory training, and additional training to include dementia care and continence care. Several staff require continence care training but this was highlighted for completion soon. In a home specialising in dementia care it is recommended that staff have regular updates in dementia care to help ensure they continue to meet all needs well. The POPP’s team, which includes healthcare professionals have supported the staff to improve record keeping, communication, person centred care, and dementia awareness. The POPP’s team have also made staff more aware of falls prevention and why people The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 26 wander, an example given to us was the need for more fluids. The night staff are also included in the POPP’s team support. We were told the assistant manager on night duty had completed a risk assessment of each room with regard to night time activity End of Life Care training is planned for two care staff in October 2008, the manager said the knowledge will be cascaded to other staff. The AQAA told us that supervision of staff will be completed more frequently. We interviewed two care staff and the cook, and we were told that the manager and the assistant manager had formally supervised both care staff in the last three months. They had both completed a dementia care course and all mandatory training and felt that the home was cleaner, more organised and that they everyone had benefited from the POPP’s team support. Several staff were spoken to informally during the inspection and at the handover period, they told us they generally felt well supported and were observed treating people with dignity and respect. We were told the quality of care by the agency staff varied, but the majority had completed dementia care training. The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home has stabilised and some good procedures and training have been implemented to help ensure that people are safe and well cared for. Quality assurance is open and transparent and the manager knows where improvements can be made to ensure the service meets the needs of everyone. Health and safety is taken seriously and checks are in place to help ensure that systems work. EVIDENCE: The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 28 The registration of the home as a Limited company is complete and this is the first inspection since the new registration. The registered manager is the Responsible Individual for the home and works full-time with the support of the assistant manager. The Statement of Purpose should record the new registered provider as Craigdale Care Limited, and Mrs Eileen Winchle represents the company as the Responsible Individual, but the director’s names can be an added if required. The assistant manager has started NVQ level 4 training and continues to provide direct support and supervision to the care staff. There is also an assistant manager on night duty that has completed NVQ level 3 in care. As mentioned in the Staffing section of this report the manager and assistant manager complete formal supervision with the care staff. The information provided in the AQAA and during the inspection told us that the home is well maintained and equipment and systems are serviced regularly. The electrical installations service is due this year and was to be completed soon. The home has employed an outside agency to help monitor health and safety matters and they visit twice a year. In addition to that the assistant manager is responsible for ensuring that procedures in the home are completed and people are safe. The assistant manager completed a comprehensive Health and Safety in the Workplace course in July 2008 and a Risk Assessment course is planned for January 2009. The assistant manager takes her role seriously and has implemented good policies and procedures to check systems in the home. This includes, risk assessments, safe hot water checks, monitoring hot surfaces and temperatures, safe storage of any chemicals used, fire safety and detailed reviews of all accidents in the home. We looked at some of the records and they were well recorded, the accidents are recorded in detail and a pie chart is used to look at different trends. Since July 2008 there have been excellent audits recorded of the accidents in the home, including the reason and any action taken, for example bed sides being provided and one person having hourly checks temporarily and a alerting device being used to enable staff to attend before a person falls. Also several new internal door keypads are soon to be fitted to help prevent people accessing the stairs and falling. The manager agreed to involve the local environmental health officer to try and prevent more accidents, and we sent the home accident prevention information regarding footwear. Since the last visit by the Environmental Health Officer all recommendations have been completed with the exception of the Legionella protection, which is being addressed. The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 29 We looked at the fire safety records where the correct checks were being made, and the recommendations from the fire officer’s last visit had been implemented, which included a map of the house on the wall and the purchase of Ski-pads for evacuation use on the top floor. The assistant manager organises the fire training where all staff watch a DVD on fire safety, complete a written test and gain a certificate if they pass, or have to retake the test. The manager sent out ten quality assurance professional surveys to include doctors and thirty relatives surveys this year, and received fourteen relatives surveys back. We looked at the results for 2008 in the current Service User Guide that is displayed for everyone to see. This is good practice and shows an open and transparent management that is willing to change to help ensure people are satisfied with the service. All fourteen surveys said they were happy with the home, that they were made to feel welcome, the staff were respectful and friendly and that the residents were well cared for. Comments from the relatives survey for improvement included the following; • There should be more music and more varied activities • Easier access to the garden and more seating in the garden • To be offered a drink when residents have theirs • The front door made more obvious and a sign that says ‘entrance’, and step access is difficult there • More nutritious food • The turnover of staff is disconcerting especially senior and managerial. Relatives also added the following comments; ‘the care my husband receives and the support I receive is outstanding and greatly appreciated’, ‘as a constant visitor everything is excellent, with patient and attentive staff’, and ‘on the whole I think my mum is happy and well cared for. She is certainly warm and well fed.’ There is also a survey to ask people if the Service User Guide can be improved in any way. We spoke to a healthcare professional visiting the home who told us that everything appears to be running smoothly when she visits. The AQAA told us that the home could improve by having more staff meetings and encourage staff to put forward their ideas, and more supervision of staff to include policies and procedures in the home, especially moving and handling, and care plan recording. We looked at the administrator’s record of personal expenses for people living in the home, these are collated quarterly and an invoice sent to the relatives. There were good records of hairdressing, chiropody and clothing purchased, and appropriate signatures were present to help safeguard people from financial abuse. The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 30 The manager has addressed some diversity issues but recognises there is more to learn, and the AQAA told us that they will have more staff training about ethnic origins and people with a learning disabilities that have dementia There are three male staff and eleven male residents, which may help with choice and equality. One person originates from the Caribbean and discussion revealed that all her needs are being met. The AQAA told us that all but one person follows a Christian religion and the one person had no religion recorded. The AQAA told us twentynine people have impaired vision, one has impaired hearing, one has a learning disability and nine have a physical disability. Everyone living in the home has dementia, which means that many have more than one disability, this requires staff to be continually aware of promoting equality and diversity to help ensure peoples rights are protected. We saw some good examples of people being cared for when staff addressed their disabilities and were respectful, but more training may be required to ensure all staff know how to address these issues. Most policies and procedures in the home were reviewed in 2007. The AQAA told us the inspection reports are not made available to new and existing people in the home this should be rectified as stipulated in Regulation (5) (d). The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 31 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 x 3 3 3 3 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 3 X 3 X X 3 The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? N/A 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. 1 Standard OP12 Regulation 18 (1) (a) Requirement There must be sufficient staff that are able to complete varied activities to meet peoples individual needs each day, and trips out when required. Timescale for action 30/11/08 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 3 Refer to Standard OP1 OP1 OP1 Good Practice Recommendations We recommend that the length of trial period is the same in all literature in the Service User Guide. The Commission for Social Care Inspection should be referred to as CSCI not NCSC. There should be more specific information in the Service User Guide about how the home cares for people with dementia. The records about doctor’s visits should be recorded in the professional healthcare records to help ensure continuity. DS0000071333.V372765.R01.S.doc Version 5.2 Page 33 4 OP7 The Old Vicarage [Frampton on Severn] 5 OP7 Care should be taken about where information is recorded when communicating with the district nurses to help ensure data protection issues are addressed and that the individual care plans are accurately maintained. We recommend the home has a 2008 version of the British National Formulary to help ensure medication references are up-to-date. We recommend that a small medication carrying case is used, which can also hold the administration record to identify the person and the medication at the point of administration, when the trolley is not used. We recommend that activities are planned with specific emphasis on the ‘life interests’ contained in their care plans or life profile that each resident has on admission to the home. Activities completed should be recorded in individual care plans. We recommend that the complaints procedure has minor changes and is provided in different formats so that all people can understand it. We recommend that the home should have appropriate décor for people with dementia to include identifying notices. We recommend that recruitment interview notes are always made to ensure that questions about previous employment and the exploration of gaps in employment can be recorded. 6 OP9 7 OP9 8 OP12 9 OP16 10 OP19 11 OP29 The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Old Vicarage [Frampton on Severn] DS0000071333.V372765.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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