Care Home: The Old Vicarage Nursing Home

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What the care home does well The Old Vicarage continues to provide a good standard of care to residents under new ownership and a management regime that has very recently started work. This is achieved by a trained and dedicated team of staff that are supported by the management systems in place. The registered provider continues to ensure that the property is well maintained both internally and externally, which provides a comfortable and safe environment for the residents. All of the residents spoken with spoke highly about the level of care and support provided by the staff team. What has improved since the last inspection? This is the first inspection of this service since it was re-registered in September 2009. What the care home could do better: Two statutory requirements have been made as a result of this inspection that relate to the need for everybody living at the home to have care plan and the legal responsibilities of the home`s owners to have a registered manager in post. There are five good practice recommendations that relate to indirect aspects of care and people`s leisure activities. CARE HOMES FOR OLDER PEOPLE The Old Vicarage Nursing Home Stretton Road Clay Cross Chesterfield S45 9AQ Lead Inspector Brian Marks Unannounced Inspection 10th February 2009 09:00 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 Nursing Home DS0000072637.V374139.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 Nursing Home DS0000072637.V374139.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Vicarage Nursing Home Address Stretton Road Clay Cross Chesterfield S45 9AQ 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) 01246 251635 01246 251634 The Old Vicarage Care Home Ltd Manager post vacant Care Home with nursing 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places The Old Vicarage Nursing Home DS0000072637.V374139.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is 40 This is a newly re-registered service and this is the first inspection. 2. Date of last inspection Brief Description of the Service: The Old Vicarage is a well established home, which was bought and reregistered by the current providers Adept Care, trading as The Old Vicarage Care Home Ltd., in September 2008. The home is registered to provide nursing and personal care for up to 40 older persons and comprises of the original vicarage with an extension to the rear. There is a choice of communal lounge and dining areas for people to use and the home is kept in a good state of repair and decoration, well equipped and well furnished throughout. There are a total of 39 single bedrooms and one double with 23 having en suite facilities. There are also communal bathrooms and toilet throughout the home; all are conveniently located and suitably equipped. There is level access to the garden with seating for residents and there is car parking to the front and rear of the home. At the time of this inspection the home is without a registered manager as the person employed by the company at the time of taking over left in January 2009. It is being run by an acting manager, actively supported by a registered manager from another home in Derby. The scale of charges for accommodation at the time of inspection was from £365 to £492 per week. Other personal items such as newspapers, magazines, hairdresser, toiletries are charged extra. The Old Vicarage Nursing Home DS0000072637.V374139.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. This was a Key unannounced inspection that took place at the home over one day. Additionally, time was spent in preparation for the visit, looking at key documents such as previous inspection reports, records held by us and the written Annual Quality Assurance Assessment document (AQAA), which was returned before the inspection. All of the above material assisted with the preparation of a structured plan for the inspection. Written survey forms had been previously sent out to the home’s staff and the people living there; six were returned by the former and ten by the latter. At the home, apart from examining documents, care files and records, time was spent with the newly acting manager of the home, who was in charge during the visit, and a registered manager from another of the company’s homes in Derby, who is supporting the former to re-establish the home in line with the company’s principles and standards. We also talked to nine of the staff working on the day shifts. The care records of four people who live at the home were looked in detail and their experiences of care at the home formed the basis of this inspection. They were interviewed personally along with a number of others, as well as two relatives who were at the home on the day of the inspection. Because the home was re-registered in September 2008 this is regarded as the first inspection of this service. The assessment of the home’s quality was made against the key National Minimum Standards (NMS) identified at the beginning of each section of this report, as well as other Standards that were felt to be most relevant. What the service does well: The Old Vicarage continues to provide a good standard of care to residents under new ownership and a management regime that has very recently started work. This is achieved by a trained and dedicated team of staff that are supported by the management systems in place. The registered provider continues to ensure that the property is well maintained both internally and externally, which provides a comfortable and safe environment for the residents. All of the residents spoken with spoke highly about the level of care and support provided by the staff team. The Old Vicarage Nursing Home DS0000072637.V374139.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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 Nursing Home DS0000072637.V374139.R01.S.doc Version 5.2 Page 7 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 Nursing Home DS0000072637.V374139.R01.S.doc Version 5.2 Page 8 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, 4, 5 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People do not come to live at the home without the care they need being properly identified, but little information is included in these early assessments about their social world and background history which would provide a more complete picture about them. EVIDENCE: In the AQAA we were told that all prospective residents and their families are invited to visit and have a look at home and are given information regarding the home’s Statement of Purpose, Service User’s Guide and the role of the Commission and its inspection reports. We were also told how a full assessment of individual needs is made prior to admission by the home’s manager, which is carried out with other nursing professionals. A nursing assessment and/or social services care plan is also obtained which helps to inform the decision for confirming placement at the home. We were given a copy of home’s Information Booklet, which is given out to The Old Vicarage Nursing Home DS0000072637.V374139.R01.S.doc Version 5.2 Page 9 people as indicated above. This contains all the information required by law of a Statement of Purpose and Service User’s Guide and is practical and useful for people before making a decision to move in. We did note that some of the information about the registered manager and the Commission is not up-todate. The people we spoke to also told how they or their relatives had visited the home, to see how it was being run and to satisfy themselves that they liked the arrangements, before they decided about moving in. We looked at the care records of four people who are living at the home, including somebody who had moved in about two weeks before the inspection and somebody who had lived there for some years. Within these records, there are clear assessments of the physical care needs of the person concerned including details of health and medical issues. The information had been obtained from the person concerned, from their family, and in all cases in the form of the standard care plan/assessment from the Adult Social Services Department. However the amount of information obtained about the psychological and social worlds of the people concerned is variable and, apart from one of the records looked at, is very brief. This does not fully support the stated intention within the home’s Information Booklet to provide individualised care for everybody living at the home. Additionally all files contain assessments of the general and specific areas of risk that are relevant to them individually, such as bed safety, safe moving and handling, skin breakdown and pressure sores, falls and nutrition as well as overall dependency. The records of the person who came to live in the home 2 weeks before the inspection had these documents on file but they had not been completed, and staff could be working in unsafe ways. When we spoke to him he did say that he had had less falls since coming to live at the home because ‘there’s always somebody around to keep an eye on me’. The home does not provide intermediate care so Standard 6 does not apply. The Old Vicarage Nursing Home DS0000072637.V374139.R01.S.doc Version 5.2 Page 10 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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living at the home have care and risk assessment records that promote safety and consistency, and staff work in ways that respect individuality, privacy and dignity. EVIDENCE: In the AQAA we were told how everybody has an individual care plan and risk assessments, which are subject to ongoing review to identify any changes that may be required. We were told about the involvement of outside professionals from healthcare services and how medicines are managed properly by the staff who are trained and qualified. Care activities are carried out with respect for people’s dignity and privacy and the latter is supported by access to the home’s telephone and personal post. The care records that we looked at contain clear descriptions of the areas where people need help or where they experience risk, as well as the areas in which they are independent, and the care and nursing activities to be carried out by staff are identified. As referred to above, the descriptions of social interests and life background, apart from those of one person, are generally The Old Vicarage Nursing Home DS0000072637.V374139.R01.S.doc Version 5.2 Page 11 brief. Generally the links between activities identified in the care plans and the assessments of need and risk previously carried out are clear, except for the one person admitted two weeks before the inspection. His only plan of care was described in general terms within the documents prepared by the professional worker from Adult Social Services; this is not precise enough to describe day to day staff activities in detail. As noted above, the risk assessment documents of this person had not been completed and do not describe the required actions by staff in full detail. The various elements of the care records looked at held documented evidence that they had been reviewed and evaluated at monthly intervals, but this activity had not continued after the last months of 2008. The two managers running the home at the time of the inspection described how they were starting the process of transferring all care records onto the company’s preferred format which they said was more efficient and easier for staff to use and, because these records are stored electronically, easier to update and manage. The care records that we looked at confirmed that contact with external healthcare services is routinely made, particularly the local doctors and district nurses, as well as a number of specialist healthcare services, such physiotherapist, dermatology clinic and mobility specialists. We also identified from records good practice in relation to the management of diabetes, and saw equipment in place in bedrooms that matched care plans for the management of pressure sores and skin breakdown. Additionally from comments in the written records and the direct verbal and written comments from people, it was evidenced that the staff at the home work hard to care in sensitive and dignified ways, and to keep people as independent as possible: ‘They look after mum really well and the staff are careful and respectful’. ‘I can get up at any time I want and there’s always someone there; they care for me very well’. However, in two of the written surveys people referred to having to wait for attendance because staff were busy and all of the people who were in their rooms that we spoke to spoke specifically about having to wait, particularly in the mornings when ‘staff seem to be busy’. One person who uses a wheelchair commented about difficulties in obtaining alternative seating in her room with the result that she is in her wheelchair all the time, which ‘gets very uncomfortable for my back and arms’. Examination of the arrangements for the receipt, storage and administration of medicines indicated that these are generally satisfactory and that, apart from one specific day, all entries in the written records had been made properly. Medication is stored securely and the home uses a Monitored Dosage System for administration. Regular audits are carried out by the home’s pharmacist and we were told that the written reports from these visits help the staff continue to operate safely. A number of people are prescribed drugs for occasional (PRN) but specific instructions for their administration were in care plans but not included in the medicines records, which may lead to inappropriate use. The Old Vicarage Nursing Home DS0000072637.V374139.R01.S.doc Version 5.2 Page 12 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People at the home enjoy lifestyles and routines that suit them and have the opportunity to take part in organised leisure and social activities. The meals provided at the home meet people’s preferences but dining arrangements are not homely in the way people are served their meals. EVIDENCE: In the AQAA we were told how activities and planned events for people living at the home are advertised through the home and that these include the involvement of local schools and other care providers. We were also told about the home’s choice of menu, the provision of specialised diets and the establishment of a kitchenette that is available for visitors. The notice board in the entrance hall indicated a list of forthcoming events at the home, which included something for each month, such as outside entertainers or annual festivals. Unfortunately the event for January had been cancelled. On the afternoon of the inspection somebody from a local church led a big group for a service of worship, which we were told is a regular event. The people spoken to confirmed that they are generally happy with life at the home and they are able to do very much what they like, although two new people were still having difficulty settling in and wished to return to their own The Old Vicarage Nursing Home DS0000072637.V374139.R01.S.doc Version 5.2 Page 13 homes, however impractical or unsafe that may have been. People told us that they develop their own routines, including spending their time in the communal areas or in their rooms; the former is the choice of the majority although quite a number choose the latter. As well as receiving written feedback we spoke individually to people around the home and they told us about their lives: ‘This is a lovely home and I enjoy my life here’. ‘I like my own company and this small lounge is nice to spend my time in’. ‘I can get around by myself now as my mobility has improved since I came here’. ‘I’ve now got my own routine in my own room and since the new management took over I’m getting things sorted out better’. ‘My family come to see me often so I’m happier here now’. ‘I like a bit of a laugh with the staff and enjoy the banter’. ‘There are some organised activities but more day trips would be useful’. A brief visit was made to the kitchen and the cook described current arrangements. Good standards in the catering service have continued, and a 4-week menu is being followed. The menu indicates a choice at the main meals of the day and a hot option regularly available for breakfast and at teatime. People were generally very positive in their feedback about the standard of food at the home with several mentioning good quality and quantity: ‘The choice is OK but I am very particular’. ‘The food is very good and there’s always plenty’. ‘Meals are great and I have mine in my room usually’. Arrangements for purchase, storage and stock control are satisfactory. The cook routinely deals with people who have special dietary needs, and at the time of the inspection these included diabetic and softened. Regarding the latter the cook described how these were served: each item is mashed and served separately, indicating a sensitive approach to individual needs. We observed the lunchtime meal being served and noted that dining tables were set up in the sitting areas or people were given their food at the chair they had been sitting in during the morning. These arrangements did not give people the opportunity to vary their daily routines and indicated a lack of sensitivity towards people’s individuality. The Old Vicarage Nursing Home DS0000072637.V374139.R01.S.doc Version 5.2 Page 14 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home responds to complaints made by residents and their representatives according to a written procedure, and aims to safeguard them from harm through its policies, procedures and staff training programme. EVIDENCE: The AQAA told us how the home’s complaints procedure, which includes action within set timescales, is displayed throughout the home and includes details of outside organisations and contacts that can support and look at complaints people may have. The complaints record book indicated that there have been three complaints made about the home in the past year and the record also indicated 2 quality failures reported by the visiting manager in recent weeks. All the issues raised had been looked at proerly and dealt with. In the feedback that we received before and during the inspection, everybody said that they knew about getting their problems resolved and were confident that they would be listened to. The AQAA told us how there are systems in place to protect people living at the home and how all staff have received training in their responsibilities to recognise and alert others to suspected abuse. We were also told during the inspection how the home has an in-house trainer to keep this subject at a high profile within the staff group. Staff records indicate that all staff have received training in the need to safeguard the vulnerable people living at the home and the staff spoken to were able to describe their understanding of this subject and were aware of their responsibilities. The policies and procedures in place The Old Vicarage Nursing Home DS0000072637.V374139.R01.S.doc Version 5.2 Page 15 are in line with the statutory procedures on safeguarding adults, and the AQAA indicated that there had been no incidents regarding the use of those procedures since the new owners took over the running of the home. The Old Vicarage Nursing Home DS0000072637.V374139.R01.S.doc Version 5.2 Page 16 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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People at the home live in a safe, well-maintained environment with good standards of hygiene and cleanliness. EVIDENCE: The AQAA told us how the home has a programme of routine maintenance and that redecoration is carried out following discussion with the people living at the home. We were also told that there was a domestic cleaning schedule in place and that the home complies with the requirements of the local fire service. The laundry equipment has been upgraded and the reception area and two lounges have been redecorated. The manager also informed us that an extension was being planned for addition to the back of the home. From a brief tour of the building and visits to some of the bedrooms we saw that a light spacious atmosphere had been maintained, particularly in the newer part of the building, with wide corridors and doorways. Furniture and furnishings in bedrooms are modern and coordinated, with a good amount of The Old Vicarage Nursing Home DS0000072637.V374139.R01.S.doc Version 5.2 Page 17 personalisation that made for individual environments. We noted a good range of equipment in different parts of the building available for staff to help people with mobility difficulties; all the rooms in use for people identified with nursing needs had been provided with a specialised bed to improve the standards of their care. The manager described how the strict distinction between the ‘nursing’ and ‘residential’ wings of the home was being slowly removed as new people came to live at the home. Everybody we spoke to was satisfied with standards of comfort and facilities of the home. From the last visits by the Environmental Health and Fire Officers recommendations that were made have been carried out or are in hand for completion. On the day of the inspection the home was clean, tidy and free from odours and people spoken to were complimentary about the service provided by the laundry. All residents observed in the home wore clean and well-presented clothing and the laundry areas were well equipped and kept in good order. The Old Vicarage Nursing Home DS0000072637.V374139.R01.S.doc Version 5.2 Page 18 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The skill mix and numbers of staff on duty at the home are adequate to support a safe environment in which to live and work, and they have received training necessary to do their jobs properly and in more professional ways. EVIDENCE: In the AQAA we were told how the home’s management believes that there is sufficient staff on duty at all times to meet peoples’ needs and that the home operates a safe system for recruiting new staff with references and checks being carried out, including from the Criminal Records Bureau (CRB). We were also told that care staff have either obtained or are working towards the National Vocational Qualification (NVQ) Level 2 and that they are encouraged to undertake training within the home. During the inspection we interviewed most of the staff on duty during the day, and those recently appointed described their induction training which they followed just after they started working at the home. The files of two recently appointed staff supported that their recruitment had been carried out properly with the right checks being made, although the CRB check for the last nurse to be appointed had not been received and, inline with the standard of checks that had been confirmed, we were told that she always worked ‘under supervision’ of another nurse. We were unable to confirm how this was worked in practice. The Old Vicarage Nursing Home DS0000072637.V374139.R01.S.doc Version 5.2 Page 19 Examination of the duty roster and discussion with staff indicated levels of nursing and care staff on duty was maintained at 2 nurses and 6 carers for the daytime shifts and 1 nurse and 4 carers at night. In the written feedback we received, all the people who replied said that there is ‘always’ or ‘usually’ enough staff, and most of the people we spoke to agreed with this. However, as we have noted above, those people upstairs in their rooms for much of the day were concerned that response times to their buzzer calls were quite slow at times: ‘I may have to wait if the staff are busy with someone else’. The staff spoken to did not generally feel that their workload was routinely excessive but that ‘things can get very busy with the buzzers, particularly in the mornings’ and that ‘we get the work done but sometimes it’s more rushed than others’. The workload is arranged so that carers are in three pairs within the building and all the staff felt that that this system was a good way of sharing out the work but that they deal with difficulties ‘through good teamwork. Staff told us that they have received good opportunities for continuing training and records indicated good achievements in most key areas although we discussed with the manager shortfalls in emergency first aid, medicines administration updates and more in depth instruction around safe moving and handling. The home’s managers have developed a detailed training programme for the rest of the year that should address these shortfalls. The commitment to getting staff through the NVQ has continued with the required 50 target already achieved, and the rest of the carers group have been enrolled to boost this achievement. Some of the staff spoken to also described attendance on a course aimed to help them care better for people with dementia provided by the Council, and about the positive impact this training had had on them and how they had a better understanding of this condition. As a general comment we noted good standards of morale and enthusiasm expressed during our staff interviews; staff spoke positively about the working environment that has quickly developed with the current managers, compared to the previous arrangements at the end of 2008. This commitment of staff to the home and its residents is something the home’s management can build on for the future. The Old Vicarage Nursing Home DS0000072637.V374139.R01.S.doc Version 5.2 Page 20 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, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is a well-managed and safe environment in which to live and work, and the new management regime has made progress in re-establishing a quality service at the home. EVIDENCE: The AQAA told us about the management arrangements of the home but as this information was supplied at the end of 2008 it is not relevant to the current running of the home. Since that time the previous manager has left the home and the previous deputy manager has taken on the responsibility of running the home. She has not submitted an application to register with the Commission as is required by law. At the time of the inspection she was being supported by an experienced registered manager from one of the company’s homes in Derby. Between them they have acted to turn around what, as The Old Vicarage Nursing Home DS0000072637.V374139.R01.S.doc Version 5.2 Page 21 described by everybody we spoke to, was a rapidly deteriorating standard in the home’s operation. Staff told us that ‘they are making a lot of changes in a very short time, all for the good’ and ‘they are really sorting things out’ with the result that ‘everybody is now much happier’. People living at the home told us that ‘I had problems with basic care practices as the home went downhill for a while. Things are much improved with the new managers’ and that ‘the new managers have turned things around for the better’. Good administrative and management systems are in place at the home and an administrator, who is responsible for the home’s office work, supports the managers. We were told how they had recently resolved problems with the management of cash at the home with the result that much smaller amounts are stored at the home and any money looked after for the people living there is properly managed. We were told that ‘the previous manager had allowed things to ‘drift’ on a number of fronts’ and one of these was the operation of a formal system for meeting with and offering support and supervision to staff. From our discussions with staff and from their records we looked at there have been few instances where they have been meeting with a senior member of staff in a planned way in recent months. This also extends to meetings that staff have been having with the home’s management as a group. Systems for monitoring how well the home is doing have been reintroduced recently and the current managers have just carried out audits of medicines systems and kitchen hygiene. These will be followed by regular activity in all aspects of the home in order to bring it up to the standards required by the company. Unannounced spot checks have been carried out during evenings and weekends and monthly visits have been made by board members from the company’s HQ on behalf of the owners, as is required by law. The AQAA told us about good standards of health and safety activity and regular servicing of equipment, and observations made around the building and a sample of fire safety and servicing records indicate that the home was hazard free at the time of the inspection. The Old Vicarage Nursing Home DS0000072637.V374139.R01.S.doc Version 5.2 Page 22 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 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 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 2 X 3 X 3 2 X 3 The Old Vicarage Nursing Home DS0000072637.V374139.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Not applicable 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 OP7 Regulation 15 (1, 2) Requirement Timescale for action 30/04/09 2. RQN 9(1) All people living at the home must have a plan, prepared by the manager or senior staff that describes how the home will meet their assessed personal and healthcare needs, and keep this under review, evaluated monthly. This is so that proper care and support is arranged to meet those needs in a timely and individual way. The manager must apply to 31/05/09 register with the CSCI. This is so that the home will benefit from professional confirmed by the requirement of the law 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. Refer to Standard OP8 Good Practice Recommendations All risk assessments should be completed and evaluated regularly so that staff work safely and are using up to date DS0000072637.V374139.R01.S.doc Version 5.2 Page 24 The Old Vicarage Nursing Home 2. OP9 3. OP10 4. 5. OP15 OP30 6. OP36 information. The descriptions and protocols for the administration of occasional use (PRN) medicines should be completed and kept in the individual medicines administration record (MAR) for the person concerned. Staff practices in relation to caring for people in wheelchairs, people who need assistance with feeding and those occupying their rooms during the day should be focused on the needs of the individual person, so that their health, welfare, safety, privacy and dignity is maintained. The home’s mealtime arrangements should be reviewed so that the dignity and individuality of people living at the home is maintained. Staff should be given the opportunity to receive training in relation to the care of people with Dementia and in the key features of the new Mental Capacity Act so that they are able to care for the broad range of people in their care with greater professional standards. All staff should receive formal 1-to-1 supervision from their line manager, at intervals of every two months. This will ensure the opportunity for regular consultation about and monitoring of their work. The Old Vicarage Nursing Home DS0000072637.V374139.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Nursing Home DS0000072637.V374139.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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